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Dome - Charting a Mindful Approach

Dome March 2013

Charting a Mindful Approach

Date: March 1, 2013

Physician examining patient

Clinician courtesy and sound design are the keys to patient-centered electronic medical records.

As Johns Hopkins Medicine prepares to launch the first phase of an enterprise-wide electronic medical record system, wary providers are asking: Won’t the computer itself become a barrier to quality patient care?

It’s a legitimate concern, says Scott Wright, a professor of medicine at Johns Hopkins Bayview Medical Center, where he also directs the Miller-Coulson Academy of Clinical Excellence. Wright, too, recognizes the challenge of “being fully present in caring for patients” while entering a multitude of data in the patients’ electronic charts. “One could easily look at a screen instead of the patient, and you need to think about it every time with every patient.” 

To guard against poor electronic charting manners, academy members developed a checklist of “do’s and don’ts” for all medical staff who will be using a computer while caring for patients. A video presentation produced by the academy also showcases the do’s and don’ts and will be screened for providers during Epic training sessions, Wright says.

Although using a computer may at first fluster clinical staff accustomed to computer-free conversations with patients, the new software system will ultimately improve the quality of care, says Bryan Barshick, a nurse who is helping to lead the transition to Epic in outpatient settings. They’ll be able to engage patients in their own care, Barshick says. For example, a provider will be able to “turn the screen to a patient and say, ‘I’m seeing a trend. You’re on the verge of having to use insulin. What can we do to change this?’”

The patient-centered advantages of an integrated electronic medical record system far outweigh a computer’s potential to hinder personalized care, say Barshick and others supervising the Epic transition. A PowerPoint presentation (available at developed by Stephanie Poe, chief nursing information officer at The Johns Hopkins Hospital, showcases Epic’s ability to incorporate patients’ values, preferences and goals into their charts and make this information available to their Johns Hopkins providers, no matter where they receive care. The software system also enhances safety across the range of care, alerting providers, for example, to a patient’s risk factors, such as an allergy to a certain medicine. Back in the paper age, that alert could have easily fallen through the cracks.

—Stephanie Shapiro


EPIC: Do’s & Don’ts

First, knock before entering the room, wash your hands, shake the patient’s hand, introduce yourself, sit down, smile and ask the patient how he’s doing. 


DO’s for every encounter:

  1. Acknowledge the computer in the room and explain Epic’s role in patient care.
  2. Before you begin charting in Epic and at the visit’s end, give undivided attention to patient.
  3. Collaborate with the patient when using Epic; make sure the visit is patient-centered rather than computer-centered.
  4. Direct the position of the computer screen so that both you and the patient can view
  5. the information.
  6. Maintain eye contact with the patient as much as possible.


DON’Ts for any encounter:

  1. Distract yourself with incoming pages and phone calls during the patient encounter.
  2. Object to using Epic in front of the patient.
  3. Neglect psychosocial issues or ignore the patient’s emotions.
  4. Turn your back to the patient, if at all possible.
  5. Sacrifice humanism and compassion for the patient by focusing on Epic data collection.