Charting a Patient Encounter With the EMR: Desktop or Mobile Device?

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There are a couple of ways of charting a patient encounter with the EMR:  a desktop computer in the exam room and mobile devices (laptop or tablet) you carry from room to room. Charting the encounter first on paper then transcribing it to the EMR at your desk is a common practice that can lead to errors in transcription.

One common thing is that the current EMR model is less than perfect (and many find that to be a huge understatement) as it presents many challenges to the traditional patient-provider model, as well as how successful the industry moves forward in the HIT evolution.

The desktop in the exam room has its advantages:

  • It’s likely hard-wired and, as long as the network’s up, there’s probably a good connection to the EMR.
  • The keyboard and monitor are the same or similar to the clinician’s workstation.
  • The screen is larger than most mobile devices.

The desktop’s disadvantages include:

  • It frequently causes a distance between you and the patient unless you’re able to bring the keyboard and monitor over to the patient while you’re talking with them. Most exam rooms weren’t designed to have a computer in them, so very often the clinician will have to face away from the patient while they talk with them. The room will most likely have a spring-loaded arm system to hold the monitor and keyboard, which is an awkward setup for the important patient interaction. Many clinicians and patients hate this.
  • A room can have a faulty desktop that remains a problem until IT sends someone to fix it, which may be a while. (Think of that sticking key that you have to work around.)
  • They can take up valuable space if the exam room is small. Many patients feel that desktop roll-around carts are an intrusion and cramp the room space.

Mobile devices like laptops and tablets are brought into the room. Clinicians either have their own to use throughout the day or one that’s shared throughout the clinic. The pros for mobile devices include:

  • The patient interaction is much easier since you can talk to the patient normally. A mobile device lets you move around and behave as you normally would if you didn’t have a computer in the room. This is a huge benefit.
  • You can show the patient their record and helps to educate them and share what their record is, taking some of the mystery out of the EMR. This is very good.
  • You can chart anywhere there’s an EMR connection, in the hallway, nurse’s station, wherever. Pretty handy.

The charting can get done quicker since you can, if there’s time in the encounter, complete the encounter’s charting during the encounter. This is very handy. You can do this with a desktop, of course, but people I’ve worked with are more likely to finish it quicker if they have the computer with them during clinic time.

Cons for mobile devices include:

  • The EMR connection can be less than desirable. The wi-fi has to be pretty strong to provide access to the network if there are a lot of devices tapping into it for the EMR connection. Pray that the wi-fi doesn’t bog down or drop out during the encounter. Lots of frustration when that happens.
  • It’s a higher potential risk to privacy if an errant screen with someone else’s chart opens when you’re next to the patient.
  • Less options software-wise. There are currently less options for tablets than there are for desktops or laptops. This will change, of course, if tablets become more common in clinics.

So in light of all this, I’m hoping that the technology we use to chart in the EMR for the encounter will evolve, and quickly, to ease the patient interaction and to make this technology footprint in the encounter as small as possible. There already are barriers to the provider-patient interaction. The technology we use to chart in the EMR for the encounter shouldn’t be one of them.

Read more about EMR functionality in the exam room here, from KevinMD.

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