Viewpoint: How the EHR became the third member of the patient-physician relationship 

EHRs have had a significant impact on the physician-patient relationship, arguably taking on more of a presence in the patient care experience as an additional member of the care team, according to NYU Langone Health's Danielle Ofri, MD.

In an Oct. 31 op-ed for STAT, Dr. Ofri wrote about New York City-based NYU Langone Bellevue Hospital's recent Epic EHR installation and how the new system has affected her workflow and relationship with patients. 

"Six months in, now that I’m used to Epic's kinks and quirks, a new reality has set it," Dr. Ofri wrote. "It's not so much whether one EMR is better than another — they all have their breathtaking assets and their snarling annoyances. What is really becoming clear to me is the uncomfortable realization that there are actually three of us in the room now: the patient, me and Epic."

Dr. Ofri argued that while the EHR was initially designed to assist with billing purposes and serve as a database to store information, the technology has become a part of the medical team. However, unlike clinicians who undergo extensive medical training, EHRs are held to the same standards. Medical technology and equipment like pacemakers, blood pressure cuffs and MRI machines are required to meet federal safety standards; medications must undergo clinical trials for approval, yet the only regulation EHRs are subject to is ONC's voluntary federal certification process, Dr. Ofri wrote.

Despite the EHR's benefits for storing and tracking patient data, retrieving the data has become a time-consuming headache for physicians. Further, EHR administrative requirements have hindered the patient-physician relationship, according to Dr. Ofri.

"A typical medical visit these days consists of the [physician] wrestling with the computer while the patient gazes at the supply cabinet," Dr. Ofri wrote. "I try valiantly to maintain eye contact with my patients, but it's virtually impossible with the demands of the EHR."

While most patients seem understanding of the EHR's demand for attention by their physician, some have commented on the "impersonal nature" associated with the system and their physicians' lack of ability to maintain eye contact with them while in the presence of the computer screen, Dr. Ofri wrote.

More articles on EHRs:
Google Cloud adds EHR voice assistant: 4 things to know
Vively Health to deploy Cerner EHR, population health solutions 
How NYC Health + Hospitals boosted physicians' use of OpenNotes

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