As 2012 draws near the end, there are more and more physicians moving towards using an EHR in their medical practice. Not only are there benefits available for incorporating its use — from the bonus available from CMS for meeting meaningful use to the improved efficiencies of having patient data available at your fingertips — but utilizing an EHR can actually improve your day-to-day practice operations.
There are many EHR software options to choose from. While choosing the right EHR for your practice is akin to test driving a car before purchase or trying on a pair of shoes, it is important that you are able to use your EHR efficiently once the choice has been made. Further, the way in which you utilize and enter data into your EHR during the patient encounter is very important as well. Patients are very used to physicians using computers in medical practice. I have used an EHR in my practice from day one in late 2003. It is very important that the use of your EHR does not take away from the important doctor-patient interaction in the exam room.
Several options for data entry are available for most EHR software titles. Probably the easiest to incorporate would be the addition of a desktop PC in each exam room. This option has benefits of allowing ease of data entry and preventing the fatigue of carrying a computer around. However, unless the exam room is arranged efficiently, the use of a desktop PC can place a barrier for the physician and it can potentially make the patient feel as if they are not being heard during the visit.
In my residency program, we had desktops in each room. I found myself sitting with my back to the patient while entering data. While I was able to accurately capture all aspects of the history and physical examination efficiently into my note, I felt as if my interaction with my patients was not optimal. I was trained to make eye-to-eye contact with my patient as I interviewed them. Using a desktop PC in a poorly designed exam room can certainly place a barrier for effective communication.
The next option would be to carry a laptop into the exam room. Laptops are generally very powerful and most can give you the power of a desktop PC in your hands. However, most laptops are bulky and most require a desk to place them on for effective data entry. Again, this process can place a physical barrier between the doctor and the patient and can prevent effective communication. When I visited my primary physician last, he entered the room with a laptop and a corded mouse. While I was able to adapt to the constraints of his documentation process, most patients will not easily be able to do this and as a result will feel uncomfortable.
Enter the tablet PC. The tablet has evolved from a clunky machine to very svelte choices over the past few years. Deciding against using a desktop or a laptop in my practice initially, I opted to use a tablet in 2003. I was able to place the tablet on my lap and use it to enter data much like taking notes on a paper chart or clipboard. Further, the tablet being relatively small compared to most laptops, it allowed me to interview my patients and for the most part I felt it was not acting as an obstacle between the patient and me. My first tablet was relatively slow and underpowered at that time. However, as the years passed, I was able to upgrade my tablet to a very powerful machine that allows me to very efficiently and effectively take a good history and document my physical exam findings while the patient is in the room. Couple that with a fast processor and additional RAM, and you can use voice recognition software that prevents swinging around the keyboard, allowing for very efficient note taking and completion at the point of care.
EHR software is here to stay. Gone are the days of using the old fashioned paper and chart from years past. As we embrace technology and move forward with the ever-changing requirements from CMS and most insurance payers, we must do so without placing a physical barrier between ourselves and the patients.
If you choose to use a desktop, be smart and arrange your exam room in a way so you are not talking to the patient with your back turned to them. Remember that the computer is only a device for data entry and the use of this tool must not detract from the encounter. For my preferences, the tablet allows me to enter the data I need and does not take away from the encounter.
However you choose your software, use it to its highest potential, and remember that the patient — and not the computer — is the most important item in the exam room.