Physician interactions with electronic health records in primary care

Abstract

Objective: It is essential to design technologies and systems that promote appropriate interactions between physicians and patients. This study explored how physicians interact with Electronic Health Records (EHRs) to understand the qualities of the interaction between the physician and the EHR that may contribute to positive physician–patient interactions. Study Design: Video-taped observations of 100 medical consultations were used to evaluate interaction patterns between physicians and EHRs. Quantified observational methods were used to contribute to ecological validity. Methods: Ten primary care physicians and 100 patients from five clinics participated in the study. Clinical encounters were recorded with video cameras and coded using a validated coding methodology in order to examine how physicians interact with EHRs. Results: Three distinct styles were identified that characterize physician interactions with the EHR: technology-centered, human-centered, and mixed. Physicians who used a technology-centered style spent more time typing and gazing at the computer during the visit. Physicians who used a mixed style shifted their attention and body language between their patients and the technology throughout the visit. Physicians who used the human-centered style spent the least amount of time typing and focused more on the patient. Conclusion: A variety of EHR interaction styles may be effective in facilitating patient-centered care. However, potential drawbacks of each style exist and are discussed. Future research on this topic and design strategies for effective health information technology in primary care are also discussed.

Keywords:

• health information technology
• clinician's interactive style
• primary care
• human computer interaction

Acknowledgements

The University of Wisconsin–Madison Systems Engineering Initiative for Patient Safety (SEIPS) and the Wisconsin Research and Education Network (WREN) provided support on this project. We thank undergraduate research assistants who assisted with data analysis and graduate research assistants who assisted with data collection.

Funding Source: This publication was supported by Grant No. 1UL1RR025011 from the Clinical & Translational Science Award (CTSA) program of the National Center for Research Resources of the National Institutes of Health.

Ethics approval: This study was conducted with the approval of the University of Wisconsin-Madison Health Science Institutional Review Board.

None of the authors have any conflicts of interest that could bias this work.