Perspectives of English, Chinese, and Spanish-Speaking Safety-Net Patients on Clinician Computer Use: Qualitative Analysis

Abstract

Background Safety-net systems serve patients with limited health literacy and limited English proficiency (LEP) who face communication barriers. However, little is known about how diverse safety-net patients feel about increasing clinician electronic health record (EHR) use. Objective The aim of this study was to better understand how safety-net patients, including those with LEP, view clinician EHR use. Methods We conducted focus groups in English, Spanish, and Cantonese (N=37) to elicit patient perspectives on how clinicians use EHRs during clinic visits. Using a grounded theory approach, we coded transcripts to identify key themes. Results Across multiple language groups, participants accepted multitasking and silent clinician EHR use if focused on their care. However, participants desired more screen share and eye contact, especially when demonstrating physical concerns. All participants, including LEP participants, wanted clinicians to include them in EHR use. Conclusions Linguistically diverse patients accept the value of EHR use during outpatient visits but desire more eye contact, verbal warnings before EHR use, and screen-sharing. Safety-net health systems should support clinicians in completing EHR-related tasks during the visit using patient-centered strategies for all patients.

Scenario-based design for a hospital setting: An exploratory study of opportunities and barriers for personal health records usage

“…12 Like others, we observed how electronic systems can aid to enhance communication between patients and healthcare professionals but might move focus from the patient to the screen and reduce eye contact. 13 Recording of urgent information was slowed down by the electronic system. This is consistent with the literature; clinicians Personal health records in hospital perceive computer systems as slower than their previous practice and have implemented extensive workarounds including the usage of medical scribes.…”

Impact of an Educational Comic to Enhance Patient-Physician–Electronic Health Record Engagement: Prospective Observational Study (Preprint)

“…Electronic health record (EHR) use in clinical care has become the norm in the United States [1][2][3]. Studies on the impact of EHR use have found that certain physician behaviors (eg, poor eye contact, long silences) may lead to decreased patient satisfaction with the patient-physician relationship and communication [4][5][6][7][8][9][10][11]. While studies show there are certain patient-centered care behaviors that can positively impact patient satisfaction and health outcomes, with Table 1 serving as a model for incorporating many evidence-based behaviors, physicians are faced with the challenge of staying focused on their patients while efficiently navigating the EHR during clinical encounters [4,6,[12][13][14][15][16][17][18][19][20].…”