to construct 3 categories of mammogram history: (1) never had a mammogram, (2) had over a year ago, and (3) had less than a year ago. We tested for differences in importance evaluations by mammogram history using ordered logit regression. Analyses applied the GfK survey weights to adjust for nonresponse bias and panel nonresponse to produce nationally-representative estimates. The study was determined to be exempt from review by the University of Minnesota institutional review board.Results | Fifty-eight (14.2%) participants reported never having a mammogram, 197 (56.4%) reported having a mammogram within the past year, and 103 (29.4%) reported having a mammogram less recently. Nearly all respondents (366, >90% for each) were aware of 4 statements describing mammography benefits (Table 1). When asked to rate their importance, most (223 [54.8]) concluded that each benefit was "very important." Respondents' awareness of harms, however, was much more variable (Table 2). Although only 108 (26.5%) reported prior awareness of overdiagnosis and 161 (39.7%) of overtreatment, 305 (74.9%) were aware of false-positive results and the potential of psychological distress. In contrast to their evaluations of benefits, fewer women rated harms as very important, ranging from 61 (15.1%) (health care system costs) to 117 (28.7%) (overtreatment). There were no statistically significant differences in awareness or ratings of importance by age group (40-49 years vs 50-59 years).Women who reported having a mammogram within the past year were significantly more likely to rate all 4 benefits as very important, compared with those who who never had a mammogram (62.4%-74.9% vs 44.9%-58.0%; differences significant at P<.05). Women who reported having a mammogram within the past year were significantly less likely to rate health care system costs and radiation harms as very important compared with those who never had a mammogram (11.5% and 15.1% vs 22.9% and 25.7%; differences significant at P<.05).Discussion | Women are more aware of the benefits of mammography screening than the harms, and women who have recently undergone mammography are more likely to judge these benefits as important. This may be owing to a lack of balanced information from physicians, 5 public health officials, news media, and disease advocacy groups that have long emphasized screening's benefits. Our findings suggest that there are opportunities for targeted education and communication at both the general public and individual levels, with a focus on educating women on the harms of screening, which they are much more likely to experience than benefits. However, the fact that women are predisposed to consider benefits as more important than harms poses a challenge to informed decision making about screening, suggesting the need for new paradigms in communicating the cumulative risks of the benefits and harms.

BackgroundClinicians’ use of electronic health record (EHR) systems while multitasking may increase the risk of making errors, but silent EHR system use may lower patient satisfaction. Delaying EHR system use until after patient visits may increase clinicians’ EHR workload, stress, and burnout.ObjectiveWe aimed to describe the perspectives of clinicians, educators, administrators, and researchers about misses and near misses that they felt were related to clinician multitasking while using EHR systems.MethodsThis observational study was a thematic analysis of perspectives elicited from 63 continuing medical education (CME) participants during 2 workshops and 1 interactive lecture about challenges and strategies for relationship-centered communication during clinician EHR system use. The workshop elicited reflection about memorable times when multitasking EHR use was associated with “misses” (errors that were not caught at the time) or “near misses” (mistakes that were caught before leading to errors). We conducted qualitative analysis using an editing analysis style to identify codes and then select representative themes and quotes.ResultsAll workshop participants shared stories of misses or near misses in EHR system ordering and documentation or patient-clinician communication, wondering about “misses we don’t even know about.” Risk factors included the computer’s position, EHR system usability, note content and style, information overload, problematic workflows, systems issues, and provider and patient communication behaviors and expectations. Strategies to reduce multitasking EHR system misses included clinician transparency when needing silent EHR system use (eg, for prescribing), narrating EHR system use, patient activation during EHR system use, adapting visit organization and workflow, improving EHR system design, and improving team support and systems.ConclusionsCME participants shared numerous stories of errors and near misses in EHR tasks and communication that they felt related to EHR multitasking. However, they brainstormed diverse strategies for using EHR systems safely while preserving patient relationships.

Background Safety-net systems serve patients with limited health literacy and limited English proficiency (LEP) who face communication barriers. However, little is known about how diverse safety-net patients feel about increasing clinician electronic health record (EHR) use. Objective The aim of this study was to better understand how safety-net patients, including those with LEP, view clinician EHR use. Methods We conducted focus groups in English, Spanish, and Cantonese (N=37) to elicit patient perspectives on how clinicians use EHRs during clinic visits. Using a grounded theory approach, we coded transcripts to identify key themes. Results Across multiple language groups, participants accepted multitasking and silent clinician EHR use if focused on their care. However, participants desired more screen share and eye contact, especially when demonstrating physical concerns. All participants, including LEP participants, wanted clinicians to include them in EHR use. Conclusions Linguistically diverse patients accept the value of EHR use during outpatient visits but desire more eye contact, verbal warnings before EHR use, and screen-sharing. Safety-net health systems should support clinicians in completing EHR-related tasks during the visit using patient-centered strategies for all patients.

BackgroundSafety net health systems face barriers to effective ambulatory medication reconciliation for vulnerable populations. Although some electronic health record (EHR) systems offer safety advantages, EHR use may affect the quality of patient-provider communication.ObjectiveThis mixed-methods observational study aimed to develop a conceptual framework of how clinicians balance the demands and risks of EHR and communication tasks during medication reconciliation discussions in a safety net system.MethodsThis study occurred 3 to 16 (median 9) months after new EHR implementation in five academic public hospital clinics. We video recorded visits between English-/Spanish-speaking patients and their primary/specialty care clinicians. We analyzed the proportion of medications addressed and coded time spent on nonverbal tasks during medication reconciliation as “multitasking EHR use,” “silent EHR use,” “non-EHR multitasking,” and “focused patient-clinician talk.” Finally, we analyzed communication patterns to develop a conceptual framework.ResultsWe examined 35 visits (17%, 6/35 Spanish) between 25 patients (mean age 57, SD 11 years; 44%, 11/25 women; 48%, 12/25 Hispanic; and 20%, 5/25 with limited health literacy) and 25 clinicians (48%, 12/25 primary care). Patients had listed a median of 7 (IQR 5-12) relevant medications, and clinicians addressed a median of 3 (interquartile range [IQR] 1-5) medications. The median duration of medication reconciliation was 2.1 (IQR 1.0-4.2) minutes, comprising a median of 10% (IQR 3%-17%) of visit time. Multitasking EHR use occurred in 47% (IQR 26%-70%) of the medication reconciliation time. Silent EHR use and non-EHR multitasking occurred a smaller proportion of medication reconciliation time, with a median of 0% for both. Focused clinician-patient talk occurred a median of 24% (IQR 0-39%) of medication reconciliation time. Five communication patterns with EHR medication reconciliation were observed: (1) typical EHR multitasking for medication reconciliation, (2) dynamic EHR use to negotiate medication discrepancies, (3) focused patient-clinician talk for medication counseling and addressing patient concerns, (4) responding to patient concerns while maintaining EHR use, and (5) using EHRs to engage patients during medication reconciliation. We developed a conceptual diagram representing the dilemma of the multitasking clinician during medication reconciliation.ConclusionsSafety net visits involve multitasking EHR use during almost half of medication reconciliation time. The multitasking clinician balances the cognitive and emotional demands posed by incoming information from multiple sources, attempts to synthesize and act on this information through EHR and communication tasks, and adopts strategies of silent EHR use and focused patient-clinician talk that may help mitigate the risks of multitasking. Future studies should explore diverse patient perspectives about clinician EHR multitasking, clinical outcomes related to EHR multitasking, and human factors and systems engineerin...