Health IT in the Exam Room

A doctor’s waiting area and exam rooms today look much like they appeared in the 1950s.  Patients used to sit in waiting rooms reading their magazine after filling in paper health forms, then were called into the exam room where the forms helped the medical team target patient health concerns.  Fast forward 60 years, and outwardly little has changed with this picture.  Health information technology (Health IT) has made great strides in recent years, putting information that’s relevant and current into hands of patients and caregivers as well as physicians and staff in medical care settings.  But during medical appointments, arguably the most important minutes for both patients and doctors, there’s still untapped potential for patient engagement in the waiting room – and the most visible technology available in the exam room is utilized most often for data entry. The biggest influence in patient care happens in the exam room, so why isn’t healthcare technology integrated for and throughout this critical interface, connecting issues and needs to information and resources?
Patients could become more invested and empowered by using a waiting room kiosk with a touch screen menu of healthcare concerns, illness symptoms, and wellness topics.  Rather than merely checking “fatigue” on a paper form, patients would review a list of options on a touchscreen that allowed freedom to tap selections that could more effectively inform and guide exam room discussions.  Medical appointments are brief and can feel rushed for both physician and patient, so wouldn’t it make sense to take a proactive approach in the waiting room and make appointment time as effective and efficient as possible? Use of health IT in the waiting room could help determine key issues to target during the exam, such as honing in on whether the patient noted fatigue issues possibly associated with depression or if other symptoms indicated the fatigue might have an organic cause.  Technology allows for rapid gathering and sharing of information, so waiting room kiosks would provide physicians an immediate and accurate ‘snapshot’ of how patients view their health.   Medical appointments may seem very brief when an issue exists, so if the minutes cannot stretch perhaps we should look more closely at ways to maximize that precious patient-doctor facetime.  The technology exists, so why can’t ‘waiting rooms’ become ‘doing rooms’, with patients engaged in providing meaningful information to help guide exam room discussion?
The days of the ‘brochure wall’ in doctor’s offices may be long gone, but the need for patient information continues.  While going paperless is the trend across all businesses and offices, as well as for individuals, health IT has stepped up in some areas but lags far behind its capabilities.  Patient portals can help support information flow and communicate important details about test results, appointments and much more. Digital technology such as text messages, voicemail and emails can provide channels to both support outreach and to provide patient care between visits.  But in the exam room itself, other than a physician reviewing or entering data, we fall far behind in developing and utilizing health technology.  We can shop online with ‘retail tech’ built to anticipate our needs, we can select a restaurant based on our location or menu preferences.  There’s an app for that.  Developing algorithms and writing code for lifestyle needs and applications has boomed in all other areas of society and consumerism, so why has the medical exam room missed innovative heathcare technology advancements that could develop a culture of integrating technology throughout patient interactions with physicians?
Look around most doctors’ offices and you’ll find technology updates have centered mostly around electronic health records (EHR).  Many patients may be surprised to learn that the computer or tablet used by their physician can do much more than patient information retrieval and data entry.  Did you know that physicians using an EHR platform can tap into a wealth of patient education materials directly from their tablets, with the ability to summon up and print a page of information on everything from high blood pressure to lower back exercises?  For the 1 in 10 patients with one of the estimated 8000 different rare diseases or disorders, that’s an amazing asset.  It provides the power of personalized medicine, capable of creating a customized ‘patient brochure’ tailored to individual needs and medical issues.  Perfect!  You haven’t seen or been offered this wonderful patient resource?  Wondering why?
What obstacles have left today’s waiting and exam rooms largely unchanged regarding patient education and health IT?  It’s not that physicians and their staff don’t like technology, although it’s likely most medical professionals would admit that while critically vital, data entry is no one’s favorite part of healthcare and patient care.  Going paperless in a medical office is a worthy goal, but not to the detriment of patient education.  Patient portals can fill that gap to some extent, as most technology platforms utilized have a section where patients can search and print materials relevant to their health concerns or wellness goals.  Point to ponder:  What percent of patients or caregivers for pediatric patients will wait to get home and log onto their physician’s patient portal to search for, then print patient materials?  Most physicians using electronic health records (EHR) have the tech ability on their tablets to ‘click and print’ personalized patient materials during medical appointments, which can be tailored to an individual patient’s needs.  Think of the benefits to all patients and caregivers by utilizing health IT to provide such immediate information, support and resources.  The impact for such personalized ‘patient brochures’ is even greater for patients with a rare disease, where information and resources are difficult to find or access.
While social media abounds with mentions of “patient engagement”, a neglected component is the utilization of healthcare technology from when the patient enters the medical office, in the exam room during the appointment, and for support at home after the appointment.  Shouldn’t we be integrating heathcare technology in a more connected and meaningful way, guided by those most impacted? Would a more informed patient be a more compliant patient, leveraging patient involvement into better patient outcomes? Privacy is always an underlying concern.  Time is always in short supply.   Money is always an issue.  Still, options to improve always exist.


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