Nurses often use electronic health records (EHRs) to document assessments, record observations, and complete electronic checklists while simultaneously communicating with the person receiving care. Balancing these documentation requirements with face-to-face communication can affect how nurses interact with patients.

As evidenced by an integrative review exploring the impact of EHRs on the quality of nurse–patient interactions and communication, “The use of EHR impedes face-to-face communication, interaction styles and ultimately a person-centred approach.”

The review also identifies potential ways to reduce these effects, encouraging nurses to use technology to maintain more open, person-centred interactions.

 

How EHRs can influence nurse-patient communication

The review reports that “closed nurse-patient communications, reflecting a task-driven approach, were predominantly used when nurses used electronic health records.”

One concern identified in the review is that electronic checklists and scripts can shape the interaction. The authors state that “without careful planning, nurses' use of EHR checklists and scripts may promote formulaic interaction styles and ‘passive’ patient engagement.” They explain that this can occur when nurses' attention is directed toward electronic checklists rather than the patient, potentially inhibiting open conversations.

Therefore, nurses must understand how EHR systems can be used effectively. In one of the studies discussed, a nurse's “legs and torso turned towards the computer,” and this orientation appeared to obstruct discussion of the patient's concerns. In another case, the nurse kept eye contact, faced the patient, and encouraged the patient to expand the conversation.

The review therefore suggests that the technology itself does not determine the interaction completely; nurses' behaviour and adaptation also influence the encounter. The review cites further evidence that nurses can adapt to these competing demands. For example, the results of a case site analysis on nurses' use of an integrated electronic health record found that many nurses developed a “sophisticated ability to juggle these competing demands” between the patient and the EHR, including documenting assessment information and vital signs at the patient's bedside.

Ultimately, these findings show that EHR use and patient communication do not have to be competing activities, but that maintaining a person-centred interaction may require conscious adaptation.

 

Maintaining person-centred nursing

The review places these findings within the Person-centred Nursing Framework, which includes prerequisites, the care environment, person-centred processes and expected outcomes. To achieve patient-centered nursing, nurses must also allow patients to ask questions and participate in decisions about their care.

The review therefore recommends further development of nursing education and practice around EHR use. It suggests that nurses may need interpersonal, communication, and technical skills that allow them to involve patients while using EHR scripts and checklists.

The authors warn that “without this evidence base we risk losing the art and person-centred nature of nursing; with patients ending up as passive receivers of care.” Their conclusion is therefore not that EHRs should be removed, but that their implementation and use should be evaluated in relation to communication and person-centred care.

 

Using HIPAA compliant email alongside the EHR

HIPAA compliant email solutions, like Paubox, can be used in conjunction with an EHR to support appropriate patient communication. While the EHR maintains the clinical record, HIPAA compliant emails allow nurses to securely communicate this patient’s protected health information (PHI) when needed.

Depending on organizational policies and workflow, this separation can help nurses distinguish documentation tasks from patient communication tasks. For example, after a consultation or discharge, a nurse may need to provide educational information, follow-up instructions, or other appropriate information. Paubox email directly supports this communication, so nurses can answer the patient's questions while the EHR continues to capture clinical documentation.

Used this way, secure email does not replace the nurse's communication role or the EHR. It simply allows appropriate communication after the patient encounter. It can also help reduce the temptation to use the EHR as the communication channel for every patient interaction when secure email is more appropriate.

 

Supporting care coordination

HIPAA compliant emails are proven to support care coordination between patients, nurses, physicians, and other care team members. Nurses can use these emails to help patients understand care plans and coordinate information between different providers. They can use the clinical information gathered from the EHR to give providers a comprehensive overview of the patient's health status for more effective care delivery, ultimately improving patient outcomes.

For example, if a patient's clinical record states that they have diabetes, the nurse can communicate this information to all relevant providers through a HIPAA compliant email, so that everyone involved in the patient's care is aware of their condition. Additionally, the EHR can also provide alerts for potential medication interactions or allergies, helping to prevent adverse events and improve patient safety.

 

Improving workflow

Using HIPAA compliant email to complement the EHR upholds the review's finding that some nurses develop a “sophisticated ability to juggle these competing demands” between the patient and the EHR. Secure email simplifies the nurses’ workflow as nurses can distribute communication and documentation tasks across appropriate systems.

Paubox email automatically encrypts outgoing emails, so nurses don’t have to deal with unnecessary security steps, like manually encrypting emails. Additionally, patients don’t have to navigate inconvenient patient portals where they have to memorize separate login details.

Nurses can send a secure email directly to a patient’s inbox, giving them easy access to their health information. Nurses can also securely email other providers, like pharmacists, to coordinate patient care more efficiently. For example, if a patient is diagnosed with a new condition and needs a prescription, the nurse can quickly communicate with the pharmacist, so the patient receives the necessary medication.

As the review suggests, if EHR use can influence the flow of nurse-patient communication, complementary communication tools provide additional options for communicating with patients and other providers outside of the EHR interface.

 

Supporting patient-centered care

The integrative review found that some EHR practices can contribute to “formulaic interaction styles and ‘passive’ patient engagement” when nurses focus on electronic checklists rather than the patient.

HIPAA compliant emails are proven to support patient-centered care, complementing the EHR. For example, after a consultation, a nurse could securely email a newly diagnosed HIV positive patient with educational resources and follow-up instructions, promoting ongoing engagement and support outside of the clinical setting. This allows for personalized communication that considers the patient's preferences, ultimately enhancing the overall quality of care provided.

Here, the EHR is the central record of clinical care, and HIPAA compliant email extends appropriate communication, giving the patient easily accessible information afterward.

 

Integrating Paubox email with an EHR

Healthcare organizations can integrate Paubox Email with existing EHR workflows using the Paubox Email API. When integrated with an EHR or a connected healthcare application, the API can help automate appropriate patient communications.

For example, when a nurse completes discharge documentation in an EHR, an integrated workflow could trigger a secure email containing approved discharge instructions or educational resources for a new diagnosis. Similarly, a care-management workflow could send a patient an appropriate reminder or care resource based on an event recorded in the EHR, so nurses don’t have to manually transfer information between systems.

This type of integration can help distinguish clinical documentation from patient communication. Healthcare organizations should also implement policies for determining which information belongs in the EHR, which communications can be sent via email, and when an email interaction should also be documented in the patient's record.

When appropriately integrated, Paubox Email can complement an EHR, reducing manual administrative steps nurses have to take and improving their overall workflow.

Learn more: Understanding APIs

 

FAQs

What are HIPAA compliant emails?

HIPAA compliant emails are secure email platforms that adhere to the regulations outlined in the Health Insurance Portability and Accountability Act (HIPAA) to protect patients’ protected health information (PHI).

 

Can patients request additional support or clarification via email?

Yes, patients can directly email their providers for clarification; their provider can then respond with a HIPAA compliant email, offering support while ensuring patient privacy.

 

Can HIPAA compliant emails include attachments, like medical images or documents?

Yes, HIPAA compliant emails can include attachments containing medical images, documents, or other sensitive information, protecting patient privacy and preventing unauthorized access during transmission and at rest.