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The doctor - EMR - patient relationship

Posted by Dan Mazanec, MD on Mar 3, 2016 9:12:00 AM

What really is the EMR's impact on physician-patient communication?


There’s a third party in the most doctor’s office exam rooms now – the computer housing the electronic medical record (EMR). A new study by Ratanawonga, et al published in this month’s JAMA internal Medicine (JAMA Intern Med 176 (1) 125-127, 2016) raises serious questions about the impact of the EMR on physician-patient communication. The authors recorded videos of 71 office visits to 39 different clinicians in practices commonly dealing with patients of low health literacy. High computer users (less eye contact) were compared with low users in domains of patient satisfaction and communication style. Patients of high computer users were less likely to rate their care as excellent. Communication style was altered by higher computer use with a tendency to "less authentic engagement” with the patient and more “negative rapport building.” The core of medical practice is the physician-patient relationship, built on communication, empathy, and physical touch. This relationship is critical not only to patient satisfaction but successful high quality clinical outcomes. Preserving this human connection in the age of the EMR requires both improved computer use habits by the clinician and an improved EMR user interface.


Frankel (JAMA Int Med 176:128-9) suggests “POISED” as a mnemonic for a structured approach to optimizing clinical use of the EMR: “Prepare, Orient, Information gathering, Share, Educate, Debrief. Incorporating the elements of this approach certainly should improve the integration of the computer into the patient-physician interaction.


Streamlining data entry along physician-created workflows improves efficiency and restores opportunities for authentic and critical interaction with the patient. When the physician spends less time performing as a data entry clerk and more as an empathetic clinician both provider and patient satisfaction improves.  

Realizing the promise of the EMR to improve value in health care cannot ignore the human connection between the physician and patient which is heart of the art of medicine.

- DM

About Dan Mazanec, MD

Prior to joining Dorsata in 2016, Dan Mazanec, MD was the Associate Director of the Center for Spine Health at the Cleveland Clinic. Board certified in internal medicine and rheumatology, he has been a leader in the development of the emerging specialty of Spine Medicine. A frequent lecturer at international and national meetings, he has authored more than 70 book chapters and papers. He is an active member of the North American Spine Society with a particular focus on the development of evidence-based clinical guidelines as a member of the Clinical Guidelines Committee and the role of non- surgical care as chairman of the Rehabilitation Interventional Medical Spine Committee. Dan led the development of the Cleveland Clinic Spine CarePath which merges evidence-informed clinical management of spine disorders with patient-entered clinical outcome data focusing on optimizing value. He was the clinical lead for technologic enablement of the CarePath in the EMR and the implementation of the Spine Carepath across the entire Cleveland Clinic Health System.

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