Electronic Health Records: Are they helping or hurting?

Technological development has led to both major medical breakthroughs and improvement in quality of life for patients on the receiving-end of new therapeutic interventions. One major medical advancement, though not necessarily the first that comes to mind, includes electronic medical or health records. Electronic medical (EMR) or health records (EHR) not only make the recordkeeping itself easier, but also allow for more efficient use of the information stored in these systems. Furthermore, by using EMR or EHR, doctors are able to communicate with both their patients and colleagues more conveniently. Accessibility to patients' past medical histories is a key tool present in EHRs and EMRs, especially as rapid access proves imperative in cases of emergency. Unfortunately, although EMRs have brought convenience to several different processes within the healthcare space, they have also been criticized for their negative effect on several elements of medical practice.


For example, EHRs put a strain on non-verbal communication during consultations, as physicians tend to make less eye contact with their patients. This has been shown to hinder engagement and productive conversation between patient and provider [2,3]. Reduced engagement has the potential to cause further downstream effects, as patients may be discouraged to take initiative when addressing medical concerns.


Moreover, there are issues concerning patient privacy and confidentiality in health records and medical histories. Patients are concerned with the accuracy of this information, as it is not easy to change errors that physicians or other health care providers make [6]. Some individuals have expressed the desire to have more control over their records via the ability to fix incorrect information or remove information they feel uncomfortable sharing with future healthcare professionals in their care network. Other patients are concerned that different health care providers can contribute to shared files, as this often creates discrepancies within their medical information. In this case, patients frequently have to answer the same set of questions when interacting with different health care providers, which further affects the patient-provider interactional experience. Another flaw with EHRs is that they lack a “collection of psychosocial and emotional information” [5]. Without complete access to information on the patients’ mental health and social well-being, physicians are not able to provide the individualized attention that their patients need. This disconnect may lower the quality of the time that they spend together, with significant impacts on a patients’ desire to continue seeking care and addressing their health concerns.


Furthermore, EHRs are one of the most commonly-cited burdens among physicians. For healthcare providers, documenting in EHRs is one of the leading reasons for burnout at work [4]. This is due to the fact that they often have to document these records after work hours. Such mental and emotional challenges can further increase dissatisfaction and lead to greater difficulties in showing up as authentic care providers.


On a hopeful note, there are many ways in which health care providers can use EMRs or EHRs to their benefit while interacting with their patients. For example, there are specific “gaze patterns'' that allow the patients to be more engaged and feel involved in the conversation. These patterns include patients looking at their EHRs, then doctors making eye contact with their patients, and vice versa [1,3]. This type of non-verbal communication is as crucial for the interaction as is verbal communication. The use of scribes can also lessen the burden on physicians and other health care providers when documenting in EHRs or EMRs [4].


In summary, while there are negative elements of EHRs and EMRs, use of these systems as “bridges rather than dividers” may enhance patient-provider interaction while holding on to the efficiency and convenience of common healthcare technologies.


References


1. Alkureishi, M. A., Lee, W. W., Lyons, M., Press, V. G., Imam, S., NkansahAmankra, A., Werner, D., & Arora, V. M. (2016). Impact of Electronic Medical Record Use on the Patient–Doctor Relationship and Communication: A Systematic Review. Journal of General Internal Medicine, 31(5), 548–560. https://doi.org/10.1007/s11606-015-3582-1


2. Asan, O., Smith, P. D., & Montague, E. (2014). More screen time, less face time - Implications for EHR design. Journal of Evaluation in Clinical Practice, 20(6), 896–901. https://doi.org/10.1111/jep.12182


3. Asan, O., Young, H. N., Chewning, B., & Montague, E. (2015). How physician electronic health record screen sharing affects patient and doctor nonverbal communication in primary care. Patient Education and Counseling, 98(3), 310–316. https://doi.org/10.1016/j.pec.2014.11.024 .


4. Lam, C., Shumaker, K., Butt, M., Leiphart, P., Miller, J. J., & Anderson, B. E. (2022). Impact of medical scribes on physician and patient satisfaction in dermatology. Archives of Dermatological Research: Founded in 1869 as Archiv Für Dermatologie Und Syphilis, 314(1), 71–76. https://doi.org/10.1007/s00403-021-02206-1


5. Rathert, C., Mittler, J. N., Banerjee, S., & McDaniel, J. (2017). Patientcentered communication in the era of electronic health records: What does the evidence say? Patient Education and Counseling, 100(1), 50–64. https://doi.org/10.1016/j.pec.2016.07.031


6. Sanyer, O., Butler, J. M., Fortenberry, K., Webb-Allen, T., & Ose, D. (2021). Information sharing via electronic health records in team-based care: the patient perspective. Family Practice, 38(4), 468–472. https://doi.org/10.1093/fampra/cmaa145


7. Totzkay, D., Silk, K. J., & Sheff, S. E. (2017). The effect of electronic health record use and patient-centered communication on cancer screening behavior: An analysis of the Health Information National Trends Survey. Journal of Health Communication, 22(7), 554–561. https://doi.org/10.1080/10810730.2017.1338801


8. Zubrzycki, C. M. (2021). Privacy from Doctors. Yale Law & Policy Review, 39(2), 526–592.

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