While EMRs certainly do improve physician-patient communication in person, online and over the phone, systems also can detract from the relationship between doctor and patient, according to a report from the Center for Studying Health System Change.
"[M]y concern now is that we're listening less because we have more information when we walk in the room, and it's not all trustworthy," one unidentified internist said in the report. Other physicians said that the structured nature of EMR documentation reduces the number of open-ended questions they ask, which may unintentionally cause them to miss "subtle or nuanced" symptoms. And, of course, the mere presence of a computer in the exam room might be a distraction. "It's like having a two-year old in the room," said another doctor.
"Just as EMRs can tempt a clinician to disengage from patients, they also can detract from communication within a practice or between clinicians. The use of asynchronous EMR communication tools, such as email and instant messaging where there is a time lag between responses, can be a double-edged sword, according to respondents," the report adds.
The report, which was supported by the Commonwealth Fund, suggests that all of these shortfalls are fixable as vendors refine their products. "Efforts around health information technology implementation at the federal and clinical practice level might incorporate training to improve interpersonal communication skills for practitioners and medical trainees in the presence of an EMR. The modification of office processes and clinical workflows to maximize interpersonal communication while using an EMR is also likely to be helpful," the issue brief says.