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    Phyician-patient dynamic reshaped in era of EHR

    Computers in exam room draw clinician's attention away from center-of-care process


    Laptop solution

    One solution is to carry a laptop and stay logged in, he suggested. Current-generation laptops are light enough to carry easily and can be placed on any convenient surface. The physician can find the patient and review the case outside the room, then bring the laptop inside, ready to consult.

    “A laptop lets you glance down at the screen instead of having to turn away, which makes for a better interaction with the patient,” Dr. Hwang said. “You can use it to show imaging or some other information point to the patient. Having a portable screen gives a more visual connection with the patient and helps with patient education.”

    Tablets are less useful, he continued. Smaller size and light weight are pluses, but a tablet is terrible for data entry compared wtih a conventional keyboard.

    Another alternative is to use a scribe.Scribes were common in the paper chart era, Dr. Hwang noted, finding specific chart entries or updating information during the exam while the physician focused on the patient. A scribe can be helpful in the EHR world, handling the laptop, searching for details, and updating information.

    However, a scribe does not relieve the physician of the need to check the EHR. The real value of the EHR is the immediate access to complete patient information. The physician who fails to consult the EHR will miss key details.

    “Do you remember the Ebola patient in Dallas who went to the ER and was sent home, then later died?” Dr. Hwang asked. “The intake nurse had asked all the right questions and had made a note that the patient had just returned from Liberia and had a high fever, suggestive of Ebola. But the ER physician didn’t see the note because it was so cumbersome to interact with the EHR. Quick and easy access is a safety issue as much as it is an issue of physician-patient interaction.”


    Move patients

    Another potential solution: Move patients, not physicians. Instead of moving from room to room, each physician stays logged in in a single exam room and patients come to that room. The work space can be redesigned to improve eye contact between patient and physician with the screen placed so both can see it.

    “The key is to put the patient at the center-of-the-care process, not the EHR,” Dr. Hwang said. “Just adapting the old office layout with a computer on the desk or on the wall is not the best approach.”


    Thomas Hwang, MD

    E: [email protected]

    This article was adapted from Dr. Hwang’s presentation at the 2016 American Academy of Ophthalmology meeting. Dr. Hwang did not indicate any proprietary interest in the subject matter presented.

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