Electronic Health Records (EHRs) in the oncology clinic: how clinician interaction with EHRs can improve communication with the patient.

Interacting with computers in the clinic can feel like a burden, or even a barrier to important interpersonal aspects of patient care. Similar barriers can be posed by other electronic devices used in patient care, such as tablets, smartphones, or PDAs. Despite the expectation that such devices might improve the quality of care, electronic health record (EHR) systems in particular generally have complex, cumbersome computer interfaces that demand much attention and many keystrokes during a clinical encounter.1 Coupled with increasing documentation requirements and “meaningful use” initiatives, EHRs can be a time sink in a busy clinic. EHRs pose a particularly difficult problem in the oncology clinic, where emotionally difficult topics are often addressed, requiring sufficient time and attention; in this setting, the computer can feel particularly obtrusive and distracting. Patients and clinicians alike express frustration about these issues publicly. A recent report in the lay press describes the phenomenon of “distracted doctors” who are so busy interacting with computer screens that they fail to make eye contact with their patients.2 Similarly, clinicians write that EHRs interfere with their ability to attend to the patient as a person.3,4 On the other hand, although patients may not like distracted doctors,5 they seem to be excited about the prospects of EHRs. In a recent national survey, 41% of patients said that they would consider changing clinicians just to gain online access to their medical records.6 Regardless of this tension, one thing is certain: the EHR in the examination room is here to stay. Our goal here is thus to provide evidence-based suggestions to help busy clinicians integrate the EHR into their workflow in a way that is constructive for communication and the patient-clinician relationship in oncology. We recognize that not all EHRs are created equal, and that some may impose additional barriers. However, we contend that even a “perfect” EHR can be disruptive to patientclinician communication, especially without conscious attention to how one interacts with it in the examination room. With careful attention, the EHR might actually enhance patientclinician communication, even on a busy day. Here we will highlight relevant data on EHRs and then make specific recommendations for how clinicians can successfully integrate the EHR into a clinic visit. EHRs in the Primary Care Clinic: What We Know So Far