The EHR: Uniting physicians and patients in common frustration

"The third person in the exam room," is how one former practicing physician describes the electronic health record (EHR)--one that gets in the middle of the doctor-patient relationship.

That's Cheryl L. Branche's take on the EHR in her commentary in Medical Economics, where she makes the case that it is has changed the physician-patient encounter.

That's one way to look at it. But I wonder if the EHR is also uniting physicians and patients in a common bond: one of frustration.

That was certainly my experience as a patient at my primary care physician's office a couple of years ago. I had an appointment with a nurse practitioner, who had never met me before. He knew nothing about me. The EHR wasn't working and it almost brought our visit to a complete stop. Fortunately, I was able to fill him in on my relevant medical history. But I wondered what would have happened if I had been an elderly person with memory problems. No computer, no record, no history.

I hear about physician frustration with the EHR every time I visit my OB/GYN. He is always struggling with that darn computer. Often it seems he has to re-enter information into my record because the practice's system has changed--again. Or he is scrolling through to find the right place to enter information. Or the computer system is down and he can't even get my record. Sometimes he is doing more typing than paying attention to me, his patient. And it's clear he isn't happy about it. I wonder if it played even a small part in his decision to retire later this year.

Some physicians are so frustrated with the process that they have medical scribes follow them around to check boxes and type notes into the EHR for them.  As FiercePracticeManagement reported this week, the number of medical scribes in the country has grown from about 7,000 in 2014 to nearly 17,000 today.

Short of that step, physicians can adapt better ways to deal with the EHR when working with patients. Richard Frankel, Regenstreif Institute investigator and Indiana University School of Medicine professor, suggests physicians:

  • Review the EHR before you see the patient
  • Spend as much time as possible during an office visit interacting with the patient rather than the computer
  • Look up from the computer and make eye contact with patients frequently
  • Don't type when the patient is talking

"Medicine is fundamentally a human enterprise that is still practiced one conversation at a time," Frankel said. "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."

I bet both physicians and patients agree on that. I do.-- Joanne (@PracticeMgt)