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The use of electronic health record (EHR) in the exam room changes the dynamics of the clinical charting process. Many health professionals are not that savvy with new technology and it can be exacerbating to say the least. As a result, many doctors spend too much face time with the computer rather than the patient; more than 80 percent of the visit time, according to Richard Frankel, PhD, investigator for the Regenstrief Institute. While the benefits of EHR use outweigh the distractions, it is very important to minimize the distractions to keep the patient-provider relationship strong.
 
Through a study of exam room computer use Frankel determined the best ways to improve your patient engagement during electronic charting. He designed the POISED model, to help improve patient-provider interaction.
 
P – Prepare: Before you even get to the exam room, review the health records of your patient – then enter the exam room making eye contact with your patient.

O – Orient: Spend a couple of minutes explaining to the patient how computer use is necessary for charting. This is especially important with the elderly population who may not be familiar with new technology.

I – Information Gathering: Enter the data during the exam not afterward. This will help make the patient feel that their concerns are being heard and documented with nothing being left out. It
will also save time for the provider from having to enter it later.

S – Share: Let the patient see what you’re entering into their notes. After all, it is their record and they want to know that it is accurate. Turn the computer screen so patients can confirm what has been typed, this will also signal a patient-provider partnership.

E – Educate: Use the EHR software to show a graphic representation of the patient’s progress over time, such as weight, blood pressure etc., so it can become a basis for conversation.

D – Debrief: Use the information in the patient’s records to better explain and discuss recommendations for treatment plans. It can also be a great time to make sure the patient fully understands the diagnosis, treatment and potential outcomes.
 
In addition, Frankel warns about improper computer placement in the exam room. Do not arrange the computer in a place where it will cause the provider to sit facing away from the patient such as a fixed workstation set in the corner of the room. Continue to make eye contact with the patient throughout the charting process. According to Frankel, “female physicians typically look up from the screen approximately every 30 seconds or so, making eye contact with the patient to signal that they are still actively engaged in the relationship, and return to typing. However, male physicians tend to lock on to the computer screen and rarely look up to signal engagement.”