This is the conclusion of a two-part series on the effective and efficient use of EHRs.

In our last article in Psychiatric News, you learned tactics for optimal use of the electronic health record, or EHR. Many EHRs have features—like order sets and text-expansion shortcuts—that can help you finish the work day on time. But what about managing the therapeutic alliance, when you’ve introduced the EHR as the third entity in the room? Or the transference toward the EHR?

For starters, the physical placement of your computer can make the difference between effective and poor nonverbal communication.

A study involving nonverbal communication found that the least effective spaces are ones where the clinician’s back is to the patient. An observational study of 50 videotaped sessions in the VA Health System found that an open setup—in which a computer and patient are positioned within the same field of view as the physician—helped the physicians view both the EHR and patient simultaneously, verify data, and even share information on the monitor for patient education. Sustained eye contact, a close distance to the physician, and direct body orientation contributed to a feeling of positive affect, social readiness, emotional support, and availability for communication.
Photo: Steven Chan, M.D., John Torous, M.D., John Luo, M.D.

In contrast, closed setups prevented the physicians from making eye contact. In closed setups, the patient’s chair and the computer were placed 180 degrees from the physician. The physician had to turn his or her back to the patient while using the computer.

Aside from computer and furniture placement, there are many other strategies for improving nonverbal communication. Remember to be mindful of body language, even while typing. And think of the computer as an opportunity to use visual aids.