Computer-Based Documentation: Effects on Parent-Provider Communication During Pediatric Health Maintenance Encounters

Johnson, Kevin B.; Serwint, Janet R.; Fagan, Lawrence M.; Thompson, Richard E.; Wilson, Michèle; Roter, Debra

doi:10.1542/peds.2007-3005

Cited by 34 publications

(35 citation statements)

References 27 publications

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“…Four studies noted that EMR use appeared to facilitate clarification, questions and discussion, as well as more open-ended questions and partnership strategies. 32,34,35,40 Specific behaviors that seemed to facilitate a more patient-centered interaction included actively inviting patients to look at the screen and using it as an educational tool (i.e., showing test results), signposting computer use, maintaining eye contact, cessation of computer use when patients spoke about sensitive or important topics, continued verbal and nonverbal cues of listening, and reading aloud while typing. 30,34,38,42,54 Additionally, being able to make computer use less obvious (i.e., typing softly, continuing to speak while typing) resulted in fewer patient speech pattern modifications.…”

Section: Characterizing Emr Communication Behaviorsmentioning

confidence: 99%

“…30,34,38,42,54 Additionally, being able to make computer use less obvious (i.e., typing softly, continuing to speak while typing) resulted in fewer patient speech pattern modifications. 29 Five studies 29,32,36,40,49 included both a pre-and a post-EMR implementation observation group; however, only two paired findings were to the same physician at both points. 29,36 Paired observations showed greater doctor preoccupation with computer use and alterations in doctor and patient speech patterns, such as delaying speech until finished with the computer.…”

Section: Characterizing Emr Communication Behaviorsmentioning

confidence: 99%

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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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Section: Characterizing Emr Communication Behaviorsmentioning

confidence: 99%

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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“…The other 3 articles (Garrison et al, 30 Hsu et al, 2 and Johnson et al 31 ) give patient satisfaction results in percentage format; that is, what percent rated their overall care as either "excellent" or "very good." Even if all 5 papers reported their results using similar statistics (such as all Likert scores), we still think that, because 2 articles sampled physicians and 3 sampled patients, the individuals cited in these articles are too different; therefore, pooling the responses from these articles would not be appropriate.…”

Section: Data Extraction and Poolingmentioning

confidence: 99%

“…Two of the 4 studies that evaluated patient satisfaction before and after EHR implementation found no effect on patient satisfaction (ie, neutral results by Johnson et al 31 and Garrison et al 30 ), whereas one found a positive result (Hsu et al 2 ) and another found a negative effect (Gadd and Penrod 29 ) (Table 3). Hsu et al 2 showed positive findings when assessing patient satisfaction 2 months before and at 1 and 7 months after EHR implementation.…”

Section: Pre/post Studies' Findingsmentioning

confidence: 99%

The Use of Electronic Health Records in the Exam Room and Patient Satisfaction: A Systematic Review

Irani¹,

Middleton²,

Marfatia³

et al. 2009

The Journal of the American Board of Family Medicine

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Background: Physicians may hesitate to implement electronic health record (EHR) systems because they fear a decrease in patient satisfaction. We conducted a systematic review to determine whether physician EHR use in the patient room affects patient satisfaction.Methods: We searched the literature using MEDLINE (Ovid), EMBASE, CINAHL, Cochrane Library, PsycINFO, Proceedings First, and ProQuest Digital Dissertations. Our inclusion criteria were a description of physician EHR use in the examination room, EHR use in an outpatient setting, setting in the United States, publication year no earlier than 2000, and measurement of patient satisfaction. We included both qualitative and quantitative research. We included 7 articles in the final analysis: 3 crosssectional, and 4 pre-design and post-design.Results: Several studies had methodological concerns. Six studies found that physician EHR use had either a positive or neutral effect on patient satisfaction. One study found a negative effect on the physicians' perception of patient satisfaction. The reported statistical results from these studies were not homogenous enough for meta-analysis. Conclusion

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“…6 We conducted a systematic literature review on the effect of the EMR on the patient-physician relationship and communication. 7 While observational studies identified behaviors that researchers believe promoted communication (i.e., clarification of information, facilitation of discussion), [8][9][10][11] potentially negative behaviors (i.e., increased speech interruption and unsuccessful physician multitasking) [12][13][14][15][16] have been noted as well. 7 A limitation of most of these studies however is their lack of correlation between researcher-observed behaviors and the patient's own experience.…”

Section: Introductionmentioning

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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Computer-Based Documentation: Effects on Parent-Provider Communication During Pediatric Health Maintenance Encounters

Abstract: The introduction of ClicTate into the health maintenance encounter positively affected several aspects of parent-clinician communication in a pediatric clinic setting. These results support the integration of computer-based documentation into primary care pediatric visits.

Cited by 34 publications

References 27 publications

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

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

The Use of Electronic Health Records in the Exam Room and Patient Satisfaction: A Systematic Review

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

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