Electronic Health Records

Use & Optimization News

Nurses need to interact with patients while using laptops, EHRs

By Jennifer Bresnick

- In a presentation at HIMSS13, Beth D. Strauss, DNP, RN, AHCNS-BC, Assistant Professor at Edgewood College in Wisconsin, discussed the role of technology in the consult room from the patient’s perspective.  Strauss, a veteran clinical nurse and health information specialist, interviewed 11 patients, most of whom were highly educated and familiar with technology. She discovered that while patients are generally positive about the existence of EHRs, and value the positive aspects of the technology, they expressed concern and dissatisfaction about the way nurses failed to interact with them on a human level during intake procedures and ongoing care.

“I believe technology is a double-edged sword,” Strauss said.  “It has been effectively used for healthcare providers to provide safety in patient interactions.  In my own work as a staff nurse and clinical information specialist, I have found the value that technology has in providing safe, effective care.  But as a nurse, I always wonder about the opposite side of that.  What is the humanistic side to the use of this technology?  There’s very little research focusing on it.”

In her study, she found that patients strongly disliked when a nurse starting clicking and typing without explaining what she was doing.  “It caused quite a bit of anxiety,” Strauss noted, citing the example of a patient coming to her provider rule out the possibility of a very serious illness.  The patient didn’t understand that the nurse’s questions were routine as she typed information and stared at the screen.  The patient thought she was going to die, and the nurse was so busy focusing on the computer that she didn’t connect with the patient’s mounting anxiety.

“I think some basic idle chit-chat up front with what you’re doing is important,” said one of the patient participants.  “The first thing they do when they come into the room is pull up the screen and start entering passwords, and they’re obviously well-versed in using the equipment, but maybe some better communication with the patients would help.”  Another patient said he felt like he was “was just an information bank that they had to tap into in order to fill all this stuff out.  It seemed like after they got the information filled out in the computer, they had already done what they thought was their job.”

Participants were concerned about respect, not only during face-to-face interactions, but also behind the scenes.  They worried about what the nurses might think about them after reading their information, especially if there was little social interaction during the exam.  “Nurses and providers now have everything I’ve got wrong with me with the click of a button,” Strauss stated.  “If I come in because I have a cold, but you find out that I have a severe mental illness, will you judge me based on that?  Will you not offer me what I need, or will you think I’m faking this cold because of my other issues?  Will there be a bias out there regarding my privacy?”

Strauss made sure to stress that in her 29 years of experience, it was very rare for a nurse to truly not care about the patient as a person or to judge a patient negatively based on his health issues.  But if that concern isn’t coming across, there is a serious disconnect that has to be addressed by the provider through training.  Simply telling the patient what is on the computer screen helps to reduce the apprehension and discomfort involved in any serious illness or hospitalization. “Patients have adapted to the EHR, and they want it,” she concluded.  “But they want a physician or nurse to explain what they’re doing on the computer because that gives them a sense of safety.”

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