Today I was included on what I’d consider a tweetstorm about the EMR and they ways it can impede the Doctor-Patient relationship. I thought many of you would find his comments interesting and might want to add to and extend his comments.
@DrLindaMD @smcroft @ehrandhit @AAPSonline Patients unhappy with EMR use. https://t.co/NfAnA1Kou0
— Douglas Ashinsky (@drdashinsky) January 18, 2016
@ehrandhit @DrLindaMD @smcroft @AAPSonline Come to my office and see what it's like to have the doctor looking and talking to patient
— Douglas Ashinsky (@drdashinsky) January 18, 2016
@ehrandhit @DrLindaMD @smcroft @AAPSonline That's what a doctor/patient relationship is. And this is not concierge medicine
— Douglas Ashinsky (@drdashinsky) January 18, 2016
@HeartOTXHeartMD @drdashinsky @DrLindaMD @smcroft @ehrandhit @AAPSonline Worst part is that, while no one is surprised, nothing is done.
— Fraz Ahmed Ismat (@fismat) January 19, 2016
@ehrandhit @DrLindaMD @smcroft @AAPSonline It's time for the patient to be the focus of the patient encounter and not the data
— Douglas Ashinsky (@drdashinsky) January 19, 2016
@ehrandhit @DrLindaMD @smcroft @AAPSonline Patient centered care means the patient is the center of the care and not the computer
— Douglas Ashinsky (@drdashinsky) January 19, 2016
Those are some strong opinions? While I’d love to visit his office, I don’t really need to visit it. I’ve seen many doctors not use the computer in the exam room so they could focus on the patient. In fact, I’ve seen the whole spectrum of computer use in the exam room from a lot to none. My conclusion is similar to the one that Amy Hamilton described here. The setup can really impact the experience of the patient.
I do agree with Dr. Ashinsky that many doctors are spending too much time on the data/computer and not enough time on the patient. That doesn’t mean that the data isn’t important, but many have taken it too far.
What do you think? Does the computer get in the way of he doctor-patient relationship?
Eric Topol tweeted one suggestion:
Fixing the doctor-patient relationship
Step 1: make it the patient-doctor relationship https://t.co/0mMFFmCjR5 pic.twitter.com/SRcSmWSqbM
— Eric Topol (@EricTopol) January 19, 2016
As I see it, the current problem is that the clinician is being coerced into using a computer interface to an EHR that is not designed to be used as a clinical tool. The result is that both the patient and the clinician resent the distraction.
Instead, I would suggest designing the EHR (and the interface) to be used as a collaborative tool by both the patient and the clinician to collect, store, integrate, present medical information, make smart suggestions, and let them document their discussions and plans. When it is a tool that is being used collaboratively, much of the resentment vanishes.
Each individual patient or clinician cannot redesign the EHR tonight, but each can – tomorrow – insist on working together on what goes into the EHR and how it is used. Sit next to each other and work together and make sure everything in the EHR is fully accessible to both parties.
Thanks for your comments Peter. What’s interesting is that what you describe could be done with any EHR.
Sounds like you’ve been talking to Jimmie (http://twitter.com/jimmie_vanagon) or that you would like to talk with him. His #ProjectedEHR (which is basically what you describe) has changed how he practices medicine.