- Since 2006, physician assistant Nicole Green has used a number of different electronic health records during her time in a variety of practices both big and small. What she has learned about the way patients interact with laptop-wielding providers shows that positive reactions aren’t always guaranteed, but it is possible to foster meaningful relationships despite the pitfalls of health IT. With Stage 2 of meaningful use demanding more engagement from patients and more extensive outreach from providers, it is important to review these real-life lessons from the trenches to identify where patients get frustrated, and what providers can do to help.
How do patients typically react to EHRs in the consult room?
Some patients don’t like it so much because the EHR is so cumbersome to the provider that patients feel like they’re not the center of the visit anymore. That was a challenge initially, to not be distracted by that. I hate when the EHR goes down, and you’re waiting for it to come back up with a patient in the room. You’re forced to ask if they brought their medicine list with them, and they’re like, “No, of course not. I’ve been seeing you for years.” Technology isn’t always your friend.
Kids are totally not fazed by any of it, but a 90-year-old patient might be like, “What are you doing with that computer in here? Aren’t you paying attention to me?” I mean, I’m facing them, and I’m trying to pay attention to them, and I’m a really good typer, but sometimes, you know, it can’t help but distract from the visit. I don’t necessarily think it’s older patients. It’s all patients. If they’re waiting in the room for a long time, and then someone comes in to take their vitals, and someone else comes in to put things in the chart, they want to know who is finally coming to listen to their complaints, not just type things into the EHR. But we’ve got to get things in that chart.
How does health information exchange affect the process?
In Buffalo, where I started practicing, the labs were all electronic. When results came back, you knew right away. A little button lit up in the EHR, and everything was right there and you could review it, send a message to someone, or leave a note for yourself reminding you to call the patient. I also worked for a large conglomeration of physicians that used Epic, which was very helpful because we had a lot of patients who were treated there and were also seeing someone at the Cleveland Clinic. If they signed a release, I could see all their records from Cleveland Clinic because we were all connected, and that was really useful. If people can get EHRs to work together, that’s great.
But when it doesn’t work, or we’re not online with someone, the patient gets very frustrated. They think that if anything is electronic, they’re all linked together. That’s probably the biggest misconception from the patient’s standpoint, and that’s one of the biggest hurdles to get patients to understand. The last thing I want is to have the patient drag five screaming kids into the appointment, but then I have to tell them that I don’t know if the kid has a sinus infection or needs a surgery because I don’t have the image and I need to call and wait three or four days for them to send it over. No one wants that.
What do you do when you encounter that problem?
I always say that regardless of whether or not we’re online with a different provider, please still ask them for a disc. Heaven forbid their system isn’t working, or our system isn’t working. Just bring a copy of the disc and we’ll go from there. I think it’s important to make the patient part of the process. If they are asked to bring something to the table, people are receptive to that. It’s when you don’t tell them, and then they show up and you don’t have it, that they start to get angry. That’s not the conversation I want to have with them. I want to have a productive conversation, so I always tell them what they need to bring.
What has been your experience with online patient portals?
I’ve worked in places with patient portals, and people generally really like them. But there can be issues. Sometimes patients would call and say they had done a biopsy, but it’s not under their lab results online. Well, you don’t necessarily want people to find out that they have a melanoma when they’re sitting at home alone. They might get annoyed with the fact that it’s not in there, but certainly you have to think about how you’re going to give them a serious diagnosis through the portal. Then they’re immediately on the internet looking up this condition or problem, thinking the worst, and that’s not productive.
How do you prevent patients from getting overwhelmed by all the information available online?
Let’s say a patient came in for sleep apnea. I’d say to them, “Okay, here’s the information on the sleep study, and here are the websites you’re allowed to look at.” We had informational sheets with recommended websites. And if they wanted to read more about it, I would give them national organizations that have trusted information. I’d tell them not to just go anywhere, because not everything on the Internet is true, as hard as that is for some people to believe.
Because patients are becoming more active participants, you need to let them know where they should be getting their information. And it does raise patient satisfaction. They like getting handouts; they like to know what’s going on and who to call if they have questions. They need to know what’s going on when they leave the office, and they want to feel like someone hears them and is addressing their concerns and keeping them informed. They want to feel like they have the right to know. And they do. They absolutely do.