Technology Talks: Computers & Tablets in Examination Rooms

Lisa J. Hunter, LSW, The Argus Institute, Colorado State University Veterinary Teaching Hospital

Jane R. Shaw, DVM, PhD, Colorado State University College of Veterinary Medicine and Biomedical Sciences

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Technology Talks: Computers & Tablets in Examination Rooms

Use of computers and tablets in examination rooms, and electronic health records (EHRs), are widespread in healthcare institutions.1 When integrated into veterinary practice, computers, tablets, and EHRs can complement or disrupt the veterinary professional‒client interaction. Technology adds a whole new dimension to veterinary professional‒client communication.

Today, EHRs are used in most human medicine clinical encounters, but studies on the impact of tablets and computers on communication and provider‒patient interaction are limited.1 Overall, providers report that tablet and computer use positively impacts patient communication, patient education, time management, provider productivity, and patient perception of the provider.2 (See Verbal Communication & Technology.)

However, several studies report a negative impact on physician‒patient interaction because the computer or tablet takes the physician’s focus away from the patient3 and makes establishing rapport and emotional common ground difficult.4 Other negative effects include increased moments of silence, decreased visual interaction, diminished eye contact, altered and distant communication, and the potential for loss of confidentiality.5

Following are some ways to avoid these challenges.

Non-Verbal Communication to Minimize Negative Effects

Focusing on nonverbal communication reduces the perceived barriers created by the computer or tablet and promotes partnership.

Lack of Eye Contact

Mobile computing devices and computers affect the ability to maintain eye contact and convey interest in the client’s story. In physician‒patient interactions, the computer served as a distraction, reducing the physician’s ability to pick up on the patient’s verbal and nonverbal cues.5

Maintain appropriate eye contact, look up from the device frequently, pause from typing, and reflect back so the client knows he or she has been heard. Mirroring facial expressions and a simple nod of the head also convey interest.

Verbal Communication & Technology

Verbal communication skills shift the focus from the computer or tablet back to the client, helping him or her to feel heard. 

  • When using technology in the examination room, ask permission to take notes on the computer so clients are more receptive. 
    • Before we get started with Baxter’s history, is it okay if I boot up this tablet so I can make sure everything we discuss is included in his record [asking permission]?
  • Allow clients to work with you and the computer or tablet rather than battle for attention. (See Reducing Barriers.)
    • Let us look up Baxter’s vaccination history together, so we can determine what he is due for today. 
  • If feasible, ask one team member to type while another takes the lead on the case and interacts directly and attentively wih the client.
    • I want to introduce you to Kelly, one of our veterinary nurses. She is helping us out today by entering Baxter’s information into the computer [introduction].
  • Use pauses and minimal encouragers (eg, Yes, Go on, Mmm, Hmm, Uh-huh) to let clients know they are being heard and to encourage them to continue.
  • Open-ended questions encourage the client to share concerns in elongated answers and provide valuable information.
    • Tell me what brings you and Baxter in today [open-ended question]?
  • Reflect back what you heard and incorporate the client’s key phrases to reinforce that you are listening closely.
    • You mentioned that Baxter has not been acting normally [reflective listening]. What have you noticed at home [open-ended question]?
  • Summarizing a client’s response checks for understanding and creates a space to actively engage with the client as typing or data entry is suspended. While summarizing, move the focus away from the keyboard, place the tablet to the side, and look up to make prolonged eye contact during delivery.
    • What I am hearing is that Baxter has not been acting normally for a week. He has a decreased appetite and no longer brings you his toys to play. He is going to the bathroom okay, although he is not drinking much water [summary]. What am I missing [check]?
Poor Body or Computer Position

Consider body position in relation to the computer. Sitting behind a computer, facing the computer with your back to the client, or balancing a tablet on the lap puts a technological wall between the veterinary team member and the client. 

To build rapport, maintain an open and inviting body posture and lean in toward the client with arms open and legs in a neutral, uncrossed position. Angle your body away from the computer and toward the client or put the tablet aside. Give undivided eye contact to the client while he or she is speaking, and then excuse yourself to capture your notes on the computer or tablet. Stop working and give full attention to clients expressing emotional or sensitive information.

Share the Computer or Tablet

Position the computer or tablet so that the information can be viewed between yourself and the client. Sitting together at the computer is an expression of partnership and it creates an opportunity for “show and tell” and for sharing information with the client.

Reducing Barriers

Focus on verbal and nonverbal communication skills to reduce the barrier created by computers and tablets.

Verbal Skills

  • Asking permission
  • Using open-ended questions
  • Using minimal encouragers (eg, Go on, Yes, Mmm)

Non-Verbal Skills

  • Maintaining open body posture (ie, open arms, uncrossed legs)
  • Making eye contact 
  • Nodding the head
  • Positioning the body to face the client
  • Summarizing
  • Practicing reflective listening

Conclusion

The use of EHRs, and computers and tablets in the examination room, is growing, as is the impact of technology on veterinary‒client relationships. The overall perception of advancing technology in human medical scenarios is positive, but tablets and computers often act as barriers, literally and figuratively, to partnership and communication. Honing verbal and nonverbal communication skills ensures that once a computer or tablet is added to the equation, the focus remains on the client and the veterinary team‒client relationship does not suffer.

1 Train team members on integrating technology into team member‒client interactions to minimize distraction and enhance client education.

2 Be aware that nonverbal communication is key when using computers and tablets to reduce barriers to connecting with the client.

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