Letting Go of The Screen (My 15-year Journey with an EMR)

(From the October 2018 Issue of MedStat)

Primary Care Matters is a guest column written for MedStat by a local pediatrician or primary care provider.

Written by William W. Long, MD, FAAP, Pediatric Associates, Inc.

Dr. Long is a pediatrician and has been at Pediatric Associates, Inc. for more than 26 years and has been on the medical staff since 1992. He went to medical school at West Virginia University School of Medicine. He completed his residency and chief resident year at Nationwide Children’s Hospital.

William W. Long, MD, FAAP

When our practice first “went live” with electronic medical records in 2003, my fellow physicians compared the process to two other important events from that year.  Some compared it to the completion of the human genome project, while others compared it to the massive Allied air strikes on the country of Iraq.  It was a painful transition for a group that had many cumulative years of documenting on paper. 

As a physician who learned how to document on paper, sharing my physician/patient relationship with a computer screen was initially not comfortable for me. 

After the initial transition from paper was over, and the electronic chart was populated with all of this excellent data, I relished in having the information at my fingertips.  A slight touch of the screen or a click of the mouse, and I was omniscient—yes ma’am the head circumference percentile was 57% and yes that prescription was refilled last week, and no you did not have strep throat at that visit three years ago.  I was a wizard.

But, my “superpower” also came with a price.  The computer competed for my attention.  I often could not resist the urge to multi-task, and I would handle staff messages, or refills for other patients, while a patient or parent was talking to me about some minor detail.  This multi-tasking caused mental fatigue and distraction.  Instead of the Wizard of Oz, I felt more like “that man behind the curtain,” furiously pushing levers, clicking left and right, with my eyes darting in many places—only some of which were the faces of my patients.

With much self-discipline work (and a few patient complaints), I gradually got better, but not entirely.  We changed EMR products.  We changed offices.  I had other responsibilities in the practice that caused me to continue to be distracted when the screen was in front of me.  On my first attempt at not documenting in the room, the screen then became a barrier at my desk, and at home, when I would finish my charting.  Sleep hygiene suffered as well.

Then, I decided that I needed to be like the two-year-old who had to be removed from his pacifier.  I left the patient’s chart outside at my workstation.  I gradually worked out a new rhythm.  I changed my workflow.  Now, I do a chart review of key items before I walk in the room.  I discuss those key items first (so I don’t forget them later).  Yes, I make sticky notes sometimes—just in case.  And yes, I occasionally do have to excuse myself to go recheck something.  It gets harder if I’m running behind. 

I now use my computer “boot up” time to practice mindfulness.  I enter the exam room with a free hand to greet the parent, or the patient.  I feel happier.  I sense my patients do too.  At least (so far) I’ve not received a complaint from a family because I didn’t have the computer in the room.  A few enhancements also are helpful.  Parents now have the ability to update histories, and do developmental screenings online, which I can also review and document before seeing the patient.   

I’m not completely screen-free in the exam room.  I take it with me for patients with complex health care needs, siblings who have multiple and varied problems, and when I need to review histories in greater detail.  When I do bring the computer in a room with me, I try to apologize in advance.  And I still fight the urge to multi-task. 

Being the best medical home provider for a patient involves two basic tenets.  The first is your relationship with your patient and family.  The EMR and the devices could jeopardize that relationship.  The second tenet is being able to KNOW your patient—her/his past history and everything that has happened to him/her.  The EMR can enhance that relationship. 

It is a balance that we all have to work out.  And each of us may have different solutions.

Thankfully, I am still learning new lessons.  And my colleagues and patients continue to teach me.  I hope someday my EMR is a flexible screen, strapped on my wrist like an NFL quarterback, and it turns on/off with a flick of the wrist.  Until then, I guess I’ll keep learning as I go through the process of relating to patients, and knowing them better, with my permanent (but now more “silent”) partner—the electronic screen.

What solutions or workflows have worked well for you?  Feel free to drop me a line or we can share in discussion on our Facebook Group, “NCH Primary Care Connection.”

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