PURPOSELittle is known about the effects of the electronic health record (EHR) on physician-patient encounters. The objectives of this study were to identify the factors that infl uence the manner by which physicians use the EHR with patients. METHODSThis ethnographic study included 4 qualitative components: 80 hours of participant observation in 4 primary care offi ces in the Pacifi c Northwest; individual interviews with 52 patients, 12 offi ce staff members, 23 physicians, and 1 nurse-practitioner; videotaped reviews of 29 clinical encounters; and 5 focusgroup interviews with physicians and computer advocates. The main outcome measures were factors that infl uence how physicians use the EHR. Researchers qualitatively derived these factors through serial reviews of data. RESULTSThis study identifi ed 14 factors that infl uence how EHRs are used and perceived in medical practice today. These factors were categorized into 4 thematic domains: (1) spatial-effect of the physical presence and location of EHRs on interactions between physicians and patients; (2) relational-perceptions of physicians and patients about the EHR and how those perceptions affected its use; (3) educational-issues of developing physicians' profi ciency with and improving patients' understandings about EHR use; and (4) structural-institutional and technological forces that infl uence how physicians perceived their use of EHR.CONCLUSIONS This study found that the introduction of EHRs into practice infl uences multiple cognitive and social dimensions of the clinical encounter. It brings into focus important questions that through further inquiry can determine how to make best use of the EHR to enhance therapeutic relationships. INTRODUCTIONT he electronic health record (EHR) is a new technology touted as a standard of practice for American medicine in the 21st century. 1,2 This technology brings the medical record and health information into the examination room through computer hardware and software, patient education materials, and Internet search capabilities. Several authorities endorse the transition to EHRs and promote a technologybased information infrastructure that eliminates handwritten clinical data within 10 years. 3,4 Numerous authors have discussed the theoretical benefi ts of computers in clinical practice, 1,[5][6][7] and differences exist when comparing the use of EHRs with paper charts. 7,8 Although these differences have not been found to affect patient satisfaction, 9-11 little else is known about the effects of this technology on physician-patient encounters.Studies examining clinical encounters with EHRs suggest that physicians using EHRs preferentially structure interviews around data-gathering demands rather than patients' own narratives. 12,13 Recent data, however, suggest that this pattern relates more to physician style than to EHR use alone.14 Physicians using EHRs also engage in a variety of computer-related The purpose of this work was to explore how EHRs affect the encounters between physicians and thei...

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Community-based participatory research (CBPR) and interpretive phenomenology, when merged, can provide insight into the experiences of a homogenous community. The purpose of this manuscript is 2-fold. First, we aim to provide a conceptual view of merging methodological approaches of phenomenology and CBPR. Principles of interpretive phenomenology, the philosophical stance, and the qualitative analysis methodology, as well as how interpretive phenomenology is complementary to CBPR, are reviewed. Second, the utility, rationale, and feasibility of merging these diverse approaches are explored. For illustrative purposes, exemplars from a Parkinson’s disease stakeholder study are used to discuss aims, methods, and results. Focus group data collection strategies and the use of Template Analysis as an analytic tool are also described. Themes that materialized from the data focused on support group experiences for this rural community. In keeping with interpretive phenomenology, the researchers’ interpretation of these themes led to the understanding of an overall essence, or essential theme, of this community’s lived experiences.

Knowledge of the patient's perspective on medical error is limited. Research efforts have centered on how best to disclose error and how patients desire to have medical error disclosed. On the basis of a qualitative descriptive component of a mixed method study, a purposive sample of 30 community members told their stories of medical error. Their experiences focused on lack of communication, missed communication, or provider's poor interpersonal style of communication, greatly contrasting with the formal definition of error as failure to follow a set standard of care. For these participants, being a patient was more important than error or how an error is disclosed. The patient's understanding of error must be a key aspect of any quality improvement strategy.