Beth Strauss, DPN, RN, AHNS-BC, assistant professor, Edgewood College, in Madison, Wis. and a member of the HIMSS Nursing Informatics Community, held an on-demand education session entitled, “Patient Perception of the Nurse Relationship During Electronic Health Record Use,” as part of HIMSS13 Online.
Strauss completed her BSN degree in 1991 and MSN degree 1999 from the University of Wisconsin-Madison. In 2011 she completed a Doctor of Nursing Practice (DNP) degree from Case Western Reserve University in Cleveland, Ohio. Her research focus is on the humanistic side of health care technology. Strauss has 29 years of clinical expertise in adult medical, surgical, and mental health nursing. She is nationally certified as an adult health clinical nurse specialist and has worked on implementation of patient technology in educational and healthcare organizations.
HIMSS: What are some of the common concerns you see that patients have regarding the use of the personal health records and data in an electronic format?
Strauss: EHRs are generally a positive addition to healthcare, and people like having them; however, I worry that the humanistic side of healthcare is being lost. There are four common concerns patients tend to have, in regard to the use of EHRs:
- Presence: Patients are concerned that the nurse is more focused on the computer than on them.
- Respect: Some patients worry that since everyone who is taking care of them can now see any aspect of their EHR, there is no longer confidential information. For example: If a patient with a previous mental health issue visits a healthcare provider for a particular medical ailment there is a concern that the provider may have a preconceived notion regarding their health care needs.
- Knowledge of the nurse: Before the introduction of EHRs, patients understood that papers could get lost. Now, when a nurse is unable to find information or successfully navigate an EHR, patients question the nurse’s knowledge and skill level.
- Trust and safety: Patients are concerned about what happens to the information in their EHR, as it is an electronic format. They question security, as online information is frequently hacked or subject to spam. Another concern is how a person’s electronic health care information is being utilized by insurance companies.
HIMSS: What are some interactions you think healthcare providers can use to engage in a positive patient relationship when communication with patients while using an EHR?
Strauss: Healthcare providers can use four interactive steps to connect with a patient within a computer interchange. If providers follow these four steps, there is a100 percent nurse-patient connection.
- Acknowledge and attend to any health care needs as soon as you enter the patient’s room prior to using the electronic health record.
- Explain all movements on the computer including when personal health data is entered.
- Explain the rationale for electronically generated questions and nursing/medical protocols.
- Acknowledge and attend to any healthcare needs before leaving a patient’s room.
HIMSS: Your session, "Patient Perception of Nurse Relationship during Electronic Health Record use," looked at the relationships between patients, nurses and EHR use. Can you discuss the challenges a nurse faces while interacting with a patient while using an EHR?
Strauss: Time is one of the greatest challenges nurses face. In today’s world of healthcare technology nurses are required to report and chart a great deal of information, and the process can be time-consuming. While the four interactive steps are helpful in engaging the patient, nurses often struggle to find the time to fit anything else into their day. I believe it would be helpful if EHRs systems adopted a patient-focused view, by adding a simple queue, encouraging healthcare providers to check on the needs of the patient. While nurses don’t intentionally disengage with the patient, it is easy to forget the patient in the process of working within the patient’s EHR.
HIMSS: Can you share a patient story or example of how you or a peer has been able to create a positive patient relationship while using and or explaining an EHR?
Strauss: A participant of the study that I conducted wrote she felt a connection with the nurse because of the face-to-face time she received, from the nurse. It is important to make sure the patient is acknowledged as an individual and as a partner in their health care delivery.
Over the past years, my awareness of how important a human connection is within our technology driven health care arena has increased dramatically. Patients are scared, nervous and feel compromised when sick or injured. By engaging and interacting with them while working with technology, nurses can decrease patient’s anxiety and promote an effective holistic healthcare approach. In my study all study participants were unaware that healthcare providers log in and out of an electronic health record system. . As health care providers, we are eager to provide a handout, but we need to take another step and follow up with a face-to-face summation of the information provided.
As a result of this study, I have adapted my approach to patient interactions when using technology by using the four key steps discussed. In my work as an educator, I also spend more time teaching student nurses how to effectively utilize the humanistic side of technology when working with a patient. Finally, sharing the patient’s voice with others will be another step to maintaining a humanistic component within our technology driven healthcare arena.