Electronic Health Records

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EHR Use in Safety-Net Clinics Affects Patient Satisfaction

"Concurrent computer use may inhibit authentic engagement, and multitasking clinicians may miss openings for deeper connection with their patients.”

By Frank Irving

Clinicians highly connected with their electronic health records systems may inadvertently suffer an interpersonal disconnect with patients in safety-net facilities, according to a newly released study. EHR implementation may adversely affect provider-patient communications in clinics serving populations with limited health literacy and English-language skills, concludes the study report published online Nov. 30 by JAMA Internal Medicine.

Lead author Neda Ratanawongsa, MD, of the University of California, San Francisco, and colleagues analyzed clinician computer use and communication with chronic-disease patients in safety-net clinics. The study took place between 2011 and 2013 at an affiliated public hospital with a basic EHR for reviewing test results, tracking healthcare maintenance, and documentation of medications and patient referrals. The study group included 47 patients who spoke English or Spanish. The patients received primary and subspecialty care.

The researchers videotaped 71 encounters among 47 patients and 39 clinicians. The study team used the video recordings to rate (numerical scale, 1 to 12) how much each clinician used the computer during an encounter. Post-appointment interviews with patients provided a measure of their satisfaction with the quality of care they had received.

The study reported 12 of 25 patients (48 percent) who had encounters with high computer use rated their care as excellent, as compared to 16 of 19 patients (83 percent) who had encounters with low computer use. Clinicians who used the EHR heavily during encounters also engaged in more negative rapport building — correcting or disagreeing with patients, the study report says.

"High computer use by clinicians in safety-net clinics was associated with lower patient satisfaction and observable communication differences,” the report states. “Although social rapport building can build trust and satisfaction, concurrent computer use may inhibit authentic engagement, and multitasking clinicians may miss openings for deeper connection with their patients.”

Doctors fixated on a computer during an encounter may miss out on an emotional connection with the patient, according to Richard Frankel, PhD, of the Indiana University School of Medicine, who wrote an accompanying commentary.

“When people are paying attention to the same thing at the same time, you get the best transmission of information,” Frankel told Reuters Health. Doctors can use specific techniques to help patients get comfortable with it, he added. For example, Frankel advised that doctors explain to patients what they are doing on the computer and arrange the screen so it is visible to patients. Doctors should also look up frequently from the computer and make eye contact with the patient.

"The study by Ratanawongsa et al reminds us that our most vulnerable patients may be at even greater risk than others when a disproportionate amount of a physician's time is spent interacting with the computer screen and not with the patient. It is said that technology is neither good nor bad, but it is not neutral. Our challenge is to find the best ways to incorporate computers in the examination room without losing the heart and soul of medicine: the physician-patient relationship," Frankel writes in his commentary.





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