Ethics Forum: Electronic Health Records Raise Concerns about Physician-Patient Relationship

A variety of approaches to improving communication while using EHRs has been suggested, starting with informing the patient what you are doing, avoiding computer use when sensitive psychosocial issues are at hand and involving patients in building their charts.⁶ Practical steps can also help, such as learning to type and pointing at the screen.6

Somehow, we must learn how to retain the patient’s narrative, both in the elicitation of the history and its documentation through EHR.⁷ And we need to be available to interact with that narrative, or we risk becoming the equivalent of computers ourselves.

Back to the Patient

After pushing the keyboard aside, you explain what you’re typing on the computer and how electronic health records have the potential to improve care. She seems impressed that your computer can check for drug interactions, a point of particular interest to your patient because her medication list is long. After discussing her newly diagnosed osteoarthritis and available treatment options, she is reassured that “ending up in a wheelchair” is not likely. Your visit is a minute or two longer than you’d aimed for, but your relationship with this patient is back on track.

Elizabeth A. Kitsis, MD, MBE, is director of bioethics education and associate professor of clinical epidemiology and medicine at the Albert Einstein College of Medicine. She is a member of the ACR’s Committee on Ethics and Conflict of Interest.
Robert H. Shmerling, MD, is the clinical chief of rheumatology at Beth Israel Deaconess Medical Center in Boston and the chair of the ACR’s Committee on Ethics and Conflict of Interest.

References

1. Title IV—Health Information Technology for Economic and Clinical Health Act. Waysandmeans.house.gov/media/pdf/110/hit2.pdf.
2. Bernat JL. Ethical and quality pitfalls in electronic health records. Neurology. 2013 Mar 12;80(11):1057–1061.
3. Spriggs M, Arnold MV, Pearce CM, Fry C. Ethical questions must be considered for electronic health records. J Med Ethics. 2012 Sep;38(9):535–539.
4. Saleem JJ, Flanagan ME, Russ AL, et al. You and me and the computer makes three: Variations in exam room use of the electronic health record. J Am Med. Inform Assoc. 2014 Feb;21(e1):e147–e151.
5. Ventres W, Kooienga S, Stewart V. Physicians, patients and the electronic health record: An ethnographic analysis. Ann Fam Med. 2006 Mar-Apr;4(2):124–131.
6. Ventres W, Kooienga S, Marlin R. HRx in the exam room: Tips on patient-centered care. Fam Pract Manag. 2006 Mar;13(3):45–47.
7. Stephens MB, Gimbel RW, Pangaro L. The RIME/EMR scheme: An educational approach to clinical documentation in electronic medical records. Acad Med. 2011 Jan;86(1):11–14.

Editor’s note: For more on EHRs, see Rheuminations, p. 10, and “Electronic Health Record Challenges,” p. 68.