As Meaningful Use becomes a more accepted concept and practices move towards outcomes-based performance measurement, one of the dependencies that is gaining more prominence is the usability of the EHR during the visit. What is the secret in becoming an effective user of an EHR and how long does it take before the system no longer gets in the way of the patient encounter? Anecdotally, many physicians who have used EHRs for some time will tell you that the application is second nature to them, just as with a pen and paper chart — they no longer have to think about what they need to do. It is just the way they practise medicine. Obviously there is a significant degree of variation in terms of individual comfort with the EHR and the computer(s); however, longtime users usually get into a routine that allows them to treat their patients most effectively.
There has been much written about EHRs and the tendency for the technology or the device to get in the way of the patient encounter. This can be a physical limitation due to the layout of the examination room, desks, computers, monitors, etc., or it can be more of a functional limitation due to the usability of the software and the clinician’s comfort with typing or using other mechanisms to get data into the system.
As a touch typist, I find it much faster to type rather than write, and reviewing past medical history, medications, lab results, and consultation reports is significantly faster and more accurate in all the EHRs that I have used. Screen positioning is key so that the patient feels part of the encounter and can participate in the discussion. I also frequently use Google images to bring up an anatomical drawing or a skin rash and use that as a way to further engage patients in the encounter. Weaknesses for me are the more complex tasks: doing searches during the encounter, generating referral letters, and determining which data to include in a way that will be most useful as part of the referral.
What do you feel were the major barriers to use of an EHR during the patient encounter? If you are a user of an EHR, what advice would you give colleagues in terms of reducing the barriers to use of an EHR?
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This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.