Commercial Electronic Medical Records (EMRs) Both Help and Hinder Physician Communication with Patients and Other Clinicians

Policies Promoting EMR Adoption Could Incorporate Communication-Skills Training

News Release
April 7, 2010

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—Commercial electronic medical records (EMRs) both help and hinder physician interpersonal communication-real-time, face-to-face or phone conversations-with patients and other clinicians, according to a new Center for Studying Health System Change (HSC) study released today.

Supported by the Commonwealth Fund, the study found that EMRs assist real-time communication with patients during office visits, primarily through immediate access to patient information, allowing clinicians to talk with patients rather than search for information from paper records.

For some clinicians, however, aspects of EMRs pose a distraction during visits, the study found. And, some clinicians may rely on EMRs for information gathering and transfer at the expense of real-time communication with patients and other clinicians.

"Electronic medical records are a double-edged sword when it comes to communication with patients and other clinicians," said HSC Senior Researcher Ann S. O’Malley, M.D., M.P.H., coauthor of the study with HSC Research Assistant Genna R. Cohen and HSC Senior Researcher Joy Grossman, Ph.D.

"The study findings suggest that continued refinement of EMRs’ design by vendors and their use by clinicians could help reduce the potential for distraction during patient visits," O’Malley said. "In particular, policies promoting EMR adoption should consider incorporating communication-skills training for medical trainees and clinicians using EMRs."

"These findings show that EMRs can indeed allow physicians to use time with their patients more effectively, for example by aiding in communication around treatment plans," said Commonwealth Fund Vice President Anne-Marie Audet, M.D. "That could potentially translate into significant benefits for patient outcomes, as other studies have shown that engaged patients understand their health problems better and are more likely to follow their doctor’s recommendations."

The study’s findings are detailed in a new HSC Issue Brief—Electronic Medical Records and Communication with Patients and Other Clinicians: Are We Talking Less?—available here. The study is based on a total of 60 in-depth interviews—52 physicians and other staff at 26 small and medium-sized physician practices with commercial ambulatory EMRs in place for at least two years; chief medical officers at four EMR vendors; and four national experts active in health information technology implementation. Other key study findings include:

• In general, immediate access to EMR data enabled physicians to focus on the patient rather than gathering information from a variety of paper sources during visits. As one physician explained, because "we do not have to call down the hall for a lab or test result, we spend more quality time [with the patient] in a more context-rich way."
• Ease of access to information also enriched patient education during visits. For example, clinicians could pull up information from the patient’s record, such as the problem list, medication list and care plan, or educational information from the Internet to review on screen with patients and family members during the visit.
• Ironically, EMRs have enabled some clinicians to engage less with patients because, relative to paper charts, so much more information is available before actually seeing the patient. One internist, who works in both outpatient and inpatient settings, noted his fear that EMRs could diminish real-time communication with patients, "A lot of us feel like we’re already seeing it… One of the hospitalists yesterday said ’This is great, I used the EMR before I came here. I was able to sit down with my bagel and coffee and do my rounds before I even got in.’"
• Given time pressures already present in many physician practices, EMR and office-workflow modifications could help ensure that EMRs advance care without compromising interpersonal communication. In particular, policies promoting EMR adoption should consider incorporating communication-skills training for medical trainees and clinicians using EMRs.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded in part by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research.

The Commonwealth Fund is a private foundation working to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable. The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy.