electronic health records – watercress words by Dr Aletha

The electronic medical record-asset or annoyance?

The increase in physician burnout has been directly linked to the introduction of electronic medical records.

You’re probably used to your doctor’s office using an EMR, electronic medical record (also called EHR, electronic health record) . By now most clinics, private medical offices, hospitals, labs, imaging centers, and other healthcare settings use computers exclusively for everything from scheduling, communication, to documentation and billing. If you are a young adult, you may not even remember a time when medical offices and hospitals used paper records.

Dr. Danielle Ofri, author of several books about healthcare delivery, wrote an astute opinion piece about EMRs for STAT which I encourage you to read. I’m going to review her post adding my own ideas, , with the goal of helping you understand why we doctors, and maybe you, have a love/hate relationship with computers in healthcare; as Dr. Ofri says about electronic health records,

they all have their breathtaking assets and snarling annoyances
Dr. Danielle Ofri

In her piece, Dr. Ofri refers specifically to the use of electronic records in hospitals, but the issues are similar in clinics and other settings.

Breathtaking assets

more efficient storage of records than paper (taking up less physical space and time for sorting and filing)
ability to generate reports
improved hospital efficiency and financial margins (possibly by the ability to analyze data and generate reports)
able to analyze the health needs of large numbers of patients, called population health, so health systems can plan for and offer needed services more efficiently
communication- the ability to contact doctors by email, get test results through a portal, schedule appointments online, order med refills, etc.
legibility and standardization in documentation

Snarling annoyances

changes the way doctors work and make decisions; current software often does not reflect the way doctors are taught to approach patient diagnosis and treatment
less efficient retrieval of data than paper (due to larger amounts of data, which may be redundant)
little evidence yet that use decreases complication rates, or improves patient care in general
less personal interaction with healthcare professionals when communicating through a portal
increased time spent documenting on a computer , much of it simple data entry, compared to writing on paper

But the greatest disadvantages attributed to the use of computers in the medical setting, ones far more than “snarling annoyances” are

interference with doctor patient interaction and communication in the office or bedside; both doctor and patient may pay more attention to the computer than to each other
erosion of staff morale, often due to more time spent on the computer than with the patient, boredom with data entry, and stress of having to learn new systems and updates
contributing to physician burnout, which can have a negative impact on patient care

Doctors like me, who did not grow up in the computer age, went through the entire medical education experience without touching a computer. For us , the transition to computerization while maintaining a busy schedule of patient visits, was difficult and stressful. The increase in physician burnout has been directly linked to the introduction of electronic medical records.

Boldly going…

As Dr. Ofri points out, the EMR is not going away, and few if any of us want to go back to the old system, as annoying as the new system can be. The annoyances are slowly being worked through and resolved, and the assets are becoming truly helpful.

The younger generation of doctors who have never known a world without computers embrace their use readily. As we senior doctors wind down and eventually retire, we can pat ourselves on the back for being the generation that led the way into this strange new world.

a graphic showing various mobile computing devices — a graphic from the LIGHTSTOCK.COM collection, an affiliate

Where you, the patient, fit in

You as a patient have a stake in this endeavor too. As already mentioned, being able to access your records, make appointments, manage payments, and send messages on your computer or mobile device brings efficiency and convenience to a process that formerly was time consuming and cumbersome. I now routinely use my doctor’s office portal for my own medical needs and my patients use my office’s online services . Here’s what you can do to help make EMR use better.

Use whatever online healthcare resources available to you. The more we all use them, the easier they will be to use, and feedback will help developers make them even more helpful.
Be patient with your doctors and other healthcare providers as they transition to EMRs, from one to another, or when problems occur. Like any piece of technology, they don’t always work perfectly, and occasionally they don’t work at all.
Give constructive feedback. A thoughtful critique will help more than irate criticism.

Here is the link to Dr. Ofri’s article-

The EMR has changed the doctor patient relationship into a menage-a-trois

“you have a role and a vested stake in communicating your concerns, questions, and even grievances to the physicians who care for you; that without such information, your physicians cannot provide optimal diagnosis and treatment for you. ”

from my review of Dr. Ofri’s book -at this link

What Patients Say, What Doctors Hear

Danielle Ofri, M.D., is a physician at Bellevue Hospital, a clinical professor of medicine at the New York University School of Medicine, editor-in-chief of the Bellevue Literary Review, and author of the forthcoming book

When We Do Harm: A Doctor Confronts Medical Error

Another physician explores the EMR

MAN’S 4TH BEST HO$PITAL By Samuel Shem

Samuel Shem (pen name of Stephen Bergman, M.D.) is a novelist, playwright, and, for three decades, a member of the Harvard Medical School faculty. His other novels include The House of God, Fine, and Mount Misery .

In this novel about a hospital dominated by computer screens and corrupted by money, an idealistic doctor has one goal: to make medicine humane again. Here is an excerpt-

“Cynical? me? I feed on ideals, on ideal care. I’m so idealistic, to you I sound cynical! And I do not call ’em Electronic Health Records, ’cause they don’t help with health, and may well harm it. With a screen between you and your patient, you get distracted, right? It’s like texting while driving.

So, to remind us of the danger let’s call ’em EMRs, the ‘M’ for “Medical’. “

After a student asks why the computer systems at the VA (Veterans) and the Indian Health Service hospitals, both government agencies, are more user friendly, he goes on to explain,

“Nobody’s makin’ money offa it. So we all gotta get together and unhook care from billing. So nobody makes an obscene profit offa the sick.”

available on Kindle (affiliate link)

exploring the HEART of the health record

I hope you found this discussion enlightening; maybe it answered some questions you had about electronic health records and maybe raised some issues you’d like to know more about. Please contact me with questions and I’ll answer them in a follow up post.

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3 keys to effective communication with your doctor

Expressing feelings honestly and respectfully, and listening with empathy and respect can build the trust that is vital to creating a connection for effective information exchange – communication.

Do you feel heard after leaving your doctor’s office? Do you feel you understand what the doctor said to you?

Surveys suggest doctors and patients often fail to communicate effectively, so public and private medical organizations have implemented programs to improve “patient engagement”. But what exactly does that mean?

doctor talking to a woman — photo compliments American Academy of Family Physicians

A failure to communicate

Patients may feel that doctors ignore their questions, dismiss their concerns, don’t listen to them,don’t spend enough time with them, and don’t use language they can understand.

Physicians wonder why patients withhold important health information, fail to follow up with recommendations, and don’t ask questions or express their concerns.

The main problem with health care communication is that it involves people- and people frequently communicate poorly, and sometimes not at all. It never will be perfect. But we can do better.

So what is true patient engagement anyway?

Dr. Rob Lamberts writes

“Engagement is about interaction, listening, and learning in relationship to another person.”

Barbara Ficarra, R.N. , puts it this way:

“Patient engagement is a connection between patient, caregiver and health care provider.

Patients and their families are empowered and they are active in health care decisions.

Those patients and consumers who choose to be actively involved and in charge of their health work together with their health care providers to successfully rech their health goals and needs. “

Why communicate better?

To make healthcare interactions more effective, efficient, and empowering, both doctors and patients need to develop skills that may be different from what they have done in the past.

Communication is a connection allowing access between persons

doctor holds patient's hand — on a mission trip to Mexico; photo by Brian Edgerton

Establishing a connection

If we try to start exchanging information, or even thoughts and feelings before we have established a connection, it is like to be unsatisfactory.

For example- think about a recent retail service experience – one that worked and one that didn’t. Perhaps it was a call to customer service to get a phone service problem resolved. Or maybe you went to a car dealership and interacted with a sales person. Whatever the situation, and whatever the outcome, you probably rated it more favorably if you felt connected with the person helping you.

Recently I called my medical insurance carrier to resolve some unpaid claims- and my insurance is through a government agency. I dreaded the call, expecting a difficult unpleasant conversation.

But the rep was professional, efficient and confident. She started immediately by telling me her name and position, then asked me my name. Next, she accessed and reviewed my account, giving me feedback about what she found. Then we started working on my problem, and continued until it was resolved.

I was surprised to have the situation taken care of efficiently and effectively so quickly. And in doing so, I felt empowered.

In dealing with others be willing to be frank , flexible, and forgiving.

The who of connection

Customer service depends on connecting, and that usually starts with knowing who you are dealing with. The first item we exchange in any human interaction is usually our name.

You should learn your doctor’s name and credentials-M.D., D.O., and specialty- internal medicine, cardiology, psychiatry, etc. in other words, what kind of doctor are they?

What is this doctor’s role in your care? Is this doctor primary or a consultant, and what issues are each managing? (especially in a hospital situation)

Tell your doctor what name you prefer to be called if it’s different than the name on file. Your doctor should know who is your legal next of kin or who has POA (power of attorney if applicable)

Introduce other family and friends and identify the primary contact person; this first level of receiving and giving information, is especially important in the hospital setting. This will create continuity as the doctor speaks to the same person every day.

If you take a friend or relative to your doctor’s office with you, make sure they understand what their role is. Your family’s insights and observations provide helpful information to supplement what your doctor learns from you. They can help you remember and understand answers and instructions. But this isn’t a time for them to discuss their own medical issues with the doctor.

The where of connection

Where you interact with your doctor is important as interaction may be quite different in a private office setting vs an urgent care clinic vs an emergency room vs in a hospital. But general principles apply to all settings.

Approaching others with generosity, grace, and gratitude makes it easier to connect.

Ideally it should be as comfortable as possible, private, and quiet, so you can hear and see each other well.

Friendly greetings are fine anytime you encounter your doctor, but discussions of personal medical information don’t belong in the hallway, elevator, or cafeteria. Likewise, if you run into your doctor at church or the grocery, just say hello.

The how of connection

Come to an office visit prepared. If you have test results, previous medical records, xrays, etc. bring them with you.

An up-to-date list of all medications you take is a must-include names, strength, how often taken; or bring the meds with you.

Turn off your phone.

Ask the office how long the appointment is for, realizing that it will only be an estimate; it will depend on what you and the doctor end up discussing and what you need done.

Showing up on time helps the office keep to their schedule and shows the doctor you are serious about your care and respectful of other patients’ time. (If the office is consistently poor at time management, address it respectfully; sometimes it is best to move on if this continues to be an issue that bothers you.)

Most hospitals and clinics have abandoned paper charts for computers, using electronic health or medical records- EHRs or EMRs. I’m not going to dwell on it now, but computer use in the exam room or bedside has changed the dynamic between doctors and patients in ways that were unexpected and challenging. Here is the link to a post I did addressing the issue of

Electronic Health Records- Challenges and Changes

The value of connection

Connecting with your physician depends on acknowledging feelings- worry, fear, despair, hope, relief, anger, resentment, frustration. Give feedback respectfully; if anything about your care is not as expected, or doesn’t seem appropriate, or you just don’t understand something, speak up.

Expressing feelings honestly and respectfully, and listening with empathy and respect can build the trust that is vital to creating a connection for effective information exchange – communication.

a male doctor talking to a middle aged woman — Dr. Weinkle with a patient

Dr. Jonathan Weinkle discusses connection and relationships in his book

HEALING PEOPLE NOT PATIENTS: Creating Authentic Relationships in Modern Healthcare

which I reviewed at this link.

exploring the HEART of communication

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Dr. Aletha talking to a mother and her son — Talking to a patient through an interpreter makes communication extra challenging. (photo from a volunteer medical trip to Ecuador)

3 keys to effective communication with your doctor, part 2

updated October 31, 2022 In part 1, we considered the importance of establishing a connection between doctors and patients before trying to communicate. The goal is to establish effective patient engagement. Now we’re going to look at some practical aspects of exchanging information with doctors- remember, exchange means give something and receive something in return. A…

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