What factors influence the use of electronic health records during the first 10 minutes of the clinical encounter?

Abstract

PurposeThe use of electronic health records (EHRs) by physicians during the consultation is common and can be problematic. Factors influencing the use of EHRs during clinical encounters include physician and patient characteristics, consultation type as well as spatial organization of the room and type of EHR template. Their relative importance is however not well known. This study aimed to explore to what extent several physician, patient and consultation factors were associated with EHR use during the first 10 minutes of primary care consultations.MethodsWe examined EHR use of 17 residents in 142 videotaped consultations at the Primary Care Division of the Geneva University Hospitals, Switzerland. We conducted univariable and multivariable analyses with patient, physician and consultation variables to predict EHR use: sex and age of the patient; physician’s sex, age, postgraduate experience and EHR-use self-perception; and language, type of consultation (new/follow-up) and content of the consultation using the Roter interaction analysis system (RIAS), the main variable being the percentage of utterances in relation to EHR use during the first 10 minutes.ResultsMale physicians (residents) and those with less clinical experience and conducting a new consultation or addressing biomedical content were positively correlated with EHR use (+5.3% for male physicians, P=0.101; +0.6% per year of experience, P=0.021; +6.0% for new consultation, P=0.097; +0.4% per 1% of biomedical content increase; P=0.018).ConclusionOnly a small number of physician, patient and consultation factors appear to have an impact on the use of EHR during primary care consultations, and this impact remains modest. Given the influence of EHR use on physician–patient relationship, further research should explore what other factors are implicated in EHR use and whether they can be changed or improved.

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

“…These variables were chosen because of their potential impact on EHR use preference. 21,42,43 We also recorded study location (hospital versus community emergency service) in order to account for potential location-related biases.…”

“…They include physicians' typing and computer skills, clinical experience, personal style of EHR use (particularly verbal and non-verbal behaviors), spatial arrangement of both the computer and the screen, and finally the design of the EHR. [17][18][19][20][21] Based on these observations, authors and experts in medical communication issued recommendations in order to facilitate patient-physician communication while using EHR during the encounter (see Box 1) 12,22,23 . These recommendations, based on principles of patient-centered approach, take into account physicians' verbal and non-verbal communication skills described in most physician-patient communication frames of reference 24,25 .…”

“…They include physicians’ typing and computer skills, clinical experience, personal style of EHR use (particularly verbal and non-verbal behaviors), spatial arrangement of both the computer and the screen, and finally the design of the EHR. 17 – 21 …”

Automatic Classification of Screen Gaze and Dialogue in Doctor-Patient-Computer Interactions: Computational Ethnography Algorithm Development and Validation

“…Chan et al [35] found that doctors spent 50% less time using computers in examinations with psychological components than in examinations with no psychological components. Lanier et al [36] found that consultation content, physicians' gender and level of experience, and whether the consultation was new or a follow-up were modestly related to the way physicians used the computer in primary care settings.…”

“…Researchers studying doctor-patient-computer interactions need to identify which interactions are taking place during the consultations. To do so, researchers have used qualitative methods such as taking notes during live observations [31,37], conducting interviews [37,38], administering questionnaires [39], and sending unannounced standardized patients to collect information [40] and quantitative methods such as videotaping consultations and manually coding the videos [36,41,42] or setting up complex mechanisms for automatic data collection and analysis inside the clinics [43]. Methods that include direct observations are likely to generate more accurate data than clinician or patient reports; however, direct observations are costly in terms of time and human resources, may be obtrusive in a clinical environment, and may cause the participants to knowingly or unknowingly alter their behavior (because of the presence of an observer) [44].…”