By Matt Kronberg, MDiv, BCC
Imagine leaving a hospital room and then charting about the patient “not coping effectively with grief” after the recent loss of their spouse. An hour later you are called back and see the patient sitting up, iPad in hand, reading your spiritual assessment in the electronic medical record.
It could happen. The technology is here — and patients’ health information is in their control.
The patient is now a key member of our documentation audience, and we must adapt. With the emphasis on patient experience and caring beyond the hospital walls, we must consider what instant chart access means for spiritual care. Our audience has expanded to include patients and families, nurses and therapists, case managers and social workers, physicians and post-acute care specialists. This new ministry landscape holds many opportunities and challenges.
The work to improve spiritual assessments in the EMR is not easy. In recent years I’ve worked with spiritual care leaders and clinical informaticists in our system, and we have made great design and process improvements. But there is more difficult work to do. Reaching consensus among chaplains in diverse clinical settings, working within both budgetary and software limitations, and figuring out how to communicate across the continuum of care is a formidable challenge.
But I don’t wish to focus on the challenges. Instead I wish to foster a vision and begin a conversation, raising awareness about the importance of communication and design in our field. The iPhone highlights how design, technology, and communication are inseparable. It isn’t enough to learn the technology; we must learn the art of communication within the new medium.
The famous words of Marshall McLuhan remind us, and perhaps warn us, that “the medium is the message.” Our tablets and devices that are now linked to our EMRs convey a message to patients and shape their experience. A medium that allows the patient to immediately view a record of a very personal, and hopefully supportive, spiritual care assessment (accessible to dozens on the medical team) may not always be welcomed. Might spiritual assessments themselves — especially if not written and designed well — now cause a level of distress? It could be, but it does not have to be.
There is a “Seinfeld” episode where Elaine’s physician writes in her medical chart that she is “difficult.” After changing doctors, she is dismayed to see her new doctor frown as he reviews her old, recently transferred chart. Elaine is unable to escape one clinician’s judgmental assessment — an assessment that clearly didn’t enhance her patient experience. With this new technology, providing empathetic spiritual care for patients and families is not enough; now our EMRs and assessments must also communicate kindness and dignity.
Opportunities for Further Thought:
- How do we move our profession forward if EMRs don’t communicate nuance across the continuum of care?
- How do we balance many chaplains’ preference for narrative with the challenge narrative presents in some research designs?
- How does real-time access to the EMRs affect design, narrative, and the visual representation of assessments? What impact might this have on professional training in spiritual care?
- What do we need to grapple with as a profession and as healing institutions to make spiritual care assessments that are professionally sound, effective, and safe?
- What design elements capture the nuances of a person’s culture and spirituality in electronic form? How might design improve both the patient’s health outcome and experience?
- Does the benefit of access to data for population health outweigh the value of patient privacy as we have understood it historically? What about spiritual privacy? How do we balance the need for a holistic approach to interdisciplinary communication with the vital need to maintain a relationship of trust, dignity, and kindness?
- How do we move beyond our spiritual care discipline and influence whole-person care among all clinicians? How can the EMR spur greater spiritual and emotional support for patients and families from physicians and other caregivers?
A chaplain mentor once told me, “Write your assessments as if the patient is reading over your shoulder.” This image should guide us, encouraging us to ask: What are we communicating? Is it necessary? Encouraging? Useful for healing? Embracing new technology may lead to new approaches: ones that leave the patient with practical tools for spiritual growth, that encourage hopefulness, or that give a focus or new direction. The goal, as always, would be to enhance the well-being of the patient. Our visits and the spiritual assessments we leave with them (in the EMR and on their tablets) could ideally be key to their healing as they transition home.
This new landscape presents an opportunity to make a greater impact on the patient — to improve patient experience, enhance outcomes, and weave the influence of spiritual care throughout the continuum of care. In addition to using presence and conversation, prayer and sacraments, listening and kindness, we now have a medium that opens the possibility of real-time encouragement and spiritual influence.
As the Ethical and Religious Directives highlight, the foundation of a healing relationship is trust. In a world with so much distrust, how can we make spiritual assessments that both respect a patient’s dignity and foster trust? Part of the answer is by improving how spiritual assessments are designed and used. I believe our charting should increasingly be characterized by:
- clarity, brevity, and professionalism
- empathy, dignity, and kindness
- sincerity, confidentiality, and acceptance
- being effective, encouraging, and educational
Progress in electronic charting is rarely fast — especially with the challenges before us. By focusing on design coupled with empathetically effective assessments, I believe we can make a larger impact. As health information shifts into the hands of the individual, my hope is that improving spiritual assessments will support healing, advance our field, and further our influence in the hospital and beyond.
Rev. Matt Kronberg, BCC, is director of spiritual care for the Dignity Health Central Coast Service Area in Santa Barbara County. A special thank you to the Rev. Tom Harshman for his contribution to this article.