Docs must follow 'POISED' best practices when using EHRs in the exam room

Physicians need to adopt better ways of incorporating electronic health records when examining patients, according to new commentary published this week in JAMA Internal Medicine by Regenstreif Institute investigator and Indiana University School of Medicine professor Richard Frankel.

EHRs are a helpful tool, but physician habits when using them in the examination room can adversely affect patient safety and relationships, Frankel says. For instance, physician time on the computer differs significantly, with some physicians spending more than 80 percent of visits interacting with patients, and others spending more than 80 percent of visits interacting with computers. Moreover, while most female physicians looked up from the computer about every 30 seconds and made eye contact with their patients, male physicians rarely looked up from the computer.

Not surprisingly, patients prefer doctors who appear to pay attention to them.

Other studies have shown that clinicians who use EHRs are less interactive with patients. This is one reason why some physicians have turned to scribes, although not all patients like having a third person, usually a stranger in the exam room.

Frankel recommends that physicians move to more patient-centric best practices when using EHRs in the exam room, which he calls "POISED:"

  • Prepare: Review electronic medical record before seeing patient
  • Orient: Explain how computer will be used during the appointment
  • Information gathering: Don't put off data entry while the patient is talking
  • Share: Turn the computer screen so patients can see what has been typed  
  • Educate: Show a graphic representation on the computer screen of information over time
  • Debrief: Assess the degree to which recommendations are understood by the patient and correct as necessary

"Medicine is fundamentally a human enterprise that is still practiced one conversation at a time," Frankel says in a announcement. "Our challenge is to find the best ways to incorporate computers [as care process partners] in the examination room without losing the heart and soul of medicine, the physician-patient relationship."

To learn more:
- access the commentary (subscription required)  
- read the annnouncement

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