Letters to the Editor
To the Editor:
I read the recent commentary by Lown and Rodriguez1 with interest, mostly because I had the opportunity to do some early research into how examination room computers affect the communication patterns between physicians and patients.2,3 The commentary prompted me to reconsider some potentially significant questions related to the education of students and residents in light of the expansion of electronic health records (EHRs) into clinical practice.
First, if indeed media constitute “the extension of man”4—and research around EHRs suggests that this is true, given that physicians’ projected beliefs about the power of computers may guide how they use EHRs3—should we reconsider how information gathering (and clinical repackaging) is taught in medical school?
Second, are there examples of best practices, beyond the basics,5,6 that physicians and educators can use to think about, implement, and teach appropriate EHR use?
Third, do vendors of EHRs have any responsibility to train physicians how best to use their products, given how interwoven relational factors are with the technical application of EHRs?
Despite over 20 years of EHR development in the United States, it is sad and telling that we are still in the dark about the answers to these and other questions that are part and parcel of this new technology. The use of EHRs, as Lown and Rodriguez note, can enhance or endanger the structure and meaning of physician–patient communication. Let us hope that commentaries such as theirs can move students, residents, and educators toward a relationally focused use of EHRs as a way of improving this communication and maximizing its therapeutic potential.
William B. Ventres, MD, MA
Visiting research professor, Master’s Program in Public Health, School of Medicine, University of El Salvador, San Salvador, and clinical associate professor, Department of Family Medicine, Oregon Health & Sciences University School of Medicine, Portland, Oregon; firstname.lastname@example.org.
1. Lown BA, Rodriguez D. Commentary: Lost in translation? How electronic health records structure communication, relationships, and meaning. Acad Med. 2012;87:392–394 Accessed August 16, 2012
2. 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;4:124–131
3. Ventres W, Kooienga S, Marlin R, Vuckovic N, Stewart V. Clinician style and examination room computers: A video ethnography. Fam Med. 2005;37:276–281
4. McLuhan M Understanding Media: The Extensions of Man. 1964 New York, NY McGraw-Hill
5. Ventres W, Kooienga S, Marlin R. EHRs in the exam room: Tips on patient-centered care. Fam Pract Manag. 2006;13:45–47
6. Shachak A, Reis S. The impact of electronic medical records on patient–doctor communication during consultation: A narrative literature review. J Eval Clin Pract. 2009;15:641–649