Promoting Mindful Clinical Interaction While Using Electronic Technologies:A Group Training to Improve Patient Experience Colleen T. Fogarty, MD, MSc.

Collaborative Family Healthcare Association 16th Annual ConferenceOctober 16-18, 2014 Washington, DC U.S.A.

Session #October __, 2014

Faculty Disclosure

Please include ONE of the following statements:

I/We have not had any relevant financial relationships during the past 12 months.

Learning Objectives

At the conclusion of this session, the participant will be able to: To describe the communication challenges and

opportunities while using the Electronic Health Record (E.H.R.) in clinical practice.

To develop a list of behaviors that help the E.H.R. use become more patient-centered.

To learn and practice brief mindfulness activities and reflective writing to assist with the challenges of E.H.R. use.

This is Progress?

Click, click, scroll, type, select, search: error. Repeat.

Blah, blah,blah goes the background din of the patient’s HPI.

Click, click, type, click…[pause]. Frozen. Reboot.

The distracting din continues.

Open, login, click, type, click…[pause]

…I wish this patient would pause. Doesn’t she realize I am trying to provide state-of-the-art care?

By Sean C. Lucan, MD, MPH, MS

Families, Systems, and Health 2011

The Cost of Technology

Reflection and sharing experience Find a partner

Focus on a recent patient care encounter using E.H.R. this could be a --particularly helpful time --particularly annoying situation --OR when you particularly noticed the E.H.R. as a

player in the visit.

Jot down a few key elements of the story before telling it to your partner

Option—write a 55-word story

Debriefing:Discuss your reactions to the exchange Now discuss your personal reactions to

telling and hearing the story Thoughts Feelings Bodily sensations

What questions were helpful and why? How did you react to the exercise and to

each other?

Take 10 minutes For the storyteller,

address:

What happened?

What helpful qualities did you bring to that moment?

Who else was involved, and how did they contribute?

What aspects of the context made a difference?

What lessons from this story are useful to you?

For the listener:

Be attentive, don’t interrupt

Ask questions to help your partner clarify and provide details

Don’t talk about your own ideas or experiences

Use reflective questions and empathy when appropriate

If you get done sooner, just be silent. We’ll let you know when it is time to switch.

Video demonstration

http://courses.washington.edu/pove/watch/06/

Electronic interfaces & clinical care Divided attention or diffused focus Effects on communication Information overload Quality of information

Bringing irrelevant things to our attention (minimal drug interactions)

Difficulty entering/retrieving information

A Focus on Focus

When  you have a computer in the room, how do you parse your attention?

When does the screen draw your attention? When does the patient draw your attention? How can you maintain dual attention; that is,

integrate your attention to both the computer and the patient?

The literature

Physicians with EHR’s structure interviews around data-gathering rather than the patients’ narratives.

Several personal habits may help improve this dynamic. Adjust the ‘geography’ Bring the EHR into the relationship Use the computer to teach

Adjust the “Geography”

Sit facing the patient Sit at eye-level when practical Adjust the computer screen to allow patient to

see it Move close to the patient so s/he can see

screen

Triad: Bring computer into the relationship Introduce yourself to the patient FIRST Introduce the computer to the patient Share information from the screen with the

patient Maintain eye contact with the patient Let the patient know when there is need to

focus only on computer

Using the computer as a tool with the patient Offer the patient a copy of something in

the record (e.g. lab result, etc.) Access online patient information

materials

Summary-- 10 Tips

Position monitor so patient can see Learn to type Know when to stop typing/integrate with pt

need Don’t let templates direct information

gathering Don’t let the E.H.R. set the agenda

Summary-- 10 Tips

Start with patient concerns Tell the patient what you are doing Point to the screen/show your patients data Involve patient in documentation Look at your patient

Use computer to teach & enhance quality of care Show patient her/his vital signs As appropriate, consider:

Showing flowsheets or other data trends Offer patient copy of visit, vitals, or other data Provide online patient education Reconcile medication list with the patient Indicate if you have seen patient entries in patient

portal

Formal practice

Home practice Each day, notice your interactions with

technology both in patient care and in learning and academic pursuit. Then take a few moments to explore your own reactions.

In what ways were you present to your patient? What was most troubling to you about the

technology? What gave the most meaning? What did you learn about your own way of

responding to electronic stimuli and stresses?

References

Ventres W, Kooienga S, Vuckovic N, Marlin R, Nygren P, Stewart V. Physicians, patients, and the electronic health record: An ethnographic analysis. Ann Fam Med. 2006 Mar-Apr;4(2):124-31.

Verghese A. Culture shock--patient as icon, icon as patient. N Engl J Med. 2008 Dec 25;359(26):2748-51.

Hartzband P, Groopman J. Off the record--avoiding the pitfalls of going electronic. N Engl J Med. 2008 Apr 17;358(16):1656-8.

Frankel R, Altschuler A, George S, Kinsman J, Jimison H, Robertson NR, et al. Effects of exam-room computing on clinician-patient communication: A longitudinal qualitative study. J Gen Intern Med. 2005 Aug;20(8):677-82.

Session Evaluation

Please complete and return theevaluation form to the classroom

monitor before leaving this session.

Thank you!