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EHR Documentation and the Patient–Physician Visit

Sheree Starrett, MD, MS
The need for physicicans to gather information for electronic health records has changed the nature of the patient visit.
• A major pitfall to avoid is allowing the EHR template to dictate the course of the visit. Physicians need to start with open-ended questions and collaborate with the patient on what is to be accomplished during the course of the visit. Statements such as “Excuse me a second while I type this into the record,” “Just give me a minute while I look at the computer—I want to make sure I get this down correctly,” and “Let me tell you what I am typing” are ways to involve patients in what one is doing when focused on the computer and not the patients.10 Physicians should explain to the patients when questions specific to templates or required data elements must be entered into the EHR.

• Physicians need to be able to follow patient cues and emotions and know when to interrupt typing and devote their complete attention to their patients. Research has shown that “emotional aspects of the interview are best accomplished when the physician moves her head, eyes, and torso toward the patient; removes her hands from the keyboard or mouse; pushes the monitor away; and gives the patient her undivided attention.”10 One of the major advantages of the computer for clinical practice and for oncology specialists is the ability to educate patients about their condition and to share information. The physician can point to the screen and offer to visually share test results, lab findings with trends, or x-ray tests. Additionally, information on treatments and possible clinical trials can be found and printed out for the patient. This ability to readily share the information in the EHR is a

major benefit and facilitator of patient engagement.


The transition from paper-based office records to documentation using electronic media has had several unplanned consequences. Physicians are finding themselves spending more time on data entry and looking at computer screens than on focusing on patients. While the EHR has greatly improved the ability to share information and educate patients, it has also had a negative impact on patient centeredness and emotional and psychological communication and the ability to establish a trusting relationship between physicians and patients. This article outlines practical ways to use the computer in a positive way. 

Sheree Starrett, MD, MS, is a board-certified hematologist/medical oncologist, recently retired as a medical director with Aetna. She is a member of the National Association of Managed Care Physicians and is currently working as a consultant in managed care.

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