How Do Patients Want Us to Use the Computer During Medical Encounters?—A Discrete Choice Experiment Study

Abstract

Background Primary care physicians (PCPs) now widely use electronic health records (EHRs) during medical encounters. Experts in clinical communication issued recommendations for a patient-centered use of EHRs. However, they have never been validated by patients themselves. Objective To explore patients’ preferences regarding physicians’ EHR-related behaviors. Design Discrete choice experiment study. Patients French-speaking patients waiting for a medical consultation at two outpatient clinics in Geneva, Switzerland. Main Measures We invited patients to watch videos displaying 2 or 3 variations of four specific EHR-related behaviors and asked them to indicate which one they preferred. EHR-related behaviors were (1) typing: continuous/intermittent/handwriting in biomedical or psychosocial focused consultations; (2) maintaining contact while typing: visual/verbal/both; (3) signposting the use of EHR: with/without; (4) position of physicians’ hands and bust: on the keyboard and towards the patient/away from the keyboard and towards the patient/on the keyboard and towards the screen. Key Results Three hundred thirty-six patients participated (response rate 61.4%). They preferred intermittent typing versus handwriting or continuous typing for biomedical issues (32.7%; 95% CI: 26.0–40.2% vs 31.6%; 95% CI: 24.9–39.0% or 14.9%; 95% CI: 10.2–21.1%) and psychosocial issues (38.7%; 95% CI: 31.6–46.3% vs 24.4% 95% CI: 18.4–31.5% or 17.9%; 95% CI; 12.7–24.4%). They favored visual and verbal contact (38.9%; 95% CI: 31.9–46.3%) over verbal (30.3%; 95% CI: 23.9–37.5%) or visual contact only (11.4%; 95% CI: 7.5–17.1%) while the doctor was typing. A majority preferred signposting the use of EHR versus no signposting (58.9%; 95% CI: 53.5–64.0% vs 34.8%; 95% CI: 29.9–40.1%). Finally, half of the patients (49.7%; 95% CI: 42.0–57.4%) favored the position with the physician’s bust towards the patient and hands away from the keyboard. Conclusions Our study shows that patients’ preferences regarding EHR-related behaviors are in line with most experts’ recommendations. Such recommendations should be more consistently integrated into under- and postgraduate communication skills training.

How to ‘Google’ in front of the patient: A practical approach to information seeking during the consultation

“…11 Patients are generally interested in knowing what a doctor is doing on the computer and appreciate screen sharing. 10,12,13 Sharing the computer screen has been reported to increase collaborative decision making and trust. 14 When it comes to information seeking, optimising the physical layout of the consultation room to facilitate patient interaction with the computer can allow patients to engage with the process and have greater ownership over the information found.…”

“…10 A doctor using a computer in the consultation room without adequate care can lead to clinician distraction, amplification of poor communication styles and loss of rapport. 13 Patients request that prior to accessing information a doctor must first 'earn the right' to turn to a resource. This 'right' is earned through assessing the patient thoroughly and focusing attention actively before seeking information.…”

“…Signposting through honest declaration of uncertainty is most valued when accompanied by confidence in finding an acceptable answer (see Box 3). 10,13 It is better to be aware of and comfortable with the gap in knowledge and show confidence in seeking an answer than to feign knowledge, which will erode trust.…”

Evaluation of Eye Gaze Dynamics During Physician-Patient-Computer Interaction in Federally Qualified Health Centers: Systematic Analysis

“…At the same time, physicians were in charge of the consultation flow by trying to involve the patients in the conversation while working on computers [ 23 ]. Furthermore, another study explored patients’ opinions regarding physicians’ interaction with the EHR by involving patients in watching videos depicting EHR-related activities and asking them about their thoughts on the matter [ 24 ]. The study found that most patients preferred physicians who talk and look at them while typing.…”

Transforming primary healthcare through natural language processing and big data analytics

“…Reducing administrative burdens by implementing NLP derived dictation tools would aid a long desired return to patient centred consultations 56. Furthermore, documenting in electronic health records was found to take up more than half of a general practitioner’s workday; many feel these time constraints impede provision of holistic care 5.…”