Computers in the clinical encounter: a scoping review and thematic analysis

Crampton, Noah; Reis, Shmuel; Shachak, Aviv

doi:10.1093/jamia/ocv178

Cited by 108 publications

(128 citation statements)

References 65 publications

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“…However, concerns have arisen about the impact of EMRs on patient-physician relationships [3][4][5] and on the clerical burden for providers. 6 -8 Concerns regarding the impact of EMR use on patientphysician relationships have centered on the computer's negative influence on patient centeredness during the clinical encounter.…”

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confidence: 99%

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Impact of Medical Scribes in Primary Care on Productivity, Face-to-Face Time, and Patient Comfort

et al. 2018

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Background: Medical scribes are a clinical innovation increasingly being used in primary care. The impact of scribes in primary care remain unclear. We aimed to examine the impact of medical scribes on productivity, time spent facing the patient during the visit, and patient comfort with scribes in primary care.Methods: We conducted a prospective observational pre-post study of 5 family and internal medicine-pediatrics physicians and their patients at an urban safety net health clinic. Medical scribes accompanied providers in the examination room and documented the clinical encounter. After an initial phase-in period, we added an additional 20-minute patient slot per 200-minute session. We examined productivity by using electronic medical record data on the number of patients seen and work relative value units (work RVUs) per hour. We directly observed clinical encounters to measure the amount of time providers spent facing patients and other visit components. We queried patient comfort with scribes by using surveys administered after the visit.Results: Work RVUs per hour increased by 10.5% from 2.59 prescribe to 2.86 post-scribe (P < .001). Patients seen per hour increased by 8.8% from 1.82 to 1.98 (P < .001). Work RVUs per patient did not change. After scribe implementation, time spent facing the patient increased by 57% (P < .001) and time spent facing the computer decreased by 27% (P ‫؍‬ .003). The proportion of the visit time that was spent face-to-face increased by 39% (P < .001). Most (69%) patients reported feeling very comfortable with the scribe in the room, while the proportion feeling very comfortable with the number of people in the room decreased from 93% to 66% (P < .001).Conclusions: Although the full implications of medical scribe implementation remain to be seen, this initial study highlights the promising opportunity of medical scribe implementation in primary care. (J Am Board Fam Med 2018;31:612-619.)

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confidence: 99%

“…6 -8 Concerns regarding the impact of EMR use on patientphysician relationships have centered on the computer's negative influence on patient centeredness during the clinical encounter. [3][4][5] In addition, an unintended consequence of EMRs has been an increase in the clerical burden for practitioners, particularly for primary care providers (PCPs).…”

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confidence: 99%

Impact of Medical Scribes in Primary Care on Productivity, Face-to-Face Time, and Patient Comfort

et al. 2018

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“…First, we identified “sentence” as the unit of analysis/meaning, which identifies the level of the detail in the analysis. 21 Second, each transcript was reviewed several times to make sense of the data. Third, the entire team reviewed the initial 4 interviews for emergent codes and developed memos and preliminary interpretations.…”

Section: Methodsmentioning

confidence: 99%

“…19,20 With the increased use and capabilities of EHRs and attention on patient centered care, the role of EHRs on patient centered care and patient engagement have become more notable. 21 Recent studies have increasingly focused on how EHR should be used and designed in more patient-centered ways. 22 Some of the studies have reported that EHR should be used as a communication and patient education tool (i.e.…”

Section: Introductionmentioning

confidence: 99%

Capturing the patients’ voices: Planning for patient-centered electronic health record use

Asan

Tyszka

Fletcher

2016

International Journal of Medical Informatics

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Objectives To understand 1) the perceptions of patients regarding use of EHR during clinic visits, 2) the impact of the presence of EHR on patient interactions with physicians, and 3) the ways in which EHR usage might increase patient engagement. Methods We conducted semi-structured interviews of a convenience sample of patients of internal medicine resident doctors from three primary care clinics. Interviews were audio-recorded and transcribed verbatim. We used thematic analysis to identify themes from the transcripts. Informed consent was obtained from each participant. Results We interviewed 32 patients; 37.5% male. Our analysis revealed three primary themes: (1) the views and beliefs of patients on the use of EHR in clinics, (2) patients' perception of the communication skills of residents, and (3) patients' perceptions about information sharing, patient engagement, and health education related to the EHR. An invitation to patients to view the screen as the physician interprets its content increases patient satisfaction and understanding. Residents' possessed skills in communication is not impeded when using EHR. Conclusion Patients generally express a positive or neutral perception of EHR use during clinic visits. Using information voiced by patients, we can teach health providers EHR strategies that are likely to engage patients in the visit and engender their trust.

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“…The EHR improves the quality of biomedical data gathering and reduces the number of medical errors [8–13]. It also facilitates the sharing of medical information with the patient [14–16].…”

Section: Introductionmentioning

confidence: 99%

Learning to use electronic health records: can we stay patient-centered? A pre-post intervention study with family medicine residents

et al. 2017

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BackgroundThe Electronic Health Record (EHR) is now widely used in clinical encounters. Because its use can negatively impact the physician-patient relationship, several recommendations on the “patient-centered” use of the EHR have been published. However, the impact of training to improve EHR use during clinical encounters is not well known. The aim of this study was to assess the impact of training on residents’ EHR-related communication skills and explore whether they varied according to the content of the consultation.MethodsWe conducted a pre-post intervention study at the Primary Care Division of the Geneva University Hospitals, Switzerland. Residents were invited to attend a 3-month training course that included 2 large group sessions and 2–4 individualized coaching sessions based on videotaped encounters. Outcomes were: 1) residents’ perceptions regarding the use of EHR, measured through a self-administered questionnaire and 2) objective use of the EHR during the first 10 min of patient encounters. Changes in practice were measured pre and post intervention using the Roter interaction analysis system (RIAS) and EHR specific items.ResultsSeventeen out of 27 residents took part in the study. Participants used EHR in about 30% of consultations. After training, they were less likely to consider EHR to be a barrier to the physician-patient relationship, and felt more comfortable using the EHR. After training, participants increased the use of signposting when using the EHR (pre: 0.77, SD 1.69; post: 1.80, SD3.35; p 0.035) and decreased EHR use when psychosocial issues appeared (pre: 24.5% and post: 9.76%, p < 0.001).ConclusionsThis study suggests that training can improve residents’ EHR-related communication skills, especially in situations where patients bring up sensitive psychosocial issues. Future research should focus on patients’ perceptions of the relevance and usefulness of such skills.

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Computers in the clinical encounter: a scoping review and thematic analysis

Abstract: In contrast to the common negative views of HIT, it affects the clinical encounter in multiple ways. By applying identified strategies and best practices, HIT can support patient-clinician interactions rather than interfering with them.

Cited by 108 publications

References 65 publications

Impact of Medical Scribes in Primary Care on Productivity, Face-to-Face Time, and Patient Comfort

Impact of Medical Scribes in Primary Care on Productivity, Face-to-Face Time, and Patient Comfort

Capturing the patients’ voices: Planning for patient-centered electronic health record use

Learning to use electronic health records: can we stay patient-centered? A pre-post intervention study with family medicine residents

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