Article Figures & Data
Figures
- Figure 1.
Themes and factors influencing electronic health record (EHR) use and physician-patient encounters.
Tables
Primary Site Secondary Sites Characteristic A B C D Note: all clinics used a Logician (Windows-based) brand EHR from GE Medical Systems Information Technologies, Hillsboro, Ore: http://www.medicalogic.com/index.html. FP = family physician; FNP = family nurse-practitioner; EHR = electronic health record. Functions: AC = automated charting; VR = voice recognition (trial only); R = computerized referrals; MM = mobile examination room monitor; FS = flat screen monitor; IE = internal electronic mail; HI = home Internet ; MC = mixed (paper and automated) charting; D = dictation commonly used; FM = fixed monitor; B = computerized billing; EE = external electronic mail (with patients). *Including videotaped and participant observations. Clinic Location Urban Urban Suburban/Rural Urban Encounters observed 52 14 10 5 Physicians Professional status 5 FPs,1 FNP 8 FPs,1 FNP 4 FPs 5 Internists No. observed 6 4 3 3 Age range, y 36 – 48 33 – 53 34 – 40 33 – 48 Years of post-training 6 – 18 3 – 20 5 – 8 2 – 19 Years experience with EHRs 2 – 6 3 – 7 4 – 6 2 – 9 Self-reported EHR skill level average, above average, or excellent All All All All Patients Age range 18 mo – 94 y 5 mo – 70 y 4 mo – 64 y 31 – 64 y Male, % 44 7 40 20 Female, % 56 93 60 80 Patient complaint Urgent, % 52 36 44 60 Chronic, % 48 64 56 40 EHR functions available AC, VR, R, MM, FS, IE, HI MC, D, R, FM, IE, HI MC, R, FM, IE, HI AC, R, B, MM, FS, IE, EE, HI Individual Interviews April–July 2001* August–October 2003† Method In-Depth Brief Videotaped Encounters August–September 2003† Focus Group Interviews April–July 2001* August–October 2003† Participant Observation April–July 2001* August–October 2003† * Research conducted at primary office site, A. † Research conducted at all office sites, A – D. Participants Site = Clinic A Physicians = 3 (n = 15) Offices = 1 primary, 3 secondary Physicians 8 15 Total encounters = 29 Early advocates = 1 (n = 6) Patients 1 42 No. of physicians = 6 Resident physicians = 1 (n = 6) Clinical encounters = 52 Office staff 4 5 Encounters/physician = 4–5 Approximate duration 1 h 10 min Duration = range 1.5–27.8 min, mean 16.9 min Duration = 1 h Duration = 80 h Data Type Analysis Activity Conducted Concurrently Process Audiotaped individual and focus-group interviews Step 1 Reviewed transcripts and field notes independently Emergent factors highlighted Illustrative quotations recorded Step 2 Discussed factors and themes jointly Identified data to confirm or refute interpretations Interpretations agreed upon by consensus Themes categorized using iterative process Videotapes Step 1 Reviewed videotapes independently Noted characteristic practice behaviors Identified factors and themes Step 2 Reviewed representative videotaped visits jointly Shared independent interpretations Interpretations agreed upon by consensus Step 3 Reviewed notes and transcripts of the post-videotape physician interviews and questionnaires Shared independent interpretations Interpretations agreed upon by consensus Written notes from fieldwork and brief interviews Step 1 Reviewed all notes from observations and nontranscribed interviews independently Emergent factors highlighted Step 2 Reviewed notes jointly Interpretations agreed upon by consensus Themes categorized using iterative process Thematic results Step 1 Results reviewed with medical anthropologist in serial meetings with researchers Probed layers of meaning about data obtained Examined consensus decision-making about interpretations Explored outlying interpretations Summarized results Step 1 Study results reviewed by four key informants Critiqued results in writing Step 2 Reviewed critiques Written comments reviewed Results adapted accordingly EHR = electronic health record. Can EHR software be designed to facilitate communication between physicians and patients? What resources are available to help physicians best integrate this technology into their style of patient care as they transition to the use of the EHR? Are there examples of best practices—standard procedures or phrases—that physicians can use to assist patients as they are introduced to the EHR? When and how should medical educators introduce the EHR to students and residents, especially given the current emphasis on training patient-centered interviewing skills? What responsibilities do vendors or health care systems have to train physicians about the relational aspects of the EHR?
The Article in Brief
Background The electronic health record (EHR), a secure computer-based resource that includes the patient�s medical information, is often viewed as a vital tool for medical practices in the 21st century.This study explores whether and how EHRs affect patients� visits to the doctor.
What This Study Found Use of an EHR by doctors in the examination room influences the patient visit. This study identified 14 factors that shape how EHRs are perceived and used in medical practice, including spatial factors (ways in which the physical presence and location of the EHR influences interactions between doctors and patients), relational factors (how patients� and doctors� perceptions of the EHR affect its use), educational factors (the need to help doctors learn to use the EHR and to help patients understand it), and structural factors (institutional and technological forces that influence how doctors perceive their use of an EHR).
Implications
- The EHR is not just a computerized version of a paper medical record. Rather, it has an identity that can influence medical care.
- Medical practices need to consider the ways in which EHRs influence the relationship between patients and doctors.
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