Headline Goes Here

1. Headline Goes Here Electronic Medical Record Point of Care Documentation: Impacts on Clinician-Patient Interaction

2. “Knowing the Patient” • “Knowing the patient” is • Central to quality patient care • Important to clinicians and patients • Establishing the clinician-patient relationship • Face-to-face healthcare • Continued patient contact • Collaboration among clinicians

3. Emergence of Technology • Changing the delivery of patient care • Supports the concept of “knowing the patient” • Enables clinician to better know the patient • Improves clinician-patient satisfaction • Establishes clinician-patient relationships • Increases face-to-face patient contact • Facilitates collaboration among clinicians

4. Point of Care Documentation • Benefits • Reduces inefficiencies • Increases patient safety • Decreases the probability of errors • Promotes information transfer • Encourages more time at the bedside • Challenges • Alienates patient • Distracts clinician focus • Decreases visual and verbal interaction

5. Evidence: Patient Care Study Objective: Assess clinicians’ visual and verbal interactions with patients Participants: Registered Nurses in an acute care hospital setting Method: Two groups- paper and electronic documentation (EMR) during the admission process

6. Evidence: Patient Care Study Results: Nurses using EMR Point of Care (POC) documentation had: • longer patient encounters BUT • 50% less visual and verbal interactions Conclusion: • Further research is needed • Indentify strategies to increase benefits of electronic documentation without nurse/patient barriers

7. Patient Perspectives • Dissatisfaction with “troubling” new clinician behavior • Little or no eye contact • Computer the focus, not the patient • Multitasking while patients talk about concerns • Patients sit idly and silently • “Leading” interviewing

8. Best Practice Recommendations • Integrate EMR POC documentation with patient-centered habits to best fit the social, emotional and medical needs • Use mobile computer monitors. • Learn to type. • Integrate typing around the patient’s needs. • Reserve templates for documentation. • Separate routine data entry and health maintenance from patient encounters.

9. Best Practice Recommendations (cont’d) • Start with the patient’s concerns. • Inform the patient what you are doing as you are doing it. • Point to the screen and engage the patient in dialogue. • Encourage patient participation in building their charts (“nothing about me without me”). • Look at the patient and maintain eye contact and positive body language.

10. Summary • Technology shifts healthcare delivery to a collaborative model • Adaption on the part of the clinician AND patient is key • Start with patient concerns, telling them what you are doing and encouraging them to help build their charts and records • Patient encounters improve with the integration of electronic documentation with mindful patient-centered habits

11. References • Duffy, WJ (2010). Point of Care Documentation Impact on the Nurse-Patient Interaction. Nurse Administration Quarterly, Vol. 34 (10), pp. E1-E10. • Macdonald, M (2008). Technology and Its Effect on Knowing the Patient: A Clinical Issue Analysis. Clinical Nurse Specialist, Vol. 22 (3), pp. 149 – 155. • Ventres, W (2006). EHRs in the Exam Room: Tips on Patient-Centered Care. Family Practice Management, March 2006, pp. 45-47. http://www.aafp.org/fpm