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    How to use scribes to get off the computer and in front of patients

    Electronic health records (EHR) have the ability to transform the current healthcare system into a place of efficiently executed, high-quality, and patient-centered medicine, but only if physicians know how to use these systems to their maximum potential.


    Related: 5 ways to get the most out of your IT partner


    Under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, eligible physicians received thousands of dollars in financial incentives to purchase and implement EHR in their practices via the “Meaningful Use” program. Compared to paper charts, EHR promotes quality healthcare by improving provider-to-provider communication, increasing patient access to their medical information, endorsing patient safety, enhancing medical information security, and promoting transparent provider-patient relationships.

    Physicians who have embraced EHR are struggling to effectively integrate the system into their practices because they must now divide their time between the patient and the computer. Unless used properly, EHR can negatively impact the patient encounter by reducing both verbal and nonverbal communication between physicians and patients. Good verbal communication allows a physician to gather a full history on a patient and to extract pertinent information about a chief complaint.

    Nonverbal communication, such as eye contact and body positioning, may be even more important than verbal communication during patient encounters. A 2015 study published in Patient Education and Counseling indicates the quality of nonverbal communication has been directly linked to the patient’s level of comfort, degree of engagement and overall satisfaction during a healthcare encounter. This, in turn, significantly impacts a patient’s honesty with the physician and adherence to a treatment plan, according to follow-up studies.


    Further reading: The need to create physician-friendly technology is more important than ever


    Research from 2014 published in the International Journal of Medical Informatics found physicians who use a technology-centered approach have the longest patient encounter times, but they also have the lowest patient satisfaction scores. This is because they spend the least amount of time gazing directly at their patients. Patient satisfaction does not depend on whether physicians use verbal or non-verbal cues (such as nodding their head) to show patients they are listening.

    Rather, patient satisfaction and patient engagement depend on the patient’s ability to engage in direct eye contact with the physician and screen share with the physician when he or she turns his or her attention towards the computer. Unfortunately, most physicians do not do this. The average physician spends 30% to 50% of a patient encounter looking directly at the EHR, with the majority of that time spent typing in an office layout that does not allow the patient to remain engaged by screen sharing, according to 2013 research from the Journal of General Practice.

    Next: No more typing, looking at the computer 


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    • Anonymous
      A scribe shouldn't be in the room without patient consent first and foremost. If the patient is there for a physical for example, I'm sure they don't want someone else in the room with them. A scribe in the room will only serve to inhibit the patient so they won't really talk to their physician whereby wasting everyone's time. Not a good idea. Regards, Raffie
    • UBM User
      the authors tell us that emr "promotes quality care by improving provider to provider communication,endorsing pt safety,and promoting pt to pt relationships etc.I have searched high and low for any RCTs that come close to proving this I know that is the intent but other than wishful thinking I ask the authors to show any RCTs that prove this.EMR is are a failure in office practice and are now optional in many countries A nassive waste , burden saves no money and does not improve care except for the bank accounts of vendors ,coders and bureaucrats
    • Anonymous
      Scribes is such a great idea! Who pays for them? Are they reimbursed by insurance companies? Why does my office have to hire a coder to assign special codes for what I do so their insurance company will pay me? Can I get that reimbursed as well? That has nothing to do with medicine. It's just one more overhead/admin item that gets in the way of me treating my patients. Speaking of getting in the way, where will this scribe stand? My exam rooms (I practice in downtown Washington DC where office space is a premium) are already sometimes too tight for the patient and a family member. I feel like so much of the way medicine is heading is not based in practical reality (ie. getting paid based on customer satisfaction). That's like trying to befriend your kid....it's not a popularity contest and often I'm handing down advice my patients do not want to hear or they would already have healthy habits (eat less, stop smoking, move more). Oh well....let's just kick the can for the next generation of doctors and patients to fix, ahem, deal with.

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