The use of electronic medical records: Communication patterns in outpatient encounters

Objective: To assess physician-patient communication patterns associated wi th use of an electronic medical record (EMR) system in an outpatient settin g and provide an empirical foundation for larger studies. Design: An exploratory, observational study involving analysis of videotape d 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 p atient 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 phys icians used the EMR and how control physicians used the paper chart. Results: Compared with the control physicians, EMR physicians adopted a mor e active role ill clarifying information, encouraging questions, and ensuri ng completeness at the end of a visit. A trend suggested that EMR physician s might be less active than control physicians in three somewhat more patie nt-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 r ecord during the initial portion of the encounter. The relatively fixed pos ition of the computer limited the extent to which EMR physicians could phys ically orient themselves toward the patient. Although there was no statisti cally significant difference between the EMR and control physicians in term s of mean time across all visits, a difference did emerge for initial visit s: Initial visits with EMR physicians took an average of 37.5 percent longe r than those with control physicians. Summary: An EMR system may enhance the ability of physicians to complete in formation-intensive tasks but can make it more difficult to focus attention on other aspects of patient communication. Further study involving a contr olled, pre-/post-intervention design is justified.