Example 10: Post-EHR Changes in Communication

Issues Encountered

A survey of commercial EHR physician users found that communication among clinicians, and between clinicians and their patients, benefitted from EHR features such as e-mail, instant messaging, improved access to patient information, and improved access to clinical guidelines. The survey also revealed that the introduction of an EHR resulted in some new communication barriers. Physicians indicated that some of the useful features of the EHR are distracting and prevent them from having meaningful personal interactions with their patients (e.g., physicians might get so wrapped up in simply filling in all the checkboxes on an EHR form that they don't take the time to ask their patients open-ended follow-up questions).

Some physicians also indicated that the EHR diminished communication with colleagues in some ways. Asynchronous communication via e-mail was viewed as problematic, particularly in the context of dealing with complex clinical cases. One cardiologist said: "If I am implanting a defibrillator, the primary care physician may have some thoughts about the patient's true life expectancy that might influence our decision-making process about whether the device is appropriate for the patient... We need to do a better job [of communicating orally], because we [cardiologists] can't do it without input from the physicians who understand the patient's complex chronic conditions."

Finding a Solution

Physicians identified some potential ways to overcome the clinician-to-patient communication challenges identified above. The primary recommendation was that strategic placement of the EHR workstation can allow the clinician to maintain eye contact with the patient. The clinicians should also engage the patient when they are reviewing relevant sections of the EHR, such as the problem list, or patient education materials. The patients can also be involved in checking the accuracy of the data in the EHR.

Physicians' primary suggestion for preventing the EHR from diminishing communication with other clinicians was to establish clear guidelines about the appropriate use of electronic communication at the organizational level. One physician respondent summed it up thusly: "The best way to ensure good coordination of care is for two physicians to speak with each other directly. You can't approach any technology solution, in as complex and risky a work environment as the practice of medicine, and have it be a substitute for appropriate human interactions."

Lessons Learned

  • The introduction of the EHR can have negative effects on communications amongst clinicians and between clinicians and patients.
  • The configuration of the EHR and organizational policies related to its use should facilitate interpersonal communications where appropriate.

Source: O'Malley AS, Grossman JM, Cohen GR, et al. Are electronic medical records helpful for care coordination? Experiences of physician practices. J Gen Intern Med. 2010 Mar; 25(3): 177-85.

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