Yes. However, the emergence of internet technology, mobile communications and the pressure on healthcare to migrate to electronic health records are presenting some patient safety and professional liability challenges. Please keep the following DOs and DON'Ts in mind when introducing or using technology in your practice.
- DO recognize that not everyone has the same level of technological aptitude
Today, the likelihood of encountering one who is not familiar with internet or mobile technologies is diminishing. However, there still exists a chasm between those who are "power users" of technology and those who are just learning the basics. It is critical that users of technology establish ground-rules for preferred communication methods. Suppose you still prefer to communicate in person or over the phone but your office staffer is inclined to communicate with you using text messaging; nuances present in face-to-face or voice communication may be lost. By establishing preferred methods of communication for various purposes, you may be able to circumvent miscommunication. E.g. text messaging is useful for information that does not require detail or response (and NEVER for patient information), while in person (voice or face) is better suited for communicating sensitive information or providing details that cannot be explained in a few words.
- DON'T forget about Privacy, Confidentiality & HIPAA
The term "friends" has taken on a whole new meaning with the advent of social networking websites. Regardless of features such as "privacy settings," users of these sites must understand that the internet is a public forum; anything sent, posted or received using the internet is available to anyone with the tools to obtain it. As generation X, Y and the "millennials" increase in numbers in professional practice, it is crucial to set expectations about what information may or may not be shared using social media websites. What may be acceptable information to share about one's personal life may be devastating to professional practice. Don't wait to find out the hard way - develop guidelines for appropriate use and educate your staff/residents.
- DO protect against information that may be lost in translation
Migration of paper-based records to an electronic format has potential benefits for patients, but during the transition from a paper-based system to an electronic one there exists a temporal window for error. Some forms hand-written or drawn today will not be easily replicated on a digital plane and may require scanning, which will take the information out of the record for a period of time. Establish contingency plans for any form or diagram that you currently complete on paper before implementing an electronic system and request assistance from medical records or risk management, if you have concerns.
- DO understand that an EHR contains pages and pages of material
Use of a centralized electronic health record will allow clinicians the ability to access a patient's entire medical history (well, that entered into the system). It is possible to miss critical details in an electronic record when they are buried in pages of text with non-essential information. Ask your EMR vendor to assist you in creating flagging and triggering mechanisms whereby you may highlight sections of the record for easy reference in the future. Work with your vendor to develop a toolkit that will allow you to flag items for follow-up or create triggering event to mark important dates, milestones or necessary precautions. Avoid "alert fatigue" by prioritizing the alert functionality to only critical alerts, so that your staff is not inundated with pop-ups and eventually desensitized.
- DON'T assume that all systems are compatible
Ensure that the EMR system you implement is compatible with other systems you frequently interface with, like the hospital or offices of a colleague and make a plan for those that you know are not.
- DO practice entering data into the EMR system while pausing to interact with the patient
One of the complaints patients have voiced regarding interactions with their physicians now using EMR systems is that the physician seems "disinterested" or "cold." This is no doubt a result of trying to manage typing on-screen while still maintaining a conversation with the patient. Technologies exist that allow you to speak into a small microphone while interacting with a patient and then convert your spoken words into text to be reviewed and loaded into the EMR. Absent these voice-to-text technologies, it may be beneficial to practice typing on the keyboard while pausing to look up and interact with a patient.
- DO understand that patients may have unreasonable expectations for available information
Once an EMR system is in place, patients may have an unreasonable expectation that you will now know everything about them and their medical history. The public has received unrealistic promises about EHRs and they are going to expect us to fulfill it. Therefore, it is critical to educate your patients on what information is available in their records and enlist their help in updating or obtaining missing information. Patients may be tempted to omit information on intake forms when they assume, that because there is a computer in the room, the physician now knows about that latex allergy. This is even more important when managing patients with implanted devices, with the advent of EHRs, patients (and likely the government in 2015) will expect physicians to manage information and be able to contact past or current patients regarding recalls or updates. We know it is not reasonable to expect all information on a patient from conception to current, but does the patient understand this?
