Using the computer in the clinical consultation; setting the stage, reviewing, recording, and taking actions: multi-channel video study

Kumarapeli, Pushpa; Lusignan, Simon de

doi:10.1136/amiajnl-2012-001081

Cited by 70 publications

(62 citation statements)

References 52 publications

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“…While our study found higher rates of screen sharing than those reported in the literature, patients still expressed frustration when physicians were not transparent with EMR use by not allowing them to see the screen or explaining what they were doing. 30 Patients also cited poor screen positioning, body positioning and eye contact as factors contributing to perceptions of decreased quality of care and unbalanced focus, with the physician appearing more focused on the computer than the patient. Furthermore, patients expressed dissatisfaction with physicians who did not engage the EMR to discuss their health or provide education.…”

Section: Discussionmentioning

confidence: 99%

Patient Perceptions of Electronic Medical Record Use by Faculty and Resident Physicians: A Mixed Methods Study

et al. 2016

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BACKGROUND: While concerns remain regarding Electronic Medical Records (EMR) use impeding doctor-patient communication, resident and faculty patient perspectives post-widespread EMR adoption remain largely unexplored. OBJECTIVE: We aimed to describe patient perspectives of outpatient resident and faculty EMR use and identify positive and negative EMR use examples to promote optimal utilization. DESIGN: This was a prospective mixed-methods study. PARTICIPANTS: Internal medicine faculty and resident patients at the University of Chicago's primary care clinic participated in the study. APPROACH: In 2013, one year after EMR implementation, telephone interviews were conducted with patients using open-ended and Likert style questions to elicit positive and negative perceptions of EMR use by physicians. Interview transcripts were analyzed qualitatively to develop a coding classification. Satisfaction with physician EMR use was examined using bivariate statistics. RESULTS: In total, 108 interviews were completed and analyzed. Two major themes were noted: (1) Clinical Functions of EMR and (2) Communication Functions of EMR; as well as six subthemes: (1a) Clinical Care (i.e., clinical efficiency), (1b) Documentation (i.e., proper record keeping and access), (1c) Information Access, (1d) Educational Resource, (2a) Patient Engagement and (2b) Physical Focus (i.e., body positioning). Overall, 85 % (979/1154) of patient perceptions of EMR use were positive, with the majority within the BClinical Care^subtheme (n = 218). Of negative perceptions, 66 % (115/175) related to the BCommunication Functions^theme, and the majority of those related to the BPhysical Focus^subtheme (n = 71). The majority of patients (90 %, 95/106) were satisfied with physician EMR use: 59 % (63/107) reported the computer had a positive effect on their relationship and only 7 % (8/108) reported the EMR made it harder to talk with their doctors. CONCLUSIONS: Despite concerns regarding EMRs impeding doctor-patient communication, patients reported largely positive perceptions of the EMR with many patients reporting high levels of satisfaction. Future work should focus on improving doctors Bphysical focus^when using the EMR to redirect towards the patient.KEY WORDS: electronic health records; patient-centered care; physician patient relations; communication skills.

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Section: Discussionmentioning

confidence: 99%

Patient Perceptions of Electronic Medical Record Use by Faculty and Resident Physicians: A Mixed Methods Study

et al. 2016

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“…37,42,45,[51][52][53] Although many studies reported long periods of silence during the encounter, only one study actually defined it as a percentage of the interaction (12 %, mean duration 15.7 s). 47 Studies reported changes in speech style of both providers (i.e., abrupt topic shifts) 29,30,42,48,51 and patients (i.e., synchronizing speech with typing pauses).…”

Section: Characterizing Emr Communication Behaviorsmentioning

confidence: 99%

“…15,36,39,41,46,48,51,54 Four studies examined typing behaviors 33,37,42,48 and six reported on screen positioning, with only 8-10 % active screen sharing during the visit. 29,30,33,37,38,52 Interestingly, one study noted patients had a more positive attitude towards the EMR when they were shown the screen. 30 Provider multitasking was another theme that emerged, highlighting providers were unsuccessful at concentrating on complex computer interactions while attending to the patient simultaneously.…”

Section: Characterizing Emr Communication Behaviorsmentioning

confidence: 99%

Impact of Electronic Medical Record Use on the Patient–Doctor Relationship and Communication: A Systematic Review

et al. 2016

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BACKGROUND: While Electronic Medical Record (EMR) use has increased dramatically, the EMR's impact on the patient-doctor relationship remains unclear. This systematic literature review sought to understand the impact of EMR use on patient-doctor relationships and communication.METHODS: Parallel searches in Ovid MEDLINE, PubMed, Scopus, PsycINFO, Cochrane Library, reference review of prior systematic reviews, meeting abstract reviews, and expert reviews from August 2013 to March 2015 were conducted. Medical Subject Heading terms related to EMR use were combined with keyword terms identifying face-to-face patient-doctor communication. English language observational or interventional studies were included. Studies examining physician attitudes only were excluded. Structured data extraction compared study population, design, data collection method, and outcomes. RESULTS: Fifty-three of 7445 studies reviewed met inclusion criteria. Included studies used behavioral analysis (28) to objectively measure communication behaviors using video or direct observation and pre-post or crosssectional surveys to examine patient perceptions (25). Objective studies reported EMR communication behaviors that were both potentially negative (i.e., interrupted speech, low rates of screen sharing) and positive (i.e., facilitating questions). Studies examining overall patient perceptions of satisfaction, communication or the patient-doctor relationship (n=22) reported no change with EMR use (16); a positive impact (5) or showed mixed results (1). Study quality was not assessable. Small sample sizes limited generalizability. Publication bias may limit findings. DISCUSSION: Despite objective evidence that EMR use may negatively impact patient-doctor communication, studies examining patient perceptions found no change in patient satisfaction or patient-doctor communication. Therefore, our findings should encourage providers to adopt the EMR as a communication tool. Future research is needed to better understand how to enhance patientdoctor-EMR communication. This research should correlate observed physician behavior to patient satisfaction, focus on physician communication skills training, and explore inpatient experiences.

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“…This is a definite gap in research which needs to be addressed, given the eventual ubiquity of EMRs in primary health care and the need to use this technology in effective ways during patient encounters. 13,14 This study found significantly higher levels of Canadian-authored publications focused on EMR implementation and EMR use, in comparison with those authored by researchers from other countries. This may reflect a past need for Canadian researchers to study these topics, given our historical low levels of EMR adoption.…”

Section: Implications Of the Findingsmentioning

confidence: 84%

How does Canada stack up? A bibliometric analysis of the primary healthcare electronic medical record literature

Terry

Stewart

Fortin

et al. 2013

Journal of Innovation in Health Informatics

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Using the computer in the clinical consultation; setting the stage, reviewing, recording, and taking actions: multi-channel video study

Abstract: The EPR system is used for a consistent proportion of the consultation and should be designed to facilitate multi-tasking. Clinicians who want to promote screen sharing should change their consulting room layout.

Cited by 70 publications

References 52 publications

Patient Perceptions of Electronic Medical Record Use by Faculty and Resident Physicians: A Mixed Methods Study

Patient Perceptions of Electronic Medical Record Use by Faculty and Resident Physicians: A Mixed Methods Study

Impact of Electronic Medical Record Use on the Patient–Doctor Relationship and Communication: A Systematic Review

How does Canada stack up? A bibliometric analysis of the primary healthcare electronic medical record literature

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