Electronic Health Record's Effects on the Outpatient Office Visit and Clinical Education

Marie B Sandoval, Mary Val Palumbo, Vicki Hart

Abstract


Background: During an office visit, the provider has the important cognitive task of attending to the patient while actively using the electronic health record (EHR).  Prior literature suggests that EHR may have a positive effect on simple tasks, but a negative effect on tasks that require complex cognitive processes.  No study has examined the provider’s perception of EHR on multiple distinct aspects of the office visit.

Methods: We surveyed providers/preceptors regarding their perception of EHR on multiple aspects of the office visit.  We summarized their EHR utilization history and their perceptions of the EHR during the visit using descriptive statistics.  We tested for associations between time spent using the EHR and distinct aspects of the visit using Chi-square tests of association.

Results: In total, 83 providers/preceptors reported use of EHR (response rate 52%). Provider/preceptors reported an overall negative effect of EHR on the patient-provider connection, but an overall positive effect on the review of medications/medical records, communication between providers, review of results with patients and review of follow-up to testing results with patients. The effect of EHR on history taking and teaching students was neutral.  We observed no correlation between the provider’s time spent using the EHR and their perception of its effectiveness.

Conclusions:  Providers reported a positive perception of EHR on aspects of the office visit that involved a single cognitive task.  However, providers reported a negative perception of EHR on patient-provider connection, which involves a high degree of cognitive processing.


Keywords


electronic health record effects, outpatient office visit, patient-provider connection, student education, EHR specific communication skills

Full Text:

PDF HTML

References


References

Sinsky, C.A. and Beasley, J. Texting while driving: a patient safety hazard. Annals of Internal Medicine 2013;159 (11):782-3.

Hayrinen K, Saranto K, Nykanen P. Definition, structure, content, use and impact of electronic health records: a review of the research literature. International Journal of Medical Informatics 2007;77(5) 291-304.

Karsh B, Holden RJ, Alper S, Scanlon MC, et al. A human factors engineering paradigm for patient safety-designing to support the performance of the health care professional. Qual Saf Health Care 2006;15:i59-i65.

Holden, RJ. Social and personal normative influences on healthcare professionals to use information technology: towards a more robust social ergonomics. Theoretical Issues in Ergomics Science 2011;13(5):1-24.

Frankel R, Altschuler A, George S, et al. Effects of Exam-Room computing on clinician-patient communication: a longitudinal qualitative study. J Gen Intern Med 2005;20(8):677-682.

Margalit RS, Roter D, Larson S, Reis S. Electronic medical record use and physician-patient communication: an observational study of israeli primary care encounters. Patient Educ and Couns 2006;61(1):134-141.

Lown B. Rodriguez BA. Lost in translation? how electronic health records structure communication, relationships, and meaning. Acad Med 2012; 87(4):392-394.

Shachak A, Hadas-Dayagi M, Ziv A, Reis S. Primary care physicians' use of an electronic medical record system: a cognitive task analysis. J Gen Int Med 2009; 24(3):341-8.

Spencer DC, Choi D, English C, Girard D. The effects of electronic health record implementation on medical student educators. Teaching Learn Med 2012; 24(2):106-110.

Morrow J, Dobbie A, Jenkins C, et al. First-year medical students can demonstrate EHR-specific communications skills: a control-group study. Family Medicine 2010;41(1):28-33.

White A, Danis M. Enhancing patient-centered communication and collaboration by using the electronic health record in the examincation room. JAMA 2013;309(22):2327-2328.

Asan O, Montague E. Physician interactions with electronic health records in primary care. Health Systems 2012;1-8.

Rouf E, Whittle J, Lu N, Schwartz MD. Computers in the exam room: difference in physician-patient interactions may be due to physician experience.

J Gen Intern Med 2007;22(1):43-8.

Kaiser Permanente. (2011). Physician Exam Room EHR Etiquette.

http://www.youtube.com/watch?feature=player_detailpage&v=LZAqeJtpzEY




DOI: http://dx.doi.org/10.14236/jhi.v23i4.151

Refbacks

  • There are currently no refbacks.


This is an open access journal, which means that all content is freely available without charge to the user or their institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal starting from Volume 21 without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open accessFor permission regarding papers published in previous volumes, please contact us.

Privacy statement: The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.

Online ISSN 2058-4563 - Print ISSN 2058-4555. Published by BCS, The Chartered Institute for IT