Opinion & Special Articles: Professionalism in neurology

Abstract

Maintaining patient rapport in a world of EMR Health information technology is playing a critical role in fostering more efficient and effective health care systems by improving how information is recorded, organized, and exchanged through the use of electronic medical records (EMR). EMR are defined, according to the International Organization for Standardization, as "repositories of patient data in digital form, stored and exchanged securely, and accessible by multiple authorized users. They contain retrospective, concurrent, and prospective information, and their primary purpose is to support continuing, efficient, and quality integrated healthcare." 1 Meaningful EMR use is being promoted by governments and organizations worldwide as it can improve health care delivery, particularly for people with chronic conditions, whose growing prevalence is the single greatest cause of rising health care spending in developed countries. 2In a recent WHO report, 3 neurologic disorders requiring long-term care cause substantial burdens, which are projected to increase further by 2030. More than half of this burden in disability-adjusted life years (DALYs) is contributed by cerebrovascular disease, Alzheimer and other dementias, epilepsy, and migraines. EMR have been shown to be useful in the management of these diseases 4,5 as they promote better coordination within the health care system. While the promises are compelling, their implementation has increased concerns about lengthened visit time, additional training needs, privacy and confidentiality breaches, and possible negative influence on patient-doctor encounters. These new technologies will inevitably shape patient-doctor communication, and little is known about how this may affect patient-centered care.There is strong evidence that patient-doctor rapport has a direct influence on health outcomes. Effective patient-doctor communication has been associated with multiple benefits. These include patient satisfaction and ability to recollect information, a better understanding of medical conditions, cooperation with treatment plans, physiologic markers (e.g., blood pressure, blood glucose levels), and functional status measure improvement.6 Patient-doctor rapport is considered effective when it leads to the following outcomes: (1) patients disclose enough information about illnesses leading to accurate diagnoses; (2) doctors, in consultation with patients, select medically appropriate treatments acceptable to the patients; (3) patients understand their condition and prescribed treatment regimen; (4) doctors and patients establish positive rapport; (5) patients and doctors are committed to fulfilling their responsibilities during treatment and follow-up care. 7Communication between patients and doctors is typically influenced by sociodemographic characteristics (e.g., sex, ethnicity, education, age) and the environment where the communication takes place (particularly, comfort and cleanliness of the clinic, time allotted for encounters, and the degree of privacy). The use...

Physician and Parent Perspectives on Psychosocial and Emotional Data Entry in the Electronic Medical Record in a Pediatric Setting

“…An EMR could be redesigned to merge the benefits of patient involvement and the information necessary for practicing clinical medicine (37). Our data are consistent with similar studies demonstrating the importance of patient-centered principles in redesigning EMR formats (23,24). However, the optimal mode of redesigning the EMR remains to be seen.…”

“…It has been shown that good physician–patient communication constitutes the heart of medicine (23). Unfortunately, it has also been shown that the EMR may in fact hinder effective communication between patients and physicians (10,11,20).…”

“…Similarly, physicians may value a place for documentation of special considerations due to the movement toward more patient-centered medicine (23,24). …”

Clinically Excellent Use of the Electronic Health Record: Review

“…It is helpful for clinicians to review the record ahead of time to identify interval events and data, and to review the patient’s social history so that communication during the patient visit is more valuable, personalized, and less superfluous [ 10 , 12 , 24 , 25 ]. Clinicians can use the EHR to remind them of current life events of patients, to help personalize the visit and couch discussion of health care issues in the context of their lives [ 26 ].…”

“…Screen sharing is a significant theme in the existing literature, for the promotion of patient engagement, facilitation of communication during the visit, transparency, and patient empowerment and education. It is helpful if clinicians ensure the screen is visible to both the clinician and patient so that they share a “joint focus of attention” [ 2 , 13 , 25 , 30 - 36 ]. It is imperative that the display be large enough for the patient to view.…”