iPatient- Who is the real patient? The person or the EHR representation of the patient? The electronic medical record has revolutionalized health care, but has it devalued the patient? While technology has improved access to data, some feel the focus is being shifted away from the actual patient and onto the computer representation of the patient. (1) Documenting in the EHR is a time consuming process, and unfortunately, time spent documenting is time taken away from direct patient care. This is evident in both physician and nursing practice.
In his article Culture Shock — Patient as Icon, Icon as Patient, Abraham Verghese, M.D. feels that the EHR is a detriment to the training of resident physicians. The history and physical exam have long been taught to be the key to diagnosis. However, with so much information on the computer, focus is placed on reviewing data, ordering more tests and consults, at the expense of the bedside exam. He believes that the traditional doctor-patient relationship has been significantly altered by the computer. (2) According to a study by Susan P. Kossman, RN, PhD nurses felt that they had less time to spend on direct patient care, and although they used of portable computers on wheels, they still felt it distanced them from patients. Nurses reported that they wanted to look at their patients and not at the computer screen and felt rushed to complete proper documentation. (3) Spending more work time using EHRs left nurses feeling they had less time to spend on patient care. Nurses could use portable computers on wheels at the patient’s bedside, but felt it distanced them from patients.
What about patients? They do enjoy having their records available on the computer, and not having to recall all of their medications. Where I work, surveys are sent to patients and one of the questions asked is “Did the doctor know your past medical history?” It is important for the physician to know the history, but it is also the patient’s responsibility to take ownership of their medical problems and medications. Too often I ask patient what medications they take and the answer is “It’s in the computer” Little do they know that almost EVERY medication they have been prescribed is in the computer, and it is not always obvious what they are taking. Still, it beats the answer of “I take the little blue pills.”
iPatient-information about the patient that is stored electronically, scans, images, history, problem list, medications, allergies, etc. According to a blog on HL7 Standards, by John Merz, an iPatient is:
- Integrated into our health care system.
- Interconnected with the health community.
- Independent in maintaining our own health.
- Informed by the physicians and clinicians we meet and by the research we do on ways to stay and be healthy.
- Interactive with physicians and clinicians.
What an iPatient is not:
- Ignorant in what it takes to live a healthy lifestyle or how to engage our health care system.
- Indifferent to maintaining our health.
- Isolated from the physicians or clinicians.
- Impersonal in knowing our primary care physician or other key providers.
- Impetuous in our health.
Is the iPatient a good thing? Yes as long as we do not forget that the human being is the REAL patient. The patients appreciate the EHR but they still value the personal touch.
3. Kossman SP, Scheidenhelm SL. Perceptions of Impact of Electronic Health Records on Nurses’ Work. Comput Inform Nurs 2008; Mar-Apr 26(2):69-77.
Submitted by (Barbara Blasko, MD)