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July 13, 2017

Electronic health records might hurt patient care, doctors say

A newly published study, conducted by researchers from both Brown University and Healthcentric Advisors, found that physicians often believe that maintaining electronic health records (EHRs) undermines their connection with patients. More than 2200 physicians —both hospital- and office-based— participated in the study.

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The study was conducted back in 2014, during which 744 doctors responded to the following free text question in the Rhode Island Health Information Technology Survey: “How does using an EHR affect your interaction with patients?” Researchers Kimberly D. Pelland, Rosa R. Baier and Rebekah L. Gardner deemed this question in need of a deeper investigation. After their qualitative analysis of all the answers, they found four main themes regarding EHR’s and patient connection. 

Focus on computer screen

The first major theme the researchers found received the title ‘EHRs mean less time to spend with patients because more time is required for documentation’. This was the most common theme found among hospital-based physicians, and the second most common theme found among office-based physicians.

As the title suggests, this theme focusses on the additional time spent using a computer for documentation, which takes away from time spent directly interacting with patients. One physician commented that he now spends less time with patients, because he has hours of data entry waiting for him. Other doctors state that they spend more time looking at a screen, than at the patient. 

Reducing quality of interaction

The second theme for hospital-based physicians covered how EHRs reduce the quality of the patient–physician interaction and relationship. One doctor wrote that he feels like “having someone at the dinner table texting rather than paying attention”. The most common complaint found was the lack of eye-contact. This depersonalizes the conversation, making physicians feel that EHR’s are intrusive, impersonal and disruptive. 

No effect experienced 

Naturally, not every physician in the State of Rhode Island thought that EHR’s are something that limits their interaction with patients. For them, EHRs have no effect on patient interaction. These doctors had either learned to incorporate EHRs without difficulty or it wasn’t a major part of their workflow.

Physicians working with infants, for example, did not feel like EHR’s affected their interaction. One could argue, however, that there is not a lot of interaction with babies to start with. Physicians in other fields commented that EHR’s did not interfere with their patient-time, because they decided to enter the data at the end of the day, resulting in longer work days. 

On a positive note

Luckily, the positive influences of EHR’s weren’t overlooked. Doctors responding to the survey did acknowledge that EHRs are both here to stay and provide important benefits, such as ready access to information. They also make it possible to interact with patients, for instance by displaying educational illustrations of medical conditions.  

It also helps physicians prepare for a visit, giving them the chance to view a patients history and lab results. The patient and physician are also able to review lab and test results together. The same applies to several physicians working one case, who are now able to read each other’s notes and comments.  

Of course the study does have its limits. For starters, it was only conducted among practitioners in Rhode Island. The researchers also state that people are often more likely to answer a free text question when they feel strongly about the subject (either positively or negatively).

However, the large sample size and high response rate do counter these limitations slightly. The three researchers hope that their findings will shape interventions to improve how EHRs are used in inpatient settings. The end-goal is, of course, to improve both physician satisfaction and patient experience.

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