Industry Tries To Steamroll Physician Complaints About EMR Impact On Patient Face Time

Some doctors — and a goodly number of consumers, too — argue that the use of EMRs inevitably impairs the relationship between doctors and patients. After all, it’s just common sense that forcing a doctor to glue herself to the keyboard during an encounter undercuts that doctor’s ability to assess the patient, critics say.

Of course, EMR vendors don’t necessarily agree. And some researchers don’t share that view either. But having reviewed some comments by a firm studying physician EMR use, and the argument an EMR vendor made that screen-itis doesn’t worry docs, it seems to me that the “lack of face time” complaint remains an important one.

Consider how some analysts are approaching the issue. While admitting that one-third to one-half of the time doctors spend with patients is spent using an EMR, and that physicians have been complaining about this extensively over the past several years, doctors are at least using these systems more efficiently, reports James Avallone, Director of Physician Research, who spoke with EHRIntelligence.com.

What’s important is that doctors are getting adjusted to using EMRs, Avallone suggests:

Whether [time spent with EMRs] is too much or too little, it’s difficult for us to say from our perspective…It’s certainly something that physicians are getting used to as it becomes more ingrained in their day-to-day behaviors. They’ve had more time to streamline workflow and that’s something that we’re seeing in terms of how these devices are being used at the point of care.

Another attempt to minimize the impact of EMRs on patient encounters comes from ambulatory EMR vendor NueMD. In a recent blog post, the editor quoted a study suggesting that other issues were far more important to doctors:

According to a 2013 study published in Health Affairs, only 25.8 percent of physicians reported that EHRs were threatening the doctor-patient relationship. Administrative burdens like the ICD-10 transition and HIPAA compliance regulations, on the other hand, were noted by more than 41 percent of those surveyed.

It’s certainly true that doctors worry about HIPAA and ICD-10 compliance, and that they could threaten the patient relationship, but only to the extent that they affect the practice overall. Meanwhile, if one in four respondents to the Health Affairs study said that EMRs were a threat to patient relationships, that should be taken quite seriously.

Of course, both of the entities quoted in this story are entitled to their perspective. And yes, there are clearly benefits to physician use of EMRs, especially once they become adjusted to the interface and workflow.

But if this quick sample of opinions is any indication, the healthcare industry as a whole seems to be blowing past physicians’ (and patients’) well-grounded concerns about the role EMR documentation plays in patient visits.

Someday, a new form factor for EMRs will arise — maybe augmented or virtual reality encounters, for example — which will alleviate the eyes-on-the-screen problem. Until then, I’d submit, it’s best to tackle the issue head on, not brush it off.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

2 Comments

  • Regardless of what non-MD health consultants and/or vendors claim EMRs will radically rearrange your patient-physician relationship (what MDs call transference). It not only pertains to the patient, but to t he provider who may experience loss of contact as well. Initial usage will drastically effect that as well as MD efficiency, resulting in extreme frustration and at times outright anger which patients may misconstrue as anger at them….There are a number of ways to enter data. Much of it depends upon the individual EHR and provider.
    1. Enter data in real time while interviewing or examining a patient. The Physical exam can be entered at the end of the examn or the end of the visit.
    2. Some MDs prefer to enter the EHR data at the end of the visit.

    Your choices may depend upon your experience using the system. You may want to skip around the EHR depending upon work flow and other exigencies. Providers should be the ultimate commander of the EHR. not the opposite.

    Absenting certain fields may be construed by legal authorities as parts of the examination that were not done. Users must be particularly careful to note important key notes related to specific diseases according to standard of care.

    There is no doubt experience increases efficiency and ‘work arounds” Providers using the same system should be encouraged to collaborate with others for ideas.

    Ultimately providers have to adopt to EHRs provided by group practices. CMS requires reporting on items which many providers know are not relevant to CMS’ desire to collect analytics

    We are only at the beginning of HIT, and advances such as tablets, virtual reality, speech logic, and real-time video recording using such online cloud devices as a secure YouTube application may render what we now use such as a No 2 pencil and yellow legal pad.

    It’s a bad situation as we become even more subservient to multiple layers of health IT

  • While I do sympathize with clinicians (more than even patients) about how the EMR is coming in between them and the patient, I have to also question how open a stance providers and provider organizations are in truly adopting tools. Sure, a lot of the tools are sub-optimal but I would go further to argue that even the best-in-breed tools would make the over-all output sub-optimal if clinical structure and processes as a whole are also not up to change and adaptation.

    For the sake of argument, if we are to assume that IT will permeate healthcare delivery organizations it would be important for these delivery organizations to have the foresight to open up the structure and process also for disruption. Something as simple as how a consultation room is setup and having the patient and provider sit together in a collaborative stance would be a good places to start. The ability to look at how and what the clinician is doing and how that is relevant to a patient would evolve into mutual engagement and rallying. The clinician does not have to scribe everything during the patient visit but the most important elements in a way that lends itself to a better experience for both stakeholders.

    All I can say is that while we do need HealthIT to evolve, we also want the provider and the organizations to truly be ready to change in fundamental ways.

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