There are myriad benefits associated with electronic health records in terms of standardizing documentation, improving provider-to-provider communication and facilitating reliable patient care. However, a 2013 study shows that many physicians see a significant downside to the EHR—it gives them less quality time to interact with their with patients.
This physician concern points to a larger worry that EHRs can sometimes negatively affect the patient experience, inadvertently leaving the patient with the impression that the provider does not care or is not invested in the patient’s emotional needs. For instance, there may be a perceived lack of provider sensitivity as he or she appears to spend more time with the technology than interacting with the patient. If technology is distracting to the physician or staff during the visit, it can further send a negative message, especially when the physician is looking at the screen and entering information rather than addressing the patient directly. In more intimate specialties, such as OB/GYN or behavioral health, patients may even see technology use as intrusive—leading to less than optimal care.
Unfortunately, negative patient perceptions—however unfounded—can be detrimental to those organizations looking to improve the patient experience and drive overall patient satisfaction.
The impact of negative perceptions
When technology detracts from the patient experience, it can create a domino effect. For example, a patient who feels the provider spends too much time with the computer may not return for subsequent appointments, which could be problematic if the patient has a chronic condition. Patient satisfaction has already come into play as part of the inpatient setting through the CMS Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) program. This same concept will make its way into ambulatory reimbursement contracting as well. Over time, patient volumes may decrease as patients leave the practice for another organization that is perceived to be more patient-friendly. Plus, if patients express their disappointment to friends, family and even other providers, the practice’s reputation can be damaged in both medical circles and the community-at-large. Ultimately, the organization could see a drop in referrals and subsequently a decline in revenue if they don’t ensure that patients and providers connect and engage during appointments.
Gauging the EHR’s effect on patients
To experience the benefits of an EHR and limit the risks, providers must carefully balance technology with the element of human touch during patient visits. In other words, technology should be a tool to enhance the patient experience and support care, not undermine it.
The following four questions can help organizations determine whether their technology is negatively impacting patients, pointing to strategies for keeping patients at the center of the visit.
1. What are patient perceptions of the EHR? By assessing whether patients feel the EHR is elevating the experience or detracting from it, an organization can identify improvement opportunities. The simplest way to gather patient feedback is to leverage existing efforts, such as the MU Stage 2 information-sharing requirement that gives providers the opportunity to ask patients for their input. Additionally, other patient-facing communication vehicles, such as a registration kiosk or a patient portal, offer easy ways to ask patients what they think.
2. Does the EHR make patient care processes smoother? While technology can enable multi-step processes, it can also complicate them if it is not used appropriately. Patients are accustomed to having technology ease their personal and professional lives and will not respond positively if the EHR and other technology solutions make their visit more difficult. Organizations should spend time reviewing current workflows and make sure that technology streamlines processes instead of disrupting them. Critical questions to ask include:
· Is there a seamless process from registration to exam room to checkout?
· Are there internal mechanisms to ensure smooth referrals and efficient and accurate information exchange between providers?
· Does portal technology make it easy for patients to get results, make appointments and so on?
3. Does patient engagement feel authentic? No one likes to hear scripted statements or feel that their provider is merely filling in boxes on a pre-created template. To make the patient encounter feel less technology-driven, every staff member that walks into the exam room should engage with the patient in a meaningful way and not be distracted by the computer. This requires organizations to thoroughly consider where, when and how technology is used throughout the patient visit, ensuring the patient is at the core of all interactions.
4. Is the physician involved in EHR design? Although physicians and nurses are the primary users of EHRs, they are not always included in designing them, sometimes resulting in cumbersome systems that do not foster strong patient-provider relationships. Physician input can improve workflows, reduce the number of screens or clicks required to support a patient encounter and increase data fluidity between systems. A new AMA initiative—driven by the previously mentioned study about physician concerns with the EHR—outlines eight priorities for improving EHR usability to benefit caregivers and patients. One of these priorities is to expedite user input into EHR design, so that the resulting technology can enable better patient care and free the physician to be more engaged with patients.
There is no doubt that a well-designed EHR facilitates superior care delivery. However, organizations must keep the patient at the center of technology design and use, balancing cutting edge systems with preserving the patient experience. When providers strike a good balance, they can improve outcomes and build a strong and lasting patient-provider relationship.
