Can we have high-tech, high-touch health care?

Does the use of Electronic Health Records (EHR) systems get in the way of doctor-patient interaction? Does it make the doctor-visit experience colder and more distanced – more dehumanized? Is there more interaction with the tools, at the expense of the emotional connection that comes from simple eye contact?

These questions have been actively debated, and were the topic of a recent interesting article on the importance of eye contact in the doctor-patient setting. The lessons are true regardless of whether a laptop or notebook computer is being used, or a paper chart is being used – if the physician keeps eyes on the chart (e-chart or paper), and not on the patient, then the connection will miss an important dimension.

As health care moves towards greater reliance on performance-based compensation – in areas such as California, where risk-taking IPAs and medical groups are paid a Pay For Performance bonus in addition to baseline capitation, and also in the newly-envisioned Accountable Care Organizations (ACOs) – measurement of Patient Satisfaction takes on increasing importance.

Patient satisfaction with a doctor is really about a collection of experiences with the office. How easy was it to make an appointment? Were there online options for self-service? How long was the wait time once arrived? Did the front office staff make me feel comfortable and welcome? Did they know why I was there? Did the doctor connect with me? Was all the information needed at-hand when I was there? Did I leave feeling confident in the care that was given? Were referral processes (when needed) easy to implement? Did I get better? These are all the kinds of questions that go into an overall assessment of satisfaction.

Pay For Performance often includes a significant component based on patient satisfaction, administered usually by questionnaires. Health Plans may send these questionnaires to their enrollees once a year; some offices use their own satisfaction questionnaire tools to survey patients post-visit.

Does technology get in the way of all this? Depends on how the tools are used. It also depends on the design of the tools. Electronic forms that put front-office staff in the position of transcriptionists of questions asked will tend to force the eyes of the front-office staff on the screen, not on the patient – self-service tools for patient check-in can work here. Staff can then focus on making the patient feel welcome (this takes in-staff training, of course).

Similarly, if a physician uses a small portable tablet or notebook computer (rather than fixed hardwired workstations in an exam room), then there is the option to set the tablet aside, sit down, fold ones hands on one’s lap, and look the patient in the eye. Same is true when the chart is on paper. When the e-chart is used, it is a “ third person in the room” – and both the physician and the patient can look at the screen to review (for example) lab results, medication lists, prescriptions, etc. When the EHR allows for health education resources, these can be shared with the patient in-room, and sent to the patient for perusal at home (via enrollment in the linked PHR). The patient becomes an active participant in the process, and appreciates the technological platform at hand.

Well-designed EHR technology should facilitate, rather than impede, the human connection between health care professional and patient. Many modern EHRs do not do this well. Portability of hardware, patient-facing self-service options, and better design will be the hallmarks of the technology that will help transform healthcare going forward. The new forms of healthcare organization, like ACOs, and the move to reward performance (which includes patient satisfaction), all point to the need to create these kinds of modern next-generation tools. That remains our guiding vision.

Robert Rowley, MD
Chief Medical Officer
Practice Fusion EMR