It’s time to rethink technology in your exam room


According to a 2018 national survey of physicians by The Doctor’s Company, 54 percent of the more than 3,400 physician respondents felt that electronic health records (EHRs) have had a negative impact on the physician-patient relationship. Sixty-one percent also felt that EHRs have negatively impacted efficiency and workflow. The survey results offer a sobering and compelling backdrop for why physicians are experiencing frustration and burnout at record levels, with 70 percent reporting they are unwilling to recommend healthcare as a profession.

Issues created by the influx of digital record keeping intended to improve healthcare are known within the industry, but the survey results might explain why many physicians may be hesitant to introduce new technology at the point of care.

But now is not the time for physicians to be averse to technology. Now is the time for them to reclaim this space and the experiences that occur in the exam room. Physicians and patients alike need to promote and design environments and workflows that leverage the power of digital records while ensuring the intimate and humanistic aspects involved in care delivery are maintained.

The bottom line is that many physicians view EHRs as intruding to the in-room experience, which is the essence of the patient-physician relationship and interaction. One reason is that the technology was not designed to benefit the physician experience at the point of care.

Research has shown that a majority of the gain from EHRs including the electronic capture of health information to enable effective billing, effective distribution of clinical information and the establishment of a single reference for comprehensive clinical data is for outside stakeholders. While physicians are responsible for the heavy lifting of populating and retrieving information from these digital platforms, most of the financial benefit is gained by those not part of the point of care experience, chiefly payers and health systems.

Not surprisingly, many patients feel that EHRs have not necessarily made the healthcare experience any better for them, either. Lehigh Valley Health Network and Leigh University conducted a study over the course of its EHR implementation and found that “patients felt the disruption at the beginning and continued to feel less satisfied with their experiences after the EHR was fully implemented.”

Today’s clinical encounters still largely occur in an exam room - where physicians work with patients to conduct annual checkups, establish care plans, validate possible diagnoses and monitor chronic conditions. Arguably, the time shared between a provider and patient is the most important aspect of the healthcare journey. Yet, how that time is spent continues to be challenged.

Here are three ways physicians can help ensure a pleasant in-room experience when introducing new technology at the point of care:

Limit electronic barriers.

Ideally, in-room digital technology should be invisible whenever possible to preserve the essence of the important interaction that happens during a patient visit. Clicks of all types need to be reduced (or eliminated), data flows from connected devices need to be automated and the user interface must be optimized for efficiency. If a computer interaction infringes on a critical patient interaction, then it needs to be reanalyzed.

Make data entry seamless.

Ordering tests needs to be completed with as few clicks as possible, allowing physicians to spend less time on data entry and focus more on the patient. Results from vital signs measurements should find their way automatically into the patient record. Data entry templates need to be painstakingly optimized to ensure the workflow is as efficient as possible.

These types of improvements can be synergistic with each other. When achieved in the collective, they will disproportionately increase satisfaction for providers and their patients. Often, when it comes to improving care interactions, too little attention is given to these quick wins (e.g., creating a single-order system for test acquisition or eliminating non-value add screen navigation problems).

Choose exam room equipment that is designed, or redesigned, with modern digital technologies in mind.

Because EHR technology impacts virtually every step in the care journey, the exam room layout needs to consider how EHR attributes can be optimized for workflow considerations. Computer carts or wall units should be selected to ensure that eye-to-eye contact can be maintained as much as possible during times of data entry. Major flaws, such as having the computer or keyboard positioned so that the provider faces away from the patient, need immediate correction.

Not only will these steps help physicians integrate proven technology that is currently available in the market, they will also help prepare the exam room for future technological advances. For example:

• Artificial intelligence (AI) and machine learning (ML) have the potential to empower physicians with new tools to improve the in-room exam experience.

• Digital analytic tools have the potential to offer new insights into a patient’s health such as identifying subtle, but significant, clinical trends that alert physicians to emerging pathology.

• Other smart tools will provide augmented diagnostic capability based on social determinants of health and genomic data that personalizes therapeutic decisions with remarkable precision for each individual. An example of precision medicine would be understanding that a difficult-to-control asthmatic patient lives with a family of smokers, resides in an allergy-rich area of town and/or works in a dusty agricultural zone.

Advanced technologies such as these will continue to expand physicians’ ability to know and understand each patient as a unique individual. These tools will help physicians determine exactly what clinical plan will work for each patient while also eliminating distractions related to data entry or data transmission. Of course, this is only possible if physicians commit to integrating technology at the point of care to enhance the patient experience and the quality of care they deliver.

Tom Schwieterman, MD, practiced family medicine for 12 years before joining the team at Midmark. As vice president of clinical affairs and chief medical officer, he leads the company’s focus on innovative technology and new approaches that enrich experiences between physicians and their patients at the point of care.