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Documenting in the EHR and Focusing on the Patient


Physicians need to document care in the EHR, but they can either keep the computer out of the room or embrace it to focus on the patient.

Mott Blair, a Wallace, N.C.-based family physician, doesn't get distracted by the EHR in the patient exam room. That's because he keeps it in the hallway, right outside the exam room. He uses an old-fashioned clipboard and paper to take notes during patient visits.

"I do all my work face-to-face with patients. I maintain that eye contact, and I always listen," he says.

This work flow has been intentional on Blair's part, since he's witnessed many physicians "caught up" entering data and not focusing their attention on patients.

His patient's experience starts with a nurse at the practice capturing their vitals, chief complaint, and current medications and documenting those details in the EHR. On his way to the patient exam room, Blair views the patient's record and then enters the exam room, where he focuses his attention on the patient in the room.

He has his clipboard with a piece of paper on it to make notes about anything that's out of the ordinary with his patient. "If things are normal, you don't have to write them down," he says. Blair updates the vast majority of his patients' records in the EHR shortly after their visits.

Towards the end of the visit, Blair asks his patient to get dressed and exits the room to update the patient's record with details from that day’s visit in the EHR. This enables him to hand the patient their visit summary and any prescriptions when Blair returns to the exam room.

Committed to not bringing work home with him at the end of the day, Blair will stay at the practice to update all of his patients' charts. Still, he acknowledges that his efficiency has gone down since he's been using the EHR to document care.

"My advice for doctors is this: Number one, never turn your back on a patient while entering information [into the EHR]. I've observed that myself, whether it's a nurse or a doctor entering data," he says.

Blair treats many complex patients in his family medicine practice, and all of that detail needs to be captured in the EHR. While sometimes devoting 20 to 30 minutes at the end of the day finishing his patients' charts is the norm, Blair says his approach works best for him and his patients.

"The most important thing as a family doctor is our interactions with patients. That's something we have to try to preserve," he adds.

Whether the physician chooses to keep the computer in the room or not, Daniel Clark, senior vice president of consulting at The Advisory Board, says maintaining the right attitude toward the EHR is important.

"If [the physician] hates [the EHR], that attitude will come across in direct and indirect messages the patient and family will pick up. The opposite is also true. If they believe that the [EHR] as a net positive, that will also come across," he says.

Clark recommends that physicians ignore the computer upon entering the exam room. Spend the first part of the visit maintaining direct eye contact with the patient and their family, he advises. Then, only if necessary, log on to the computer

The positioning of the monitor matters, adds Clark. The patient should be able to see what their physician is typing, so he recommends positioning the screen so the patient can clarify the reason for the visit, current medications, and past medical history.

Physicians can also add value by using the computer monitor to show the patient their latest lab results or X-ray, CT, or MRI images, says Clark. He also highlights that this is a great opportunity to introduce the patient to the practice's patient portal, demonstrate secure messaging between the patient and their care team, and stay on schedule with recommended screening tests and procedures, such as mammograms and colonoscopies.

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