Examination room computers can be a threat to patient safety

There is growing evidence that examination room computers can be a threat to patient safety and detrimental to good relationships and health outcomes, according to industry expert Dr Richard Frankel.

In a commentary published in the November 30 issue of JAMA Internal Medicine, Regenstrief Institute Investigator and Indiana University School of Medicine professor of medicine Dr Frankel, writes that the medical profession can ill afford not to develop and implement patient-centric, exam room computer-use best practices.

He presents POISED, a model he has devised for developing and reinforcing good exam room computer-use by physicians.

POISED stands for:

• Prepare - review electronic medical record before seeing patient.
• Orient - spend one to two minutes in dialogue with the patient explaining how the computer will be used during the appointment.
• Information gathering --don't put off data entry as patients may question how seriously their concerns are being taken if physician does not enter information gleaned from patient into computer from time to time.
• Share - turn the computer screen so patients can see what has been typed signaling partnership and also serving as a way to check that what is being entered is what was said or meant.
• Educate - show a graphic representation on the computer screen of information over time, such as patient's weight, blood pressure or blood glucose, so it can become a basis for conversation reinforcing good health habits or talking about how to improve them.
• Debrief - exam room computers provide an ideal opportunity to use a 'teach back' or 'talk back' format for the doctor to assess the degree to which recommendations are understood by the patient and correct as necessary.

"Being POISED for examination room computer-use need not cost additional visit time. Used well, just the opposite is true," Dr Frankel's commentary concluded. "Medicine is fundamentally a human enterprise that is still practiced one conversation at a time. Our challenge is to find the best ways to incorporate computers [as care process partners] in the examination room without losing the heart and soul of medicine, the physician-patient relationship."