The Path to Paperless

EMR and the Doctor/Patient Relationship

Some see it as a negative but one study finds no impact.

By Peter J. Polack, MD, FACS

A recent article in the Journal of the AMA has rekindled the debate about whether the use of electronic medical records (EMR) interferes with the doctor-patient relationship. In the editorial, the author recalls the story of a colleague whose 7-year-old daughter draws a picture of him in an examination room. Everyone is smiling, but the physician is typing away on his computer with his back to the others. The implication, of course, is that the doctor is not interacting with his patients in a meaningful fashion — and that this is evident even to a young child.

Are Relationships Affected?

Many older ophthalmologists have expressed their decision not to implement EMR, with one of the reasons being fear of disruption of the doctor-patient relationship. But, like computerized practice management systems, EMR is here to stay.

For doctors nearing the end of their careers, investing in EMR may seem akin to an empty-nester building a huge house just before retiring to a south Florida condo. But increasingly, new physicians coming out of training are looking for progressive practices to join or buy, and a practice using EMR definitely has a distinct marketing advantage.

As far as the effect of EMR use on clinic workflow, those fears are often unfounded if the implementation is properly planned and executed. Often, practices overestimate the impact that EMR will have on productivity and make the mistake of trying to do too much at once, cutting clinic volume in half in order to launch an overnight rollout on all patients. This, then, is a self-fulfilling prophecy. Our practice, on the other hand, performed a gradual EMR rollout with no reduction in patient volume and no decrease in productivity. But it took planning to accomplish this.

Patients Don't Object to EMR

So what do patients think? In a poster presented at ARVO in May, Bina Patel and colleagues studied patients' perceptions of service quality in an ophthalmology clinic EMR, with 95% of the patients aware that EMR had been implemented in the clinic.

Their results showed that patient satisfaction scores were unchanged after implementation of EMR compared with before implementation. Seventy-six percent of the patients reported efficiency of the clinic improved with EMR. Of the patients who were aware of a patient portal function, 58% felt it was a useful feature. And 48% of patients agreed that the e-prescribing function made obtaining their medications easier.

How to ‘Connect’ With Patients

But awareness of the potential downsides of using a computer instead of a paper chart is important. At our practice, we mitigated this problem with the use of scribes, the ability to “clone” previous information on established patients, and continued doctor input to a customizable EMR system resulting in easier, more efficient processes.

Additionally, some thought should go into the physical layout of the exam room to avoid turning one's back to the patient.

Still, we must make the extra effort to bond with the patient. As one of my partners, Mark Jank, MD, puts it, “Eye contact, active listening, medical speak a patient can understand, a reassuring touch when appropriate, a shared laugh or a personal remembrance are important aspects of quality care and could never be replaced by a computer.” OM

Peter J. Polack, MD, FACS, is co-managing partner for Ocala Eye, a multisubspecialty ophthalmology practice located in Ocala, Fla. He is also founder of Emedikon, an online practice management resource for physicians and administrators.