This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Makoul, G. Articles by Tang, P. C. Search for Related Content PubMed PubMed Citation Articles by Makoul, G. Articles by Tang, P. C.

The Use of Electronic Medical Records

Communication Patterns in Outpatient Encounters

Affiliations of the authors: Northwestern University Medical School, Chicago, Illinois (GM, RHC); Palo Alto Medical Foundation, Palo Alto, California (PCT).

Correspondence and reprints: Gregory Makoul, PhD, Associate Professor and Director, Program in Communication and Medicine, Northwestern University Medical School, 750 North Lake Shore Drive (ABA 625), Chicago, IL 60611; e-mail: <makoul{at}northwestern.edu>

Received for publication: 02/09/01; accepted for publication: 07/16/01.

Objective: To assess physician–patient communication patterns associated with use of an electronic medical record (EMR) system in an outpatient setting and provide an empirical foundation for larger studies.

Design: An exploratory, observational study involving analysis of videotaped physician–patient encounters, questionnaires, and medical-record reviews.

Setting: General internal medicine practice at an academic medical center.

Participants: Three physicians who used an EMR system (EMR physicians) and three who used solely a paper record (control physicians). A total of 204 patient visits were included in the analysis (mean, 34 for each physician).

Main Outcome Measures: Content analysis of whether physicians accomplished communication tasks during encounters; qualitative analysis of how EMR physicians used the EMR and how control physicians used the paper chart.

Results: Compared with the control physicians, EMR physicians adopted a more active role in clarifying information, encouraging questions, and ensuring completeness at the end of a visit. A trend suggested that EMR physicians might be less active than control physicians in three somewhat more patient-centered areas (outlining the patient's agenda, exploring psychosocial/ emotional issues, discussing how health problems affect a patient's life). Physicians in both groups tended to direct their attention to the patient record during the initial portion of the encounter. The relatively fixed position of the computer limited the extent to which EMR physicians could physically orient themselves toward the patient. Although there was no statistically significant difference between the EMR and control physicians in terms of mean time across all visits, a difference did emerge for initial visits: Initial visits with EMR physicians took an average of 37.5 percent longer than those with control physicians.

Summary: An EMR system may enhance the ability of physicians to complete informationintensive tasks but can make it more difficult to focus attention on other aspects of patient communication. Further study involving a controlled, pre-/post-intervention design is justified.

This article has been cited by other articles:

				E. E. Tracy Confessions of an Electronic Medical Record User Obstet. Gynecol., June 1, 2008; 111(6): 1435 - 1438. [Full Text] [PDF]

				J. Tsai and G. Bond A comparison of electronic records to paper records in mental health centers Int. J. Qual. Health Care, April 1, 2008; 20(2): 136 - 143. [Abstract] [Full Text] [PDF]

				J. A. Osheroff, J. M. Teich, B. Middleton, E. B. Steen, A. Wright, and D. E. Detmer A Roadmap for National Action on Clinical Decision Support J. Am. Med. Inform. Assoc., March 1, 2007; 14(2): 141 - 145. [Abstract] [Full Text] [PDF]

				C. P. Schade, F. M. Sullivan, S. de Lusignan, and J. Madeley e-Prescribing, Efficiency, Quality: Lessons from the Computerization of UK Family Practice J. Am. Med. Inform. Assoc., September 1, 2006; 13(5): 470 - 475. [Abstract] [Full Text] [PDF]

				W. Ventres, S. Kooienga, N. Vuckovic, R. Marlin, P. Nygren, and V. Stewart Physicians, Patients, and the Electronic Health Record: An Ethnographic Analysis Ann. Fam. Med, March 1, 2006; 4(2): 124 - 131. [Abstract] [Full Text] [PDF]

				A. D. Harris, J. C. McGregor, E. N. Perencevich, J. P. Furuno, J. Zhu, D. E. Peterson, and J. Finkelstein The Use and Interpretation of Quasi-Experimental Studies in Medical Informatics J. Am. Med. Inform. Assoc., January 1, 2006; 13(1): 16 - 23. [Abstract] [Full Text] [PDF]

				L. Poissant, J. Pereira, R. Tamblyn, and Y. Kawasumi The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review J. Am. Med. Inform. Assoc., September 1, 2005; 12(5): 505 - 516. [Abstract] [Full Text] [PDF]

				J. Hsu, J. Huang, V. Fung, N. Robertson, H. Jimison, and R. Frankel Health Information Technology and Physician-Patient Interactions: Impact of Computers on Communication during Outpatient Primary Care Visits J. Am. Med. Inform. Assoc., July 1, 2005; 12(4): 474 - 480. [Abstract] [Full Text] [PDF]

				C. Delpierre, L. Cuzin, J. Fillaux, M. Alvarez, P. Massip, and T. Lang A systematic review of computer-based patient record systems and quality of care: more randomized clinical trials or a broader approach? Int. J. Qual. Health Care, October 1, 2004; 16(5): 407 - 416. [Abstract] [Full Text] [PDF]

				P. J. Embi, T. R. Yackel, J. R. Logan, J. L. Bowen, T. G. Cooney, and P. N. Gorman Impacts of Computerized Physician Documentation in a Teaching Hospital: Perceptions of Faculty and Resident Physicians J. Am. Med. Inform. Assoc., July 1, 2004; 11(4): 300 - 309. [Abstract] [Full Text] [PDF]