EHR Produces New Physician-Patient Communication Dynamic

The use of electronic health records (EHRs) during primary care office visits yields a physician-patient communication patterns that differ from those observed with paper charts, a study published in the March 2014 issue of the International Journal Medical Informatics reports.

In an effort to “better understand the effects of health information technology (HIT) use on physician-technology, patient-physician, and patient-technology interactions,” Enid Montague, PhD, of the Feinberg School of Medicine at Northwestern University in Chicago, IL, and Onur Asan, PhD, of the University of Wisconsin in Madison, WI, analyzed nonverbal communication and attention patterns between primary care physicians and patients that were captured by video recordings of 100 office visits where EHRs had been accessed.

Consistent with previous research on eye contact patterns between physicians and patients, the investigators found all of the eye gaze behaviors initiated by doctors were significantly followed by patient eye gaze behaviors, which they said “indicates that doctors’ behaviors lead patients’ behaviors in the interaction,” such as observing the EHR. But in contrast to earlier findings on gaze behaviors with the use of paper charts, this study’s results showed gaze patterns initiated by patients were notably followed by physician gaze patterns, particularly when the EHR was used.

“EHR use does affect the nonverbal communication patterns that doctors may use, but also patient nonverbal communication patterns,” the authors observed, noting the finding “provide(s) some support for the potential utility of information and screen sharing to be included in the patient-physician-technology communication dynamic.”

Overall, the physicians spent approximately one-third of the visit length interacting with the EHR. Even though the physicians’ gaze behaviors largely influenced the patients’ gaze patterns, the patients spent roughly 12% of the encounter gazing at the technology, and there were several cases where the patient never looked at the computer screen.

“EHRs may serve as an interruption for physicians, but it may also serve as an opportunity for shared engagement when shared with patients,” the authors concluded. “By understanding the dynamic nature of eye gaze patterns and how technology impacts these patterns, we can contribute to future EHR designs that foster more effective doctor-patient interaction,” Montague added in a press release from Northwestern.

Although the physicians utilized some form of paper record alongside the EHR in 79% of the visits — which the researchers said “can contribute to inefficient system workflows and may be an indicator of EHRs that are not effectively designed with the care provider’s needs in mind” — the physicians only gazed at those paper charts for 8.75% of the visit length, on average.