Report examines impact of EHRs on physician-patient encounter

How computers in the exam room affect patient-physician interactions largely hinges on a physician's communication skills, according to a recent American Medical Association (AMA) board of trustees report.

In its review of various studies on this topic, the AMA said while patient satisfaction at times remained unaffected by a computer’s presence, the physicians’ attitude toward an EHR influenced the encounter. Other factors impacting this relationship include the physician's computer proficiency, typing ability, comfort navigating EHRs as well as the organization’s culture around EHR systems as a whole.

Physicians who integrated collecting data through patient interviews and recorded such information on a paper chart before introducing a computer into the room experienced a lower impact on patient satisfaction, according to one study cited.

“Whether physicians treat the EHR as simply an updated version of paper charts or perceive it in other ways, as a tool for educating patients or even a party to the interaction, also influences how exam room computing affects encounters with patients,” the report found. It cited an Australian study, which found that a computer “democratizes” and “commoditizes” information flow, leading to more patient-centered medicine.

The AMA board of trustees report discussed recommended behaviors, as noted by Kaiser Permanente and Family Practice Management, to successfully incorporate EHRs in the exam room for patient-centered care. For example, suggested actions included a physician explaining to a patient step-by-step what he or she is doing on the computer and why, encouraging patient participation and using a mobile monitor.

Ultimately, the board recommended that AMA publish more tips and resources to assist physicians in approaching their EHR use while in the exam room. Also, the board urged physicians to conduct satisfaction surveys to assess their own patients’ experiences.