Electronic Communication Doctors - Patients - Computers - Learners

Electronic Communication

Doctors - Patients - Computers - Learners

Janet Hamstra, Ed.D.. Nova Southeastern University 

College of Osteopathic Medicine

Objectives

j

The learner will be able to: The learner will be able to:

• _{Describe the impact of the EMR on physician} 

– patient communication in the exam room

• Identify skills for including the computer

• Identify skills for including the computer 

during the clinical encounter

• Describe how electronic communication can 

hinder and enhance communication in 

Are you experienced with

A di

R

S

?

Audience Response Systems?

1. No, not at all

2 Yes only as audience

2. Yes, only as audience 

member

3 Y l t

3. Yes, only as presenter

4. Yes, both as audience 

at al l

s a... s p... s a... nte...

0% 0% 0% 0% 0%

member and presenter

5. Yes, I invented ARS!

 No,  not  at  Yes,  only  as   Yes,  only  as p  Yes,  both  as   Yes,  I inve nt

Where have you used ARS most?

Where have you used ARS most?

1. Hospital

2. Clinic/Ambulatory Setting

3. COM

3. COM

4. Conference… like an OME 

Leadership Conference perhaps Leadership Conference perhaps 5. More than one of the 

above Hospi tal bula t...  CO M ce…  li... one  ... erpl a... 0% 0% 0% 0% 0% 0% above

6. Some other place, I’d 

rather not sa  Ho  Clin ic/Am bu  Conf erence  Mo re th an o  Some  oth er 

Who is in the audience?

(select your “top” title) (select your top title)

1. AOA Senior Leader/Staff

2 AACOM Senior Leader/Staff 2. AACOM Senior Leader/Staff 3. COM Dean/Administrator 4 COM Faculty/Staff 4. COM Faculty/Staff 5. OPTI Leader/Staff 6 Hospital DME 6. Hospital DME

7. Residency Program Director 8 R id P r Lea ... ior L.. . dmin ... ty/St ... er/St ... al DM E Prog. .. Prog. .. Stude ... he ab ... 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 8. Residency Program  Faculty/Staff 9 R id t/St d t  AO A Se nior  L  AACOM  Senio  COM  Dean /Adm  CO M Fa culty  OPT I Lead er/  Hos pital  Resid ency  P  Resid ency  P  Res iden t/Stu  None  of the 9. Resident/Student 10. None of the above

OME Leadership Conference

A

d

?

Attendance?

1. 1st _{time attendee} 2. 2nd_, 3rd_, or 4th _time 3. 5th – 10th time 3. 5 10 time

4. More than 10 times

5 All 22 f th ! tten ... or 4. .. htim ... 10 t.. . hem. .. 0% 0% 0% 0% 0% 5. All 22 of them!  1st  tim e att  2nd,  3rd,  o  5th  – 10 th t  Mo re th an 1  All  22 of  the

Objective #1

Objective #1

Describe the impact of the EMR on 

physician – patient communication

physician  patient communication

EMR Impact on

C

i

i

Communication

• Computers impact visual, verbal, postural 

i i h i

connections with patients.

• Baseline skills are carried forward and amplified

iti l ti l

– _{positively or negatively}

Frankel R., et. al. Effects of exam-room computing on clinician-patient communication: A longitudinal qualitative study. J Gen Int Med. 2005;20(8):677-82.

EMR Impact on

C

i

i

Communication

Facilitates or inhibits ‐

• _{Visit organizationVisit organization}

• _{Verbal, nonverbal behavior}

• Computer navigation, mastery

E ti l i ti

• _{Exam room spatial organization}

Frankel R., et. al. Effects of exam-room computing on clinician-patient communication: A longitudinal qualitative study. J Gen Int Med. 2005;20(8):677-82.

EMR Impact on

P i

S i f

i

Patient Satisfaction

↑

ll f h i i

↑

overall patient satisfaction with visits

↑

physicians’ familiarity with patients

↑

communication about medical issues

↑

comprehension of decisions made

↑

comprehension of decisions made

• _{No change in perception of visit time} • _{No change in perception of visit time}

• _{Patients felt computer helped visit efficiency}

Hsu J et.al. Health information technology and physician-patient interactions: Impact of computers on communication during outpatient primary care visits. J Am Med Inform Assoc. 2005;12(4):474-80.

EMR Impact on

f

Patient Satisfaction

• 74.6% felt computer had overall positive 

impact on quality of care impact on quality of care

• _{Positive association between patient} 

satisfaction and their rating of physician 

computer skills

Garrison GM, et al. 21st-century health care: The effect of computer use by physician on patient satisfaction at a family medicine clinic. Fam Med. 2002;34(5):362-8.

EMR and

Cli i i

P

i

S l

Clinician Practice Styles

3 Clinician Practice Styles Related to EMR Use:

• _{Informational}

• _{Interpersonal}

• _{Interpersonal}

• Managerial

Do you have EMR where you

i

di i

?

practice medicine?

1. Yes, every place I 

practice practice

2. Some places but not 

ll f th all of them 3. Not at all y pla. .. es bu ... t at  all a cli ... 0% 0% 0% 0% 4. NA ‐ Not a clinician  Yes,  eve ry   Some  plac es  No t   NA  ‐ No t a

Do you use EMR in the exam

i h h

i

?

rooms with the patient present?

1. Yes, all the time

2 Yes some of the time

2. Yes, some of the time

3. No, prefer to use it when 

patient isn’t present

patient isn t present 

4. I don’t use EMR and/or am 

li i i he t.. . of t... to ... EM. .. 0% 0% 0% 0% not a clinician  Yes , all  the  Yes,  som e of  No,  prefer  t  I don ’t us e E

Objective #2

Objective #2

Identify skills for 

including the computer 

EMR and

EMR and

Patient Communication

From Dyad to Triad

From Dyad to Triad

Maintain eye contact

with the patient

How do you really feel about

EMR?

EMR?

1. Love it – best thing to 

happen to medicine happen to medicine

2. It’s OK – I can take it 

or leave it or leave it

3. Hate it – worst thing 

t h t di i best... _{– I} ca ... wors.. . t hav ... 0% 0% 0% 0% to happen to medicine 4. NA – don’t have it or   Love  it –  b  It’s  OK  –   Hate  it –  w  NA  – do n’t h not a clinician

Do your LEVEL Best

Do your LEVEL Best…

L

t th ti t l k

L

et the patient look on

E

ye contact with the patient

E

ye contact with the patient

V

alue the computer as a tool

V

alue the computer as a tool

E

xplainp  what youy  are doingg

L

og off and say you are doing so

Switching

 

Gears

Gears

Objective #3

Objective #3

Describe how  electronic communication electronic communication  can 

hinder and enhance communication hinder and enhance communication 

To what generation do you

b

l

?

best relate?

1. Traditionalists (1922‐1945) 2. Baby Boomers  (1946‐1965) ( ) 3. Generation X  (1965‐1976) nalis t... mers  (... on X  (... on Y  (... 0% 0% 0% 0% (1965 1976) 4. Generation Y  (1977 1995)  Tra ditio na  Baby  Boome  Gene ration  Gene ratio n (1977‐1995)

To whom

d

do you

best relate?

To whom do you best relate?

To whom do you best relate?

1. Andrew Taylor Still

2 Marcus Welby 2. Marcus Welby 3. Doogie Howser 4. Gray’s Anatomy 5. House A.T.  Still s We lby How ser Anat omy  House heab ove 0% 0% 0% 0% 0% 0%

6. None of the above

 A  Marc us   Doog ie H  Gray ’s An  None  of th e 

To what technology

d

b

l

Keeping up with Change

Keeping up with Change

For medical education to flourish from one 

generation to the next, it has to reconfigure 

itself in response to changing scientific, social, 

and economic circumstances.

Medical Education Paradigm

for Millenniums

for Millenniums

• Learn About One

• See One

• Simulate One 

D E h U d Di t

• See One

• Do One

• Do Enough Under Direct 

Supervision to Demonstrate 

Competence and Confidence

• Teach One

Competence and Confidence

• Do Enough Under Indirect 

S i i

Supervision

• Be Taught to Teach One

• Teach One

Electronic Communication

i OME

Words of Advice

Words of Advice

• FormalFormal instructioninstruction and assessment and assessment onon 

communication  

Teach/Model “Triad” communication

– Teach/Model  Triad  communication

Words of Advice

Words of Advice

• Communicate about electronic communication

Social media policy

– Social media policy

– _{Electronic communication policy} – _{Generational idiosyncrasiesy}

D

LEVEL b t

Do your LEVEL best

Thank You!

Thank You!

Janet Hamstra, Ed.D.

hamstra@nova edu [email protected]