There has been much written about EMRs and the propensity for the technology or the device to get in the way of the patient encounter. This can be a physical limitation due to the layout of the examination room, desks, computers, monitors, etc., or it can be more of a functional limitation due to the usability of the software and the clinician’s comfort with typing or using other mechanisms to get data into the EMR.
Talk to physicians who have used EMRs for a long time and they will tell you that the EMR is second nature to them, just as with a pen and paper chart — they no longer have to think about what they need to do. It is just the way they practice medicine. Obviously there is a significant degree of variation in terms of individual comfort with the EMR and the computer(s); however, universally longtime users get into a routine that allows them to treat patients most effectively.
I have used a number of different EMRs in clinical settings. Each has its own strengths and weaknesses. However as a touch typist, I find it much faster to type rather than write, and reviewing past medical history, medications, lab results, and consultation reports is significantly faster and more accurate in all the EMRs that I have used. Screen positioning is key so that the patient feels part of the encounter and can participate in the discussion. I also frequently use Google images to bring up an anatomical drawing or a skin rash and use that as a way to further engage patients in the encounter. Weaknesses for me are the more complex tasks: doing searches during the encounter, generating referral letters, and determining which data to include in a way that will be most useful to the consultant.
Now a question for readers of this blog...
What is the secret in becoming an effective user of an EMR and how long does it take before the system no longer gets in the way of the patient encounter? What do you feel were the major barriers or are still barriers to use of an EMR during the patient encounter? Finally, if there were any advice you could give colleagues on how to reduce the barriers created by your EMR, please share your tips and pearls.
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