Study: EHRs an influential player in physician-patient relationships

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Electronic health records (EHRs) should be seen as an influential third-party to doctors and patients when used in examination rooms, according to a new study published in the Annals of Family Medicine.
   
This might not seem like an intuitive conclusion. After all, EHRs are computers and computers are everywhere, but physician-patient relationships are dynamic and complicated, and a patient only gets so many minutes during an office visit. Requiring a doctor to input data into a computer interface, and also pay close attention to the patient is a tough juggling act.
   
“Given the results of this study and other recent reports assessing the influence of EHRs on the office environment and clinical outcomes, it would be a grave mistake to believe that the effects of EHRs will be automatically positive,” states the report led by William Ventres, MD, MA, Multnomah County Health Department based in Portland, Ore.
   
Researchers observed nearly 80 hours of doctor visits at four primary-care practices using the same EHR system, as well as conducted numerous interviews and held discussion groups.
   
Computers turn out to be the elephant in the room everyone struggles to deal with. While patients seem reassured by the presence of EHRs, they can be a bit of a preoccupying factor for physicians that feel “conflicted between recording medical information in the EHR and giving one-on-one attention to their patients,” the study states.
   
How a physician deals with this conflict is a matter of style and priority, the study found. Some doctors offered only a quick greeting to their patients and then headed quickly to the computer to review previous records; while other doctors were a bit more smooth in their approach and made a big effort to greet the patient and spend some time gaining an understanding of the purpose of the visit, only heading to the computer after asking “tacit permission” to look at records from the patient’s last visit.
   
Physicians focused more on information often sat at the computer and used the EHR’s questions and forms to guide the visit. However, other physicians preferred to allow a patient’s narrative to direct the communication. A third variety, the study found, had more of a “managerial style” through which they alternated focus between the computer and patient.
   
Interestingly, the education background of a doctor has a lot to do with how well he or she makes use of EHR applications. Simple skills such as typing, or common things like knowledge of the internet and Microsoft Windows, has a lot to do with how well a physician uses the system, according to the study.
   
While educating physicians about EHR use was noted as essential by the study’s focus groups, there was no clear consensus about when and how this should take place.
   
One thing that interviewees were solidified on: EHRs do seem to lack the “depth and intricacy of narrated notes,” the study authors said, adding, “There was a subtle cookie-cutter effect to EHR-generated notes.”