Electronic Records In The Exam Room

The electronic health record (EHR) is revolutionizing healthcare, reducing the potential for misdiagnosis, dangerous drug interactions, duplicate testing and errors stemming from miscommunication or missing information. But the use of EHRs in the exam room can also complicate the medical visit.

Interloper In The Exam Room

A trusting relationship between patient and clinician is the key to good care. This relationship is established largely through eye contact and the open body position of the clinician facing the patient.

If the computer terminal is badly positioned, the clinician can't face the patient and eye contact is lost. In addition, a clinician may pay more attention to the screen than to the patient's concerns.

"The computer becomes an interloper in the exam room," says Laurence Baker, clinical psychologist and western regional consultant for the Institute for Healthcare Communication (www.healthcarecomm.org).

Effective Use Of EHRs

But Baker also believes that EHRs have the potential to enhance the clinician-patient relationship. "I'm really a fan of electronic records," he says. "I believe their use can make patients more active partners in their own care."

Begin by establishing rapport through eye contact, tone of voice and facial expression.

Build an agenda. Ask "What is it you want us to focus on today?" and "Is there something else?" Let the patient's concerns shape the visit. Without an agenda, it's easy to get sidetracked as you move back and forth between screens.

Tell the patient what you're doing when you turn toward the computer. For example: "Now I'll look at the report on your cholesterol levels."

Always say "your record," not "the computer." That sends the message that you're working for the patient.

Use "bridging statements," such as "Will it be OK if I write some notes to refer to in the future?"

Nancy Giguere is a freelance writer from St. Paul who has written about healthcare since 1995.