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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

    Is your electronic health record (EHR) less than magical? Part of the problem may be how you are using it.

    Many medical practices grew up in an era of paper charts and many practices have grafted their EHR into a paper chart work flow and physical environment.

    “Working with a physical chart is very different from working with an EHR on screen,” said Thomas Hwang, MD, associate professor of ophthalmology and diplomate in clinical informatics, Casey Eye Institute, Oregon Health and Science University, Portland.

    “The difference between paper and screen changes how we interact with patients, where we sit in relationship to the patient, our body language, and how we make conversation,” he said. “We need to assess where we physically place screens so that we can restore a more natural interaction with our patients.”

    Dr. Hwang explored some of the ways physician-patient interactions can be improved by adjusting the physical interface between clinician and EHR.

    There is no universal work flow or exam room design that works for every practice, but there are a few concepts which can help improve interactions between patients and clinicians.


    Eye contact dilemma

    The key issue is patients and physicians in North America expect face-to-face interaction with good eye contact. Direct eye contact is easy to achieve if the physician is consulting a paper chart that can be moved as needed.

    However, many exam room computer screens are mounted on the wall. That physical placement forces the clinician to turn away from the patient to consult the EHR or enter data.

    Exam room design is the obvious problem, Dr. Hwang continued. In the paper chart world, the physician reviewed the chart before entering the room, then brought the chart in for the exam. If there were any questions, the chart was at hand.

    In the EHR world, reviewing the chart before entering the exam room means logging onto a workstation outside the room, finding the patient, reviewing, logging out, and then entering the room--but without having ready access to the chart. If there are questions during the exam, the physician has to log in again, find the patient, and check the system.

    “When you go in the room, you have to try to remember all the details you just saw on the screen, which makes for an uncomfortable interaction,” Dr. Hwang said. “We are all a lot more comfortable if we don’t have to remember a string of details.”

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