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Health Information Technology and Physician-Patient Interactions: Impact of Computers on Communication during Outpatient Primary Care Visits

Affiliations of the authors: Kaiser Permanente Medical Care Program, Division of Research, Oakland, CA (JHs, JHu, VF); The Robertson Group, Lake Oswego, OR (NR); Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR (HJ); Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN (RF).

Correspondence and reprints: John Hsu, MD, MBA, MSCE, Physician Scientist, 2000 Broadway, 3rd Floor, Oakland, CA 94612; e-mail: <jth{at}dor.kaiser.org>.

Received for publication: 11/12/04; accepted for publication: 03/23/05.

Objective: The aim of this study was to evaluate the impact of introducing health information technology (HIT) on physician-patient interactions during outpatient visits.

Design: This was a longitudinal pre-post study: two months before and one and seven months after introduction of examination room computers. Patient questionnaires (n = 313) after primary care visits with physicians (n = 8) within an integrated delivery system. There were three patient satisfaction domains: (1) satisfaction with visit components, (2) comprehension of the visit, and (3) perceptions of the physician's use of the computer.

Results: Patients reported that physicians used computers in 82.3% of visits. Compared with baseline, overall patient satisfaction with visits increased seven months after the introduction of computers (odds ratio [OR] = 1.50; 95% confidence interval [CI]: 1.01–2.22), as did satisfaction with physicians' familiarity with patients (OR = 1.60, 95% CI: 1.01–2.52), communication about medical issues (OR = 1.61; 95% CI: 1.05–2.47), and comprehension of decisions made during the visit (OR = 1.63; 95% CI: 1.06–2.50). In contrast, there were no significant changes in patient satisfaction with comprehension of self-care responsibilities, communication about psychosocial issues, or available visit time. Seven months post-introduction, patients were more likely to report that the computer helped the visit run in a more timely manner (OR = 1.76; 95% CI: 1.28–2.42) compared with the first month after introduction. There were no other significant changes in patient perceptions of the computer use over time.

Conclusion: The examination room computers appeared to have positive effects on physician-patient interactions related to medical communication without significant negative effects on other areas such as time available for patient concerns. Further study is needed to better understand HIT use during outpatient visits.

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