AMA: Computers in exam room don't have to be disruptive

Physicians' overall comfort with computers and communication skills determine whether technology is a positive or negative influence during patient visits, according to a new report from the American Medical Association board of trustees. The five-page paper, "Exam Room Computing & Patient- Physician Interactions" is being presented for approval to the AMA House of Delegates meeting this week in Chicago.

While computers in the exam room give physicians easy access to health information, in general, and the patient's electronic records, in particular, one study found that patients see doctors as less capable if they look up information during a consultation, rather than if they do so out of sight or consult a colleague.

Yet studies have shown that health information technology can improve adherence to preventive-care guidelines, reduce inpatient medication errors and reduce cost of care, the paper points out.

The ease with which physicians use the computer can make a big difference, though, such as the ability to type and navigate through EHRs. The practice's and individual physician's attitude toward EHRs carries over into patient encounters, as well.

Computers don't have to be a distraction.

"Technical improvements in EHRs that focus required computer tasks on activities that meaningfully influence patient outcomes or that streamline data input and reduce the time needed to complete common tasks in clinical work and decrease the potential for distraction will help minimize possibility for disruption," the report's authors say.

They add that configuring the room to allow the physician to maintain eye contact with the patient and to allow the patient to see the computer screen easily can help, as well.

The report offers suggestions from Kaiser Permanente and Family Practice Management on physician computer use in the presence of patients, including:

  • Let the patient look on
  • Explain what you are doing
  • Integrate typing around your patient's needs
  • Separate routine data entry from patient encounters

The trustees recommend that AMA provide physicians with information on integrating computers in the exam room, and that physicians include questions in their patient-satisfaction surveys to assess the impact.

While EHRs offer the potential to enable physicians to better integrate clinical practice guidelines (CPGs) at the point of care, often there's too much information, or it's not presented in a way that can be used effectively during a patient visit, a recent study found.

Some medical schools have made exam-room etiquette part of their curricula. What's more, Larry Garber, M.D., an internist and medical director of informatics at the Reliant Medical Group in Worcester, Mass., has created a YouTube video on Kaiser's recommendations, including "good doctor" and "bad doctor" examples. 

To learn more:
- find the report (.pdf)
- watch the video