Computers in the Exam Room--Friend or Foe?

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Ward R Mann, MSN, FNP; Joanne Slaboch, MBA

Perm J 2004;8:14-090

https://doi.org/10.7812/TPP/14-090

At first, it might be hard to imagine how using an electronic medical record in your practice and in the exam room could improve communication with patients. In fact, it may be easier to see the computer as just another thing that gets in the way of our having meaningful interactions with patients--a third wheel, so to speak. Because patients view communication as the most important factor in the clinician-patient relationship, we certainly don't want to compromise it in any way.¹ Does the computer in the exam room assist or hinder good clinician-patient communication?

The Experience

Our experiences in Kaiser Permanente's Northwest and Colorado Regions have shown that patients give a positive rating to clinicians' use of computers in the exam room. Initially, clinicians experienced a period of time in which they were not as efficient as they were with the paper record. There might be some discomfort with the new equipment, with necessary new computing skills, with the changes in workflow and, importantly, discomfort in the conversations with members related to the computer.

We learned that this discomfort fades as confidence is gained in new skills, in a sense of consistency and reliability about critical patient data, and in satisfaction with the comprehensive level of care that the clinicians are able to provide. The information available from computers helps to demonstrate comprehensive knowledge of the patient. Additionally, exam room computing helps involve patients in decisions about medical care, something patients highly value. As reflected in the chart, A Synthesis of Recent Evidence (Figure 1), shows ample evidence that exam room computing can enhance the overall clinician-patient interaction in the exam room.

Personal Challenges

What about you and your practice? How are you supposed to maintain good communication with your patient and deal with this new "thing" in the exam room? Will you be able to make eye contact and type your note? Will you be able to keep the patient involved and not be distracted by the computer? Will you remember to secure the screen? Sound a little overwhelming? We believe that you will find the following suggestions helpful to make certain that the computer becomes a solid friend of yours in the exam room, and definitely not a foe.

Solutions

The Interregional Clinician-Patient Communication (IRCPC) Leaders of Kaiser Permanente (Table 1) have pooled their collective experience and understanding about clinician-patient communication and exam room computing. As a result they have identified five key communication behaviors to foster smooth integration of computers into practice:

Let the patient look on

Eye contact with the patient

Value the computer as a tool

Explain what you are doing

Log off and say you are doing so

The accompanying chart, Do Your LEVEL Best With the Computer in the Exam Room (Figure 2), applies these five communication behaviors and details some recommended actions to use and scripts to say to effectively integrate the computer into your exam-room interaction with your patient. The IRCPC has developed five courses to help clinicians and support staff integrate the computer into the patient visit using these LEVEL skills (Table 2).

By including a few new communication behaviors into everyday practice, a computer in the exam room will enhance the overall care experience for the patient.

References

1. Worthlin Group. Communication and the physician/patient relationship: a physician and consumer communication survey. West Haven (CT): Bayer Institute for Health Care Communication; 1995.