Why aren't doctors already POISED?

There's certainly been a lot of press on how electronic health records can negatively affect a physician's face time with patients, and that this is one of the reasons why doctors are dissatisfied with the systems.

But I must admit, I was a bit surprised at a new recommendation from Regenstreif Institute investigator and Indiana University School of Medicine professor Richard Frankel, Ph.D., that physicians incorporate six "best practices" in order better balance the use of EHRs when examining patients. Frankel, who has conducted research in this area, pointed out that physicians' habits regarding EHRs are negatively affecting their relationships with patients, not to mention patient outcomes and patient safety.

For instance, some physicians spend more than 80 percent of patient visits interacting with the computer, not the patient, during the exam. He also reported that many male doctors rarely even look up from the computer. Clearly these behaviors are not conducive to relationship-building.

Frankel then recommended that physicians adopt the "POISED" best practices to integrate the EHR into the exam (and I'm paraphrasing):

  • Prepare for the patient's visit
  • Orient the patient to the EHR
  • Information gathering of data the patient provides
  • Share the information inputted with the patient
  • Educate the patient about the information
  • Debrief the patient on the visit to see how much they absorbed 

These are all practical suggestions. But why do doctors have to be told to do this?

Let's take a deeper look at some of the recommendations. For instance, according to Frankel, "orient" means that the physician should spend a minute or two explaining how the EHR will be used during the visit. "Educate" means that that the physician should "show a graphic representation on the computer screen of information over time, such as patient's weight, blood pressure or blood glucose, so it can become basis for conversation reinforcing good health habits or talking about how to improve them."

Those are good, new ways to engage the patient with the EHR for a doctor who's still learning how to use one. But some of the suggestions should be intuitive, common sense, or at least ingrained in any physician, whether or not the physician is using an EHR.   

For example, "prepare" means "review electronic medical record before seeing patient." "Information gathering" is described as "don't put off data entry as patients may question how seriously their concerns are being taken if physician does not enter information gleaned from patient into computer from time to time." I certainly hope that all physicians are already doing these things as part of their routines.

And look at "share." It's a way of "signaling partnership." So normally physicians don't view the patients as partners in their healthcare? Even the language seems condescending, as if the physicians are putting on a façade of partnership. I didn't even realize that "share" was a problem. Even ONC has reported that doctors are better at sharing information with patients than with other providers.

The good news, Frankel said, is that there is growing interest in and scholarship on this topic. But why is it necessary in the first place? There's always been a balance between patient interaction and record keeping. The EHR may require different or more record keeping, but it doesn't create an excuse for a physician to hide behind the screen.

I'm not sure if the commentary is portraying doctors incorrectly or if doctors truly are having this much trouble interacting with their patients once they adopt an EHR. If they're not already somewhat POISED, that's troublesome.

The bottom line is that if doctors don't interact with their patients in the exam room, it will be the patients who are poised--to walk out the door and use a different doctor. - Marla (@MarlaHirsch and @FierceHealthIT)

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