Table 2.

Strategies for Success With the EHR in the Oncology Clinic

Strategy	Example	Try to …	Avoid …
Positioning	Use the computer as a bridge between you and the patient, rather than a barrier	Use it to mediate connectedness and communication; encourage patient participation in care; show graphics, trends, imaging	Positioning it directly between you and the patient, or where the patient cannot see the screen
Invitation	Introduce the EHR as an important part of high-quality cancer care, and ask permission to interact with it during the visit	Prepare patients for your use of the computer; ask the patient if they would like to learn more about your use of the EHR	Apologizing for its presence or your interactions with it
Involvement	Involve the patient in using the EHR, such as by showing radiographic images, graphing laboratory values, or trending vital signs	Discuss changes in the patient's disease trajectory via graphs, imaging, etc.	Excluding the patient; they may feel ignored, or wonder what you are typing about them
Nonverbal	Maintain good nonverbal communication behavior, such as by nodding, looking up from the screen frequently, reflecting or responding to emotion, etc.	Make it a point to periodically look directly at your patient	Letting its presence decrease eye contact with your patient
Organization	Negotiate an agenda for the visit upfront; elicit the patient's agenda, present yours, and set a plan for the content of the visit, recognizing that you cannot accomplish everything each time	Organize the encounter. Plan when to use the EHR, what to show, and when to step back from the computer to focus on the patient	Allowing the computer to preoccupy you and further disorganize the encounter
Activation	Use the computer to present and demonstrate some useful resources for the patient	Have online resources readily available to show the patient	Being unprepared and having to Google sites in the examination room

Abbreviation: EHR, electronic health record.