I have had several hospitalizations over the last several years and being a nurse my experience from the patient side has been eye opening and enlightening. I have been witness to, as a patient, the gradual integration of electronic medical records (EMR) into health care both in the clinic and the hospital setting. Aside from the obvious struggles and frustrations presented with the integration of going paperless my hospital bed provided an unusual view and it's been integral in forming my opinion of EMR and how it's impacted care from a patient perspective.
As a nurse, I am able to appreciate the complexities and challenges such a change poses. What's often meant to make things easier and safer can seem to just add extra work to an already increased patient load. When I started nursing in 1983, what the nurse did involved all the activities that are now delegated to nurses aides and medical assistants. I used to take vitals, give baths, make beds and pass meal trays. There were no nurses aides to take vitals and help patients to the bathroom. The patient care model has definitely changed over the last 30 years, for the better, I might add. This integration of EMR is different. It impacts all the people on the healthcare delivery team, including physicians. As a patient, it has proven to be a problematic distraction. At first it was only the pharmaceuticals that were converted to the EMR system. I would joke, as the patient, that I felt like an item in the grocery store as my wrist band was scanned before each administration of pain medication or change out of IV fluids occurred. It became less humorous when I had to be awakened in the middle of the night because I was sleeping in such a position that they couldn't access my bracelet with the little handheld laser scanner attached by a curly rubber cord to a rolling brightly glowing nurses computer. Not funny at 2 AM. Regardless, I felt it more a minor nuisance than anything else.
It was with the addition of fully integrated EMR that I started to feel, let's say, like a third wheel in the room. All of a sudden I felt like I was a subject and not a patient. Caregiver's eyes became locked on a screen as questions were asked into the air of an exam suite or hospital room. Ears listened as fingers grazed keyboards with fast intense strokes. I felt almost like an after thought or an inconvenience to the work at hand as med lists were reviewed and perhaps altered to reflect any mentioned changes. "Having any pain?" Point. Click. Little regard for the answer given yes, or no. It didn't seem to matter as much as filling in the blank presented on the monitor. I started feeling slighted as the patient and unheard.
Have you ever talked to someone who is focused on something else and really isn't "listening" to what you say. Many people do that with their smart phones. I am guilty of it. My spouse is talking to me whilst my eyes and attention are glued to my Facebook account and my thoughts are truly elsewhere. I've told my kids many times "Put your phone down a second and listen! Look into my eyes so I know you are hearing me!" In this high tech, super "connected" world we live in this is happening more and more. I call it living together, alone.
Awareness of the effects that EMR can have on the interaction with patients is crucial to avoiding potential disconnection with the real, living subject matter. EMR is a part of the healthcare landscape and is important to efficiency and safety. But EMR is not the job. The job is patient care. Healthcare providers need to look up from the computer and into patient's eyes. Lift caring fingers from keyboards to provide the human touch. Take time to listen undistracted by glowing screens and be fully present. Documentation modalities will forever evolve and change but the need for connection between healthcare workers and patients? That's timeless!