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Computer charting from a patient's POV

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Recently there was some discussion about computerized charting in a thread that we keep away from contentious issues. The nurse POV about computer charting was the topic. One issue that was brought up was a nurse working in a patient's home pulling out a computer and charting while in the home. This brought up a thought from me, as a consumer of health care, although I have not needed any home care.

My PCP always carries a laptop and immediately charts all information about my visit. It includes everything that would be documented on paper. Additionally, I get a copy about the visit when I leave. I like that. I like it a lot. It means there is less chance of transcription error. The MA always tells me my numbers and they are included in the summary. I have had to deal with ambulance crews that still are using written charting. There is a waste of time spelling unfamiliar drugs for them. If they used quick computer documentation they would have more time with the patient and less wasted time crossing out and not getting the right drug because of spelling and other errors.

I like to know that my information is only in a computer, not on papers that can be separated from the rest of my charts. I want people to chart in front of me so I can answer any questions that the act of charting brings up. Too often, as the nurse, I was charting after the fact and wished I had asked a follow up question that I did not think of until I wrote it up.

So, as a consumer, I want charting done in front of me on the computer. I like a written copy of a concise review of the reason for the visit, observations, implications, plans of actions, and how to implement. I don't think getting a copy is mandatory but I think as the person who has the most to gain by information, it should be offered that the patient can get a copy.

HIPAA is important to me, in spite of the fact that I have few secrets. I want to have the choice about who can get their hands and eyes on the information. The idea that no name is included in notes is not the answer. Especially in a small area any information helps to identify the person and as such there are few details that can be written that could not be used to identify the patient. Reading protected info, even if identifying data is missing still it is not right. I would not want any chance of anyone reading info about a specific person. This could happen in an auto accident or car breakdown with file material written or notes maintained, about to be written. Not necessarily any nefarious plans for the info, it just is not to be available.

No computer system is perfect. As a nurse I prefer to hand write my notes. It is easier, it means I can write things I might not want the patient to see directly. You don't have to write PIA for people to get the picture when you hand write. It is not about me. It is about the patient, the consumer, the client.

I wonder if others who have the experience as a consumer, rather than as the nurse, feel some way about electronic documentation.

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I really appreciate your comments.

When I have trained Home Care and Hospice field staff I stress to them the importance of using their laptop in the presence of the patient and family. I encourage them to normalize that documentation process from the very first visit using some of the same rationale that you have outlined.

My experience is that the patient/family is more accepting of, and comfortable with this practice than the professional who is new to the concept is.

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Echo Heron put this up on her FB a bit ago. I hope this link works for you. It fits right in with computer charting from a patient's point of view.

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Echo Heron put this up on her FB a bit ago. I hope this link works for you. It fits right in with computer charting from a patient's point of view.

That is what I feel is happening. Nobody cares about the patient; rather, it's all about getting the computer charting done. Most of the emails I get about my charting are about charging- seriously? The person on the OR bed is crashing- I am not going to worry about charging for those defibrillator pads. Technology is only a tool, but at this point, technology is becoming the darling of healthcare administrators and nurses are being pushed away from the patient's bedside to take care of the computer instead.

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Ok. Here's my Emily Post upbringing perspective. (My mom thought she was Emily Post).

It feels rude and foreign to talk to someone and never even look in their direction. Disrespectful. I'm getting over it, because I must. But my mom/Emily must be rolling in her grave.

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The question I asked was from a consumer POV. I know the nurse POV, as they say, "I are one..". While nurses see computers as something between your patient and your care, I, as a consumer, find the computer a storage unit for all the details you may or may not have easily available when you meet me, the consumer. I know it will not lose track of a piece of paper. I know as a consumer that I can ask to have any input read to me for corrections. In short I want you to chart in front of me.

If you arrive at my place for home health care, and I have belly pain, the computer can spit out that I do not have a GB. I lack a uterus so it cannot be that. My last scoping showed nothing out of the norm so it probably is not some other things that you can think of. As the nurse coming in for your first 12 hour shift after a 2 week staycation, with phone notes from the 2 minute report, you know I had a slight pneumonia and had inhaled fumes. The computer might have saved you a bit of history talking when I can barely breathe.

My pain? check my history of NSAIDs and my intake? How is my eating? Did they give me steroids for my breathing? Hmmmmm.

Being the consumer is more difficult than being the nurse, especially if you are a nurse. Self diagnose and you might be wrong and send HCP in the wrong direction. Keep quiet and waste time. All my doctors expect me to be a knowledgeable consumer and to understand computers and what they show me. Today my podiatrist complained about his computer needing a new password and how it denied his first 3. He then told me his new password and we laughed as we looked at my arthritis on x-ray. His computer had him prepared to see me. He documented in front of me and did all he needed to do. We laughed and chatted a couple of minutes while he told me he wanted to visit my store. I left, secure in the knowledge that in spite of our laughter and chatting, his computer already is prepared for my next visit.

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All the posts have been about patient POV.

Here's a good Medscape article:

http://www.medscape.com/viewarticle/810573_7

Charting in the patient's room, however, has raised concerns.Angie Kohle-Ersher is an information technology nurse who recently conducted a study that contained 2 surveys.[16] The first survey, which asked nurses about impediments to point-of-care documentation, identified the following barriers:

Location of the computers in the room. Nurses had to ask visitors to move, turn their backs on patients while charting, or chart standing up.

Unreliability of computers in patient rooms -- they are slower, and often freeze up.

Privacy concerns: visitors looking over the nurse's shoulder, reading the chart.

Some patients dislike the nurse charting in room; patients interrupt with questions and requests.

Some patients complained that the lights emitted from computer monitors disrupted their sleep.

Kohle-Ersher's findings are supported by other research[5] as well as the anecdotal experiences shared by Medscape readers.

A self-described "mature nurse" dislikes charting while talking to patients. "I like to give the patient my full attention, with good eye contact. This is very important for assessing the patient as a whole. A lot is missed when nurses (and doctors) stand at the computer and just go down the list, barking out questions to fill in the boxes." Another nurse concurs. "Some providers don't even make eye contact with a patient because they are focused on the computer. It takes some of good bedside manner away from the encounter........

It is perfectly normal to have these kinds of concerns.

Edited by Spidey's mom

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All the posts have been about patient POV.

As the consumer when I read I feel like the nurse is thinking, or trying to think for me the consumer. All of you have had the experience of being the patient for an annual physical? or other activity. What I asked, and I understand is difficult is for nurses to put away the nurse cap and respond as only a consumer, as if they had no knowledge of the other side of the coin.

I read reasons why you respond the way you do. As a nurse I feel the same. As a consumer I don't think you have to give up being a person to use a tool like a computer. No nurse would give up a stethoscope as it is a tool that makes information more easily available. You no longer have to put your ear to the chest, or carry a small ear trumpet (as one OB of old I trained under still did).

As a consumer I want every tool possible so that the care giver has easy access to my info and can share that with others immediately. As a person concerned about the cost of health care I know it takes longer to chart manually and therefore is expensive. It used to be that personnel costs were almost 90% of the budget. Anything that can improve care and stop the waste of time and space of hand writing, especially to then put into the computer will allow more money for care.

I do believe after review of more than a few charts in my life that charting needs to be streamlined and the info inputted only one time.

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I am sure that computers are the way of the future. But there are concerns.

I mentioned this on another thread but my last appointment a new MA was training. I let him do his thing and then afterwards when we were alone, I mentioned a couple of things.

Never turn your back to the patient and only look at the computer. Don't ask questions of the patient with your back to them.

My inlaws were truly pleased with the care they received from a FNP at the Vet's Clinic recently. He sat, facing them the entire time. His back was to his computer. He charted at the end of our visit and was sitting sideways so he was still open to the inlaws but could see the computer.

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http://well.blogs.nytimes.com/2011/02/02/caring-for-the-chart-or-the-patient/

....I have joked that the hospital should install video cameras to record everything that nurses do. Having a permanent record of my actions would mean that all the time I spend charting could be time spent on patients instead.

Because that’s my real concern: the effect on patients of incessant record-keeping. Each of these individual initiatives has merit and is worthwhile, but together they become a mishmash of confusing and oppressive paperwork......

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Point of Care Documentation Impact on the Nurse‐Patient Inte... : Nursing Administration Quarterly

Electronic medical record (EMR) point-of-care (POC) documentation in patients' rooms is a recent shift in technology use in hospitals. POC documentation reduces inefficiencies, decreases the probability of errors, promotes information transfer, and encourages the nurse to be at the bedside. However, EMR POC documentation has the potential to distract the nurse's attention away from the patient and compromise the nurse-patient interaction.

Edited by Spidey's mom

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At my new primary care provider's office, they have a tie-in to the hospital EMR. Each visit I've had, I felt like the PA was much more focused on the computer than on me- I got about 10% of the appointments actually being examined and 90% of the appointments where she was staring at the computer. As a patient, I felt like what I was telling her was less important than what the computer was telling her.

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