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Risk Management Tip: The Use of Computers in Examination Rooms

risk management tip from MLMIC

MLMIC Risk Management Tip #21 addresses medical professional liability risks related to “The Use of Computers in Examination Rooms.”

The Risk
The presence of laptops/tablets in examination rooms has become commonplace as more providers implement electronic health records. This method of documentation may place a barrier between the provider and the patient. Providers may miss non-verbal cues, and patients may perceive an electronic device as a hindrance to communication. In several recent medical malpractice cases, plaintiffs testified that the provider spent too much time entering information into the computer and not enough time listening. Utilizing effective communication skills to engage the patient while using a computer will enhance the integration of this technology into healthcare and improve the patient experience.

Recommendations

  1. Analyze the examination room for placement of the computer. Position the computer in a way that enhances provider/patient communication. Consider using a cart on wheels to position the computer so that the provider faces the patient.
  2. Establish eye contact with the patient and listen to his/her concerns before using the computer. Look at the patient while you speak.
  3. Reassure the patient that you are listening to him/her.
  4. Utilize the POISED1 model:
    • P = Prepare for the visit
    • O = Orient the patient to what you are doing
    • I = Information gathering – allowing time for conversation
    • S = Share what you are looking at on the screen with the patient
    • E = Educate the patient, reinforce the plan of action
    • D = Debrief and assess the degree to which the patient understands the recommendations and plan. Utilize the “teach-back method.”
  5. Print a copy of the visit for the patient and retain a copy in the patient’s record (e.g., after-visit summary).
  6. When computers remain in examination rooms, providers must log off at the completion of the encounter to protect patient privacy.

RESOURCES
1Frankel Ph.D., JAMA Internal Medicine commentary, November 30, 2015.

This MLMIC Risk Management Tip is available here as a PDF: “The Use of Computers in Examination Rooms.”