Computers in the Exam Room—Friend or Foe?

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.

Figure 1.

A synthesis of recent evidence—member satisfaction with exam room computers

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

Table 1.

Interregional Clinician-Patient Communication HealthConnect work group members

Sara Faulkner MD (Group Health)

Rich Frankel PhD (Indiana University)

Diana Burks-Goodman MPA (Southern California)

Jim Hardee MD (Colorado)

Charles James Kinsman BA (Garfield Memorial Fund)

Peggy Latare MD (Hawaii)

Maureen Leahy MBA MPH (Mid-Atlantic States)

Ward R Mann NP Chair (Northwest))

Debra Mipos MPA (The Permanente Federation)

Jan Nedin MS CCDC CEAP (Ohio)

Vivian Nagy PhD (Southern California)

Joanne Slaboch MBA (The Permanente Federation)

Sue Hee Sung MPH (Garfield Memorial Fund)

Richele Thornburg MS (Hawaii)

Robert Tull PhD (Group Health)

Elizabeth Wu MA (Southern California)

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).

Figure 2.

Do your LEVEL best with the computer in the exam room

© 2004, The Permanente Federation LLC

Table 2.

Courses for clinicians and health care team members

Introduction to CPC Issues and Future Support	10–15 minutes
LEVEL Tips for Technical Training	5–15 minutes
Connected Communicating and Computing in the Exam Room Web-Based Training Course http://internal.or.kp.org/cis/training/erc.html	30 minutes
CONNECTED CONDENSED	a two-hour workshop session
Course for Exam Room Coaches RECONNECTED

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.

Biographies

Ward R Mann, MSN, FNP, is a clinician and consultant for NWP in Portland, OR. Most recently he’s helped to create curriculum for regions to use as they implement KP HealthConnect. E-mail: ward.r.mann@kp.org.

Joanne Slaboch, MBA, has been a Project Manager for the Care Experience Council since 2001, focusing on issues related to technology-enabled cared. E-mail: joanne.m.slaboch@kp.org.