Patient centered care and the electronic medical record

On a recent trip to hospital with a family member I happened to be present on the day before the introduction of a new electronic medical record (EMR) system. The system was about to ‘go live’ in less than 24hrs and the anxiety was palpable. Everyone appeared to be nervous and unsure about what this would mean for them and, ultimately, their patients. Staff had already undergone numerous hours of training in using the system.  They were expecting the usual teething problems that generally accompany hospital-wide introduction of new systems involving technology.   There was clearly concern about the extra  time it would take for staff to carry out their ‘usual’ activities around documenting patient care, at least initially. But it was a concern about how the new computer system could impact on patient-provider communication that really got me thinking.

One of the doctors shared with me that he was concerned about how it would affect his ability to engage effectively with patients. He suspected that it would be difficult to give patients the ‘face to face’ time they need while simultaneously being required to focus on the computer screen. He was already anticipating the physical barrier between patients and providers as the needs of the computer system took control over the consultation.  I could certainly appreciate his point of view. Recently I have observed a number of medical consultations where the provider spent more time looking at the computer or typing patient responses,  than actually communicating with the patient, actively listening and assessing non-verbal communication.

While we work so hard to put control into the hands of patients through strategies that promote patient-centered care we are still at risk of impairing our communication with patients if we do not use health information technology  wisely. The EMR has the potential to support us to better personalize care and to truly improve patient engagement. It has the capacity to support patients with evidence-based information, promote consistency in the use of clinical guidelines and to improve co-ordination of care.1-3 However this depends on the way it is implemented and so far the education of healthcare providers has not caught up to the computer age. When we teach communication we still teach it as if there are no computers or EMRs present. In adopting EMRs we need to ensure that the patient –provider relationship is not lost in the wave of progress.  We need to acknowledge the physical barriers that computers can create and the change that is needed beyond learning about the program. We need to learn new ways to stay connected to our patients even in the age of greater connectivity through IT systems.

Allison Shorten RN RM PhD

Yale University School of Nursing



1. Terry A, Giles G, Brown JB, Thind A, Stewart M. (2009)Adoption of electronic medical records in family practice: the providers’ perspective. Fam Med; 41(7):508-12.

2. Gill J. (2009) EMRs for improving quality of care: promise and pitfalls.  Fam Med 2009;41(7):513-5.)

3.Ventres W, and Frankel  R. (2010)Patient-centered Care and Electronic Health Records: It’s Still About the Relationship, Fam Med;42(5):364-6

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