August 15, 2012

EMR: Communication and Patients

Nancy M. Silva, MD, FAAP

Our office went “live” with Electronic Medical Records (EMR) in March of this year.  This was and still is a difficult change to master.  EMR is supposed to streamline the work process, improve healthcare, and improve communication with our patients.  But does it really?

In the beginning, it felt as if all communication between everyone within the office and with our patients had been altered and damaged forever.  So, no, initially, EMR didn’t help or improve anything.  Frankly, it hurt a lot. 

First, everyone in the entire office needed to learn the new system.  This made wait times unbearably long.  Why?  Think of every step that an office visit entails.  There’s the phone call to make an appointment.  The front desk staff has to learn a new way of doing that.  There is new paperwork for a patient to fill out.  There’s a new registration process, which now includes capturing a photo.  There is the nurse’s and the doctor’s assessment.  There may also be office lab tests.  Lastly, and most importantly, were all the apologies given to the patient that included explaining the new process and why EMR would eventually be better for everyone.  The growing pains were excruciating.  Throughout the process, we learned that constant communication with our patients and their families was crucial.

It has been difficult to communicate in the exam room with a computer in the room.  It is literally a physical barrier.  Neither the patients nor I liked it.  That is until I figured out how to still be human with a computer in the room.  Mostly, I divide myself in two.  I explain that first we’re going to get through all the “virtual paperwork.”  Then, I’ll be hands on and have time for questions.  That divide is necessary in order to meet the EMR requirements while still being a caring doctor.  Since creating the division, the parents seem happier.   They know the course of the visit.  They know what to expect.  And they know their doctor is not just going to be looking at the computer screen the entire time.  There is still time for humanity; communication up front is the key.

On the flip side, there is an aspect of EMR that the patients and I do enjoy.  Improved communication! 

So, what has improved with regards to communication?  Parents have more options.  Now patients can call or email questions.  Parents receive more information, more quickly, and more efficiently with less errors.  The pharmacy can email prescription refill requests directly to the doctor.  Laboratory results are received more quickly.  Hence, I can give parents their results more quickly as well.  Any day parents receive an answer more quickly regarding their child’s health is a great day.  Responses to phone calls are also quicker.  In addition, they are now more accurate.  Now, there is no misunderstanding as to what advice I gave the nurse to discuss with the parents.  Everything is written in the EMR.  Messages aren’t getting forgotten or lost, as there is an electronic trail.  In addition, we can look back at every piece of advice ever given.  This is helpful with a prolonged or complicated illness.  I also enjoy showing parents their child’s growth charts on the screen.  The parents seem to understand the visual much better. Lastly, at the end of the visit, most parents receive an educational handout, either specific to that well child age and visit or to their child’s current illness.  Parents are happy to review what you just discussed, as opposed to relying solely on their memory.

So, three months later, I would say, the answer is yes.  The work process has become more efficient, healthcare has improved, and communication has eventually improved as well.  Mind you, there are still growing pains.  Updates in the electronic world are frequent.  Adjustments occur daily and are both inevitable and necessary. 

Everything seems to have changed with the introduction of the EMR.  However, communication is still paramount.  I still maintain a personal human touch, just with more options on how to do so.