There is no consensus about the best way to incorporate computers into a patient visit, but whether computers are a negative or positive influence in the exam room appears to depend on the communication skills of the physician, according to a report from the American Medical Association board of trustees.
The five-page report, “Exam Room Computing & Patient-Physician Interactions,” (PDF)
will be presented for approval at the AMA House of Delegates June 15-19 meeting in Chicago and will be considered as only “informational” and not an official position of the organization until then. The board was directed to study the issue at last year's meeting.
The report cited a 2005 study
that found patients' “overall visit satisfaction, satisfaction with the physician's level of familiarity, communication about medical issues, and the degree of comprehension with decisions made during the visit all improved significantly” after their doctor started using a computer in the exam room.
The report acknowledged how computers are increasingly becoming part of a “triadic relationship” with physicians and patients, and it noted how this both “democratizes” and “commoditizes” information flow and authority, and can be used to help foster shared decisionmaking.
Also included in the report are tips from an article in the American Academy of Family Physician's Family Practice Management journal
that encouraged doctors to tell patients what they're doing on the computer, use templates for documentation but not for structuring patient interviews, point to the screen, encourage patient participation in building charts, and to look at patients—not at the computer screen. “This may seem patently obvious, but the reality is that even with the availability of mobile screens, many experienced clinicians persistently stare at the computer monitor,” the journal article stated.
The AMA report suggested that the AMA disseminate these tips on using EHRs through its publications and that physicians solicit feedback on their computer use by including questions about it on patient-satisfaction surveys. It also suggests doctors may want to observe video recordings of themselves using computers in the exam room so they can gauge their own performance.
“The data suggest that incorporating such relatively simple behaviors may be as effective as any other response to the challenges of integrating computers and EHRs into interactions with patients,” the report concluded.Follow Andis Robeznieks on Twitter: @MHARobeznieks