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As three aspiring clinicians who are learning about primary care delivery and electronic health record (EHR) use, we read your article with great interest. In particular, four key findings stood out to us. First, this study was conducted at a single academic institution with relatively homogenous primary care clinician and patient populations. The education level of the patients (69.1% holding a 4-year college degree) participating in the study was much higher than the general US population. As such, we are left to ponder if the findings would be substantially different if this study was conducted in a non-academic and/or rural setting among patients with lower levels of educational attainment. Second, we also noted that the majority of clinicians invited to participate in the study elected to do so (response rate of 72.9%) with a majority of responses coming from physicians (64.3%). Is there a significant difference in responses depending on the occupation of the respondent?
Third, we are also curious as to how clinician age and training potentially influenced EHR experiences. Specifically, findings indicated that greater time spent on EHR-related tasks resulted in higher levels of stress and more severe feelings of burnout. Are these findings attributed to a lack of EHR training or excessive workload or both? Lastly, do the authors have plans to build on this work by the inclusion of objective technologies such as eye tracking to measure EHR use in relation to clinician-patient engagement and eliminate potential biases of self-reporting? This study was compelling and points to the need for further exploration into the development of EHR best practices in the future.