They Laughed When I Said I'd use EHR-- But When I Employ the LEVEL system in new Medical Practices, They Begged Me for My Secret!

A recent study by Pamela Lewis Dolan, revealed that a number of physicians have been doubled since 2008 who adopted electronic health records. Although EHR service is overwhelming, this source can be a reason of communication breakdown between patients and physicians. An internist and medical director of informatics at the Reliant Medical Group in Worcester, Larry Garber, MD, said that, “When physicians who are used to carrying paper charts start using tablets or desktop computers in the exam room, it’s going to be disruptive,”. This disruption “can absolutely make or break the relationship between doctor and patient,” he said.

Study said that numerous medical schools have realized the impact of bad communication affecting patient satisfaction and outcomes. Introduction of LEVEL system is a unique contribution to avoid unintended consequences based on bad communication.

Exam Room Setup: Many practices are implementing EHRs in spaces meant for paper-based practices said Glen Stream, MD, president of the American Academy of Family Physicians and chief medical information officer of the Rockwood Clinic. This undergoes with a new setup that has the physician’s back to the patient when he or she uses the computer, “which is absolutely the wrong message you want to send to the patients,” Dr. Stream said. Implementation of a basic triangle design that puts the physician, patient and computer screen at each of the three corners, allowing the doctor to look at both patient and computer screen without shifting his or her body is another method. In this way patients feel they are being looked at even when the physician is looking at the computer screen, Dr. Garber said.

Work-flow Design: Vincent WinklerPrins, MD, a family physician and associate professor of family medicine at Georgetown University School of Medicine in Washington said that computer terminal should never be the first place the physician goes when entering the room. The doctor should go to the patient first, greet him/her and establish an agenda for the visit. After that is done, the doctor should have some kind of transitional line explaining what he or she is about to do in the EHR, such as, “OK, let me jot down a few notes.”

Employ the LEVEL system: Designed by Kaiser Permanente to help physicians use an EHR in the exam room, LEVEL stands for:

L: Let the patient look on. This goes back to the triangle setup that allows the physician to easily share things on the computer screen with patients.

E: Eye contact. Dr. Garber treats every patient encounter as he would have a conversation with a friend or family member.

V: Value the computer. If the physician praises the benefits of the computer, the patient will appreciate its presence. Using such statements like “With my EHR, I can look that up” or “I can send your prescription straight to the pharmacy,” will help patients think their care is more advanced because of the computer, Dr. Garber said. Sharing visuals on the screen, such as a chart mapping historical cholesterol levels and positive framing by Dr. Stream are beneficial for the patients.

E: Explain what you’re doing. Dr. Braddock said it’s important for doctors to be transparent about everything they do. Share everything and be very clear with their work, in addition easy statements will make patients more comfortable.

L: Log off. Logging off in front of the patients, in the exam room makes them confident that the next patient won’t walk in with their information still on the screen, Dr. Garber said.

Dr. Braddock said that medical practices should look to one another for tips and guidance on how to handle this training and in this same regard, Reliant Medical Group adopted the LEVEL system from Kaiser. A YouTube video created by Dr. Garber explains the LEVEL process with “good doctor” and “bad doctor” examples. Communication is a foremost thing to bring a revolutionary change.  It reduces the uncertainty in opinions and practices. Dr. WinklerPrins said that every physician has to deal with how to work with an EHR in the exam room, and EHRs are here to stay, so every practice has to figure out how to work with them effectively.