True story: My co-worker visited the dermatologist last month. The doctor entered the exam room, asked what was wrong, wrote a prescription, and never looked at her patient or examined her face. The dermatologist stared at her iPad, which held the patient’s electronic medical record (EMR), the entire time. That was the extent of the doctor-patient relationship during the visit.
Right now I’m thinking that we have more than pimples to worry about.
How did we get here?
We might have to blame former President Obama, who signed the Health Information Technology for Economic and Clinical Health (HITECH) Act into law in 2009. The vision behind the HITECH Act was to create a national network of electronic patient data, interoperable between the myriad specialists, ancillaries and hospitals that make up our patchwork healthcare paradigm.
The law was supposed to stimulate physician adoption of digital recordkeeping while discarding all the workflow-clogging paper charting that has been bogging down the healthcare system for decades.
Fast forward to today. Most hospitals and medical practices have taken advantage of federal incentives that give kickbacks for installing EMRs. Insurance carriers (including Medicare and Medicaid) that reimburse doctors for their work have been penalizing physicians that fail to digitize their patient records. Carrot and stick aside, there is some truth to the benefits of EMR adoption, including:
- Self-service portals, where patients can access test results and schedule appointments
- E-prescribing, which allows doctors to electronically send a prescription to a pharmacy, eliminating the dangers inherent in poor handwriting
- Cost savings associated with paperwork elimination
- EMR-fueled decision-tree prompts that, in theory, alert doctors to drug interactions, patient allergies and more
Yet, here we are nearly a decade after HITECH and medical mistakes are still the third leading cause of death in the U.S. Doctors frequently complain that EMRs inhibit the doctor-patient relationship and serve only to distract during a clinical visit.
So, are EMRs doing more harm than good?
Your doctor’s digital downfall?
Medical Economics released their fifth annual survey of physician attitudes toward EMRs in 2017. The survey found:
- 17 percent of physicians say their staff views the EMR as mostly negative
- 23 percent say it’s “slightly negative”
- 14 percent say the EMR has “mostly harmed” quality of care
- 17 percent say EMR adoption has “slightly harmed” quality of care
- 76 percent say the biggest disadvantage is that they spend too much time “entering data not directly related to patient care/outcomes”
- 57 percent say their EMR disrupts practice workflow
- 56 percent say the biggest disadvantage of their EMR is that it takes away from making eye contact with their patients during examinations
Cheryl Branche, PhD, believes that EMRs are ruining the doctor-patient relationship. She describes the personal experience of visiting her doctor in this startling manner:
“I felt as though a third person in the room was getting more attention than I was and I was frustrated. Meanwhile, the doctor was doing the best that she could in a difficult situation. What was worse was that I had nothing tangible to show for my visit: No prescription. The prescriptions were electronically sent to the pharmacy. For all the technology, I left the office feeling at a loss.”
The “third person” she’s describing is, of course, the EMR.
Dr. Branche points out that digitization has changed the clinical workflow from physician-patient encounter to physician-EMR-patient encounter. So is the EMR the elephant in room of the medical profession? Do digitized processes in the clinical environment eliminate the caring part of medicine?
Dr. Branche suggests that we’ve evolved into the new frontier of healthcare, where providing that necessary element of compassion in an EMR-centric practice, might be just one more box to click.
Bringing compassion back to the doctor-patient relationship
Here’s a note to doctors: You’re doing it wrong.
The problem lies in the immersive nature of digital technology, as well as a lack of training in how to balance filling in the blanks in an EMR template with face-to-face communications with patients.
Before casting stones at the medical profession, start thinking about how hard is to find that balance in your own life, and the struggle to put down your iPhone to have dinner with your family. Or, how hard it is to get your teenager to put down his or her phone — ever.
Medical Economics sums up the problem as, “In addition, society has changed. With all our electronic devices, we don’t relate to one another with the same compassion that we might have in the past.”
It’s not just the American healthcare system struggling to balance technology with human-centeredness, either. In a Canadian Family Physician journal article, Francine Lemire, MD, a Canadian family practice doctor, wonders if there should be “caring and compassion indicators” as benchmarks of a successful practice in the digital era.
In a July 2017 article in Psychology Today, Dr. David Johnson suggests that as the lines between humans and their digital technology grow thinner, the answer to rediscovering compassion is to reprogram the software to “promote the type of interaction that increases our humanness.”
Some hospitals, recognizing the burden of balancing EMR technology and patient interaction, have added medical scribes. Medical scribes follow the clinician to document the doctor-patient interaction into the EMR. A study in the Annals of Family Medicine found that “Scribes produced significant improvements in overall physician satisfaction, satisfaction with chart quality and accuracy, and charting efficiency without detracting from patient satisfaction. Scribes appear to be a promising strategy to improve healthcare efficiency and reduce physician burnout.”
The irony of this approach is that EMRs were supposed to improve workflows by cutting out the time it takes to fill out and fax forms or copy and file patient charting.
Now, we’re adding another staff member whose role it is to fill in the blanks in an EMR. As an alternative, what if the scribe was a medical student? Acting as a scribe would give a first- or second-year college academic the chance to shadow a doctor and see what the practice of medicine is really like before he or she starts residency.
Or, what if EMR vendors actually offered training on how to keep the doctor-patient relationship intact while slaving over a hot computer screen? It’s clear that EMR technology can be used successfully in a clinical setting. However, using the tool properly should never be an excuse for devaluing the crucial human relationship between caregiver and patient.