“I’m afraid the computer will come between me and my patients.”
I can’t count the number of times I’ve heard that lament from my colleagues used as an excuse not to pursue the adoption of an electronic medical record. As if their patients aren’t already complaining that the doctor is spending all of his time scribbling in their paper chart instead of paying attention to them. No one denies that balancing the demands of medical care with medical documentation – paper or electronic – is a daunting task. But thanks to Practice Fusion, one particular patient encounter became wonderfully memorable.
It began with a phone call from a “video interpreter”. Turns out there’s this free service for the deaf which involves an interpreter on a video phone call who is communicating via American Sign Language (ASL) with the patient, while speaking with me (or anyone else) on a regular phone.
“I have a new patient who wants an appointment,” the call began.
“Um, I don’t know ASL,” I replied.
“I’ve been deaf from birth, so I’m very good at reading lips.” The interpreters are supposed to speak as if they are the patient; that must be why they call it “interpreting.”
“I’m not sure,” I continued. “What about more complicated kinds of questions?”
“We can write notes,” came the reply.
“Oh; okay.” I made the appointment with a sinking feeling, envisioning a difficult encounter. Talk about things coming between doctor and patient! Scrawling notes back and forth didn’t seem like a very efficient mean of communication.
The appointed date and time arrived. In walked a lovely young lady who easily complied with requests to fill out assorted paperwork, and to present her insurance card. I introduced myself and escorted her back to the exam room.
She was right: she was very good at reading lips. She was also very good at pantomime; acting out phrases and symptoms, including exaggerated facial expression of pain to convey severity and distress. Still, in order to communicate the essential outline of her story, the first thing she did was whip out her phone, open up a “notes” app, and began tapping away with both thumbs.
Of course, I thought. What an old fuddy-duddy I must have been to think she’d meant actual dead-tree paper notes. She just kept tapping away, answering my questions as I asked them, while I transcribed the history into her Practice Fusion chart note, just as I did with all my other patients. Things were going fine, until I got to the rest of the past history. Medical words like “surgeries”, “allergies”, “medications,” and so on were harder to recognize with lip reading than more everyday vocabulary. What to do?
Although I had an iPhone in my pocket, I was nowhere near as expert as my patient was at double-thumbed typing. However I was sitting in front of a computer, and even though Practice Fusion’s extensive system of templates allows plenty of point-and-click documentation, it also accommodates limitless free text entry. And when I can use fingers instead of just thumbs, I’m an excellent typist.
I moved my small laptop computer from the counter next to the sink where it usually sits while I see patients (exactly the same place the paper chart sat when I used them) and set it on the exam table in front of me. I rolled my exam stool a little closer to it, and beckoned my patient to hitch her chair over so she was sitting next to me, where both of us could see the screen. There were no HIPAA issues because the only patient information visible was hers. I showed her what I had already written about her PHI, which also allowed her to confirm that I had gotten her story right. Then I tabbed down a few lines and began typing my questions to her:
- Have you ever been operated on for anything?
- Do you take any medications?
- Are you allergic to anything?
All the way through the social history:
- Do you smoke cigarettes? Have you tried to quit?
- What do you do for exercise?
- What kind of work do you do?
- Are you, or have you ever been in a relationship where you’ve been threatened or beaten or abused in any way? (try acting that one out!)
Yes or no answers she was able to provide with simple head gestures. For more detailed explanations, she tapped away on her phone. Once or twice, she found herself frustrated with her own thumbs, so because we were sitting next to each other, she reached over and began typing on my machine, which I tilted in her direction. When she was done, I went back up several lines on the screen to where my actual note was taking shape and inserted her answers to finish up the Subjective section. Finally, when we were done, I went back and just deleted out the text of our “conversation”.
It was efficient and it was fun. It allowed us to communicate almost as effortlessly as I would with any other patient. Not only did the computer not get in the way of caring for my patient, it actually enhanced the encounter for both of us. No other EMR out there has that kind of functionality, unintended as it may have been by Practice Fusion’s designers.
Thanks to Practice Fusion, what would have been a frustrating exercise likely eliciting a suboptimal history became a rewarding visit with a lovely new patient.