Can EMRs Lead to a Failure to Communicate?

The application of electronic medical records (EMRs) for inpatient and outpatient use holds a lot of promise. With taps on a keyboard, data on a patient's allergies, prescription use, previous hospitalizations, or clinical tests are instantly available. But could surrounding oneself with this data build a barrier toward effective real-time, face-to-face communications between patients and providers and between providers?

Researchers with the Center for Studying Health System Change in Washington earlier this month took a closer look at whether EMR use could impact interpersonal communications. Based on interviews with 52 clinicians at 26 physician practices, they noted that reliance on EMRs could sometimes block valuable cues—obtained, for instance, from patient conversations or body language—that may prove valuable in providing quality patient care.

In general, quick access to EMR data can let physicians focus on the patient rather than gathering information from a variety of paper sources during visits. As one physician explained to the researchers, "we do not have to call down the hall for a lab or test result, we spend more quality time [with the patient] in a more context-rich way."

But ironically, this convenience can create pitfalls. The researchers noted, for instance, that EMRs have enabled some providers to lessen the number of times they engage with patients because—relative to paper charts—more information is available before actually ever seeing the patient face-to-face. As one internist who was interviewed by the researchers observed: "My concern now is that we’re listening less because we have more information when we walk in the room—and it’s not all trustworthy."

Another internist, who worked in both outpatient and inpatient settings, also agreed that he was worried that EMRs could diminish real time communication with patients: "A lot of us feel like we’re already seeing it," he said. "One of the hospitalists said [one day]: 'This is great. I used the EMR before I came here. I was able to sit down with my bagel and coffee and do my rounds before I even got in.'"

Some of the physicians interviewed noted that the format of many EMRs—with checkboxes—created a temptation to focus on filling out those boxes, rather than spend more time with open-ended questions with the patient. However, by focusing on the checkboxes in taking a patient history, the risk arises that "subtle or nuanced symptoms might go unidentified," the researchers said.

Also, reliance on EMRs could result in poorer communications with other providers in inpatient or clinical environments. While the use of other communication tools with EMRs—such as e mail and instant messaging—can sometimes help clinicians, they can also hinder care when a time lag occurs between responses.

Some of those interviewed thought that performing tasks such as scheduling or follow-up visits were enhanced by staff using EMRs with e mail or instant messaging. But on the other hand, some said that the use of e-mails with EMRs decreased the likelihood that real time communication would occur when needed most—such as during patient emergencies.

One physician commented to the researchers that individuals will use EMRs and electronic communications—instead of knocking on a practice door or walking across the hall to talk to a partner or colleague. "You might not see your partner all day, whereas in the old days, we would ask what does [that partner or colleague] think?"

But as EMR use grows, providers could take some advice from experienced EMR users in avoiding some of these pitfalls. For instance, several physicians interviewed said that showing patients portions of their records "could facilitate more accurate documentation and joint decision making." This could also help avoid a sense of alienation for patients while the physician or provider looks at the computer screen.

One physician noted that reviewing a problem list and a medication list together "provides a nice triangular interaction between the physician, the computer and the patient.

For communications between providers, many of those interviewed believe nothing could replace the "interactive aspects" of face-to face or phone conversations for complicated patient situations.

No doubt about it, EMRs are likely to provide new and improved dimensions to quality care. But in this era where data can be transferred as fast as the speed of light, maybe it might be worth considering slowing down with a little old-fashioned "face time."