How do desk-top computers affect the doctor-patient interaction

Greatbatch, David; Heath, Christian; Campion, Peter; Luff, Paul

doi:10.1093/fampra/12.1.32

Cited by 141 publications

(92 citation statements)

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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). 29,30,50 Eight studies described variation in the amount and manner in which the EMR was used.…”

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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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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“…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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“…More research is needed to clarify these issues, but the concern is that the more we use the computer, the less we look at our patients, the less we say to our patients and, in particular, the less we ask about psychosocial aspects of the illness and respond to emotional aspects of their care. 17,[18][19][20] This would fit with our existing knowledge of the effect of losing eyecontact with the patient by looking at records, whether paper or computer. We know that this behaviour decreases efficiency in the consultation by reducing patient fluency and increasing the chance of doctors missing or forgetting information.…”

mentioning

confidence: 99%

Doctors'non-verbal behaviour in consultations: look at the patient before you look at the computer

Silverman

Kinnersley²

2010

Br J Gen Pract

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How do desk-top computers affect the doctor-patient interaction

Cited by 141 publications

References 0 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

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

Doctors'non-verbal behaviour in consultations: look at the patient before you look at the computer

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