This pilot study investigated nurse practitioner students' communication skills when utilizing the electronic health record during history taking. The nurse practitioner students (n = 16) were videotaped utilizing the electronic health record while taking health histories with standardized patients. The students were videotaped during two separate sessions during one semester. Two observers recorded the time spent (1) typing and talking, (2) typing only, and (3) looking at the computer without talking. Total history taking time, computer placement, and communication skills were also recorded. During the formative session, mean history taking time was 11.4 minutes, with 3.5 minutes engaged with the computer (30.6% of visit). During the evaluative session, mean history taking time was 12.4 minutes, with 2.95 minutes engaged with the computer (24% of visit). The percentage of time individuals spent changed over the two visits: typing and talking, -3.1% (P = .3); typing only, +12.8% (P = .038); and looking at the computer, -9.6% (P = .039). This study demonstrated that time spent engaged with the computer during a patient encounter does decrease with student practice and education. Therefore, students benefit from instruction on electronic health record-specific communication skills, and use of a simple mnemonic to reinforce this is suggested.

Background Providers have the important cognitive task of attending to the patient while using the electronic health record (EHR) during an office visit. Prior literature has demonstrated that the EHR has had various effects on the office visit. This study focused on providers who were medical and nurse practitioner student preceptors, to determine their perception of the EHR on multiple distinct aspects of the office visit and clinical education. Methods Utilizing survey research, provider's EHR utilization and perceptions were collected and summarized using descriptive statistics. The relationship between the time spent using the EHR and the distinct aspects of the visit was tested using Chi-square tests of association. Results Provider/preceptors (n = 83) reported a negative effect of EHR on the patient-provider connection, but a positive effect on the review of medications/ medical records, communication between providers, review of results with patients and review of follow-up to testing results with patients. We observed no correlation between the provider's time spent using the EHR and their perception of its effectiveness.Those who responded that the EHR negatively affected their ability to teach (34%) were significantly more likely to also report that the EHR negatively affected their ability to communicate with the patient while taking a history (p = 0.04). Conclusions Providers reported a positive perceived effect of the EHR on distinct aspects of the office visit, yet they also reported a negative perceived effect of EHR on patient-provider connection. Impacts on the perceived ability of some providers to teach students were also demonstrated.

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