Since the January 2009 passage of the Health Information Technology for Economic and Clinical Health Act (HITECH)—a $30 billion effort to transform healthcare delivery through widespread use of Electronic Health Record (EHR) technology, rehabilitation providers have slowly but surely been switching from charting on paper to using electronic devices. Any therapist who has lived through this conversion process can testify that slowdowns in productivity are an inevitable part of getting used to a new system.
Unfortunately, the EHR end user experience has been full of frustration. According to a 2014 survey measuring EHR satisfaction, 92% of the 14,000 nurses who completed the survey were highly dissatisfied with their EHR, complaining that it slows down their productivity and that instead of providing more time to interact with patients, using the EHR directs their attention away from the patient. It’s pretty safe to say that therapists, who work on the same EHR systems as nurses in hospitals and skilled nursing facilities feel pretty much the same way.
Granted, EHR systems are improving healthcare in many ways. Electronic record keeping eliminates many inaccuracies, improves the efficiency of sharing information between healthcare providers, opens the door for new research, and increases billing captures. In fact, EHR can be used to enhance — not detract from — patient care. Studies have documented that after a seven month adjustment period, patients attitudes normally change from skeptical, to appreciative of having a computer in the room. A study from 2015 demonstrated similar results—showing that a computer can be helpful in enhancing the patient-provider relationship. But there’s a catch. These benefits are dependent on healthcare professionals learning new ways of interacting with their patients.
New skills in patient centered communication
Before the advent of computer documentation, patients and doctors communicated in a two-way conversation which this survey refers to as PDC (patient-doctor-communication). Now, with a computer in the room, doctors and other healthcare professionals must develop PDCC (patient-doctor-computer-communication) skills. This study defines PDCC as “the physician’s ability to provide patient-centered care while using the computer during the medical encounter.” Healthcare practitioners must begin thinking of themselves as having three-way conversations between themselves, their patients, and the information on the computer. This begs the question, can therapists use their EHR during appointments as a communication tool to help the patient, rather than a distraction that takes their attention away from the patient?
Using EHR to your advantage
If you use a laptop or other electronic device to keep track of treatment notes during your therapy appointments, follow these pointers to enhance the experience for your patients:
- Listen first, then take notes. If you attempt to take notes while the patient is speaking, you may find your notes aren’t all that accurate. Give your patient your full attention while listening, then take notes when he or she has finished.
- Allow the patient to see the screen. Position your laptop screen so your patient has full view of what you are typing. This way, the patient will feel more engaged in the process — rather than ignored while you are typing. This actions also shows them what you are doing and demystifies some of the process.
- Know when to pay close attention. If your patient is discussing sensitive information, you’ll want to “unplug” and listen closely. Save the notetaking for when this segment of the conversation is complete.
- Use your device to share information. If your EHR includes progress charts, let the patient see how far they’ve come. Perhaps you can access videos that help demonstrate certain therapy treatments — these can also be helpful during your appointments.
It takes practice to get it right
The healthcare industry is still getting used to EHR. And like anything, this involves a learning curve beyond just knowing how to use the software. Figuring out the best ways to incorporate electronics into your therapy appointments may take trial and error. Experiment with various communication techniques to determine which fits best into the “flow” of the appointment.
Have you already made the shift?
If you’re an early adopter of technology, we’d love to learn from you. Tell us about the tools and tips that you’ve developed to enhance patient centered care while using a computer in the comments section below. Thanks!