Focus: Patients and the EHR
Former President George W. Bush called for the widespread use of electronic health records (EHRs) by 2014. With that date fast approaching, many hospitals and medical practices have now implemented some form of EHR system. On-the-floor use of these systems offers some important lessons learned about the utilization of this technology during doctor-patient encounters.
For this special section, Healthcare Informatics spoke with two clinicians-a pediatrician and an emergency medicine physician-to learn more about how EHRs are being used and what patients think about their adoption. Dr. Anthony Luberti discusses his experiences with a recently implemented enterprise-wide EHR system at the Children's Hospital of Philadelphia, where he is a pediatrician and medical director of the Informatics Education Program in the Center for Biomedical Informatics. Dr. Manisha Gupta, an emergency medicine physician and partner at Questcare Partners, who practices at the Denton Regional Medical Center in Denton, Texas, offers insights into how using EHRs has improved her ability to diagnose patients.
Healthcare Informatics: The Children's Hospital of Philadelphia (CHOP) recently implemented an enterprise-wide EPIC electronic health record (EHR) system. How were you trained to use the system?
Anthony Luberti, M.D.: For our recent inpatient EHR implementation, we went through anywhere from five to eight hours of classroom training and we had e-Learning modules as a pre-cursor to that. For our ambulatory centers, we quickly learned that the more exposure the physicians and nurses had prior to going live, the better. We gave them access to the system and allowed them to abstract key data elements from paper charts to the EHRs. That gave them great hands-on practice so they were comfortable with the system before they had to use it with a patient. But, honestly, the real learning comes once you use the EHR in the exam room with the patient.
HCI: What kind of support did you have to assist that on-the-ground learning?
Luberti: We had a huge support team of what we called ‘clinician champions.’ They were on the inpatient floors and in the outpatient clinics. They were there to both support and teach our doctors how to best use the system. CHOP understood that you can't teach everything in a classroom environment and that made all the difference.
HCI: What was your initial reaction to the EHR system?
Luberti: There's always some hesitancy. Is the patient going to accept a computer in the exam room? Understand that I'm new to this, too. Will the computer get in the way of my relationship with the patient? But I quickly learned that if I engaged the patient directly and the more I incorporated the EHR into my interactions with the patient and family, the smoother it went.
HCI: How do the patients and their families feel about it?
Luberti: They love it. Many have commented that they feel more confident in the care we deliver because they know all the information we need is in that computer. In general, the feedback has been very positive. There have been the occasional concerns about the security of patient information, of course. And some parents worry that doctors pay more attention to the computer than to their child.
To make sure EHRs are meeting our needs and the needs of our patients, clinicians need to be their own advocates. - Anthony Luberti, M.D.
HCI: How do you address those concerns?
Luberti: I think it's important to have a conversation with the families and let them know that only appropriate personnel have access to that information and there are systems in place to protect it. Once the issue is addressed directly, I find patients feel much better.
In terms of where a doctor focuses, I think this is an area where our ‘clinician champions’ were a big help. We could shadow physicians and offer advice on how they can use the computer and still remain focused on the patient. Maybe you need to rearrange some of the furniture in the exam room so you can keep your line of vision on the patient. Maybe you need to start typing after you've finished talking with the patient. But, with practice, you can learn techniques to make the EHR something that actually helps you engage more with the patient, not less.
HCI: Are patients currently using your EHR, too?
Luberti: We've implemented a patient portal in just the past year. It doesn't provide access to the entire EHR, but it's a place where parents can see lab results, problems, allergies, and immunization records. They can, for example, print out their child's immunization record. The feedback has only been positive.
HCI: What are the challenges of having an EHR system in pediatrics-where you have both patients and parents as clients?
Luberti: It's tough when you have that additional party in there. The patient portal is relatively easy when you are talking about a young child. Only the parent will have access. But for our adolescent patients, there may be pieces of information that should only be shared between the patient and the physician. It's a challenge and we're still working to find the right technical and policy solutions to make sure that only the right people have access to certain information.
HCI: What do you think the future will bring for patients and EHRs?