1. Patients in clinical encounters with high clinician computer use were less likely to rate care as “excellent” as compared to encounters with low computer use.
Evidence Rating Level: 3 (Average)
Study Rundown: Electronic health records (EHR) are becoming increasingly prevalent in outpatient medical offices; but the effect of EHR on clinician-patient relationships remains controversial. Encounters at safety-net clinics that serve populations with disparities in health due to language and literacy barriers may be particularly affected by communication changes from EHR integration. The described study examined the effect of computer use on patient and clinician interactions.
Encounters with low clinician computer use had “excellent” patient-reported care ratings more often than for encounters with high computer use. High computer use was also associated with more social statements from both patients and clinicians, as well as increased number of negative rapport statements as clinicians corrected patients on errors and misunderstandings. The study does highlight some concerns with regards to increasing integration of EHR systems into clinical encounters. However, it is limited by relatively small sample size, volunteer and selection bias, changes in behavior from the lack of blinding, and inconsistent observed changes in communication styles with increasing computer use. Finally, objective measures of healthcare quality were not examined by this study and may not correlate with patient reported ratings.
Relevant Reading: The patient and the computer in the primary care consultation
In-Depth [observational study]: The described study observed 71 patient-clinician encounters for patients with chronic medical conditions seen at primary and subspecialty safety-net clinics at a single academically affiliated hospital between November 2011 and November 2013. Encounters were recorded and patients rated their medical care quality for the last 6 months. The recorded encounters were scored on computer use (rated based on amount of time reviewing computer records, eye contact, pauses, and typing/clicking the mouse), and communication.
High computer use was associated with “excellent” care ratings for 12 of 25 (45%) encounters, compared to 16 of 19 (83%) encounters with low computer use. High computer use was associated with increased patient social statements (p = 0.04), clinician negative rapport statements (p < 0.01), clinician social statements (p < 0.01), and clinician positive affect score (p < 0.01). Moderate computer use was linked to more positive rapport statements from patients (p < 0.01), and greater clinician positive affect (p = 0.02). No observed changes in patient-centeredness or verbal dominance were noted between computer use groups.
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