EHRs Could Divert Too Much Doctor Attention

The study found that doctors who use EHRs in the exam room spend about a third of their visits looking at a computer screen.

Nonverbal cues may get overlooked and affect doctors’ ability to pay attention and communicate with patients when physicians spend too much time looking at the computer screen in the exam according to a Northwestern Medicine study.

Using video cameras, Northwestern scientists recorded 100 doctor-patient visits in which doctors used computers to access electronic health records (EHRs). The videos were used to analyze eye-gaze patterns and how they affected communication behavior between patients and clinicians.

The study, published online in the International Journal of Medical Informatics, found that doctors who use EHRs in the exam room spend about a third of their visits looking at a computer screen.

"When doctors spend that much time looking at the computer, it can be difficult for patients to get their attention," Enid Montague, first author of the study, said in a statement. "It’s likely that the ability to listen, problem-solve and think creatively is not optimal when physicians’ eyes are glued to the screen."

The findings of the study support previous research that suggests the way EHRs are currently used in the exam room adversely affects physicians’ communication quality, cognitive functioning and the ability of patients and physicians to build rapport and establish emotional common ground.

"We found that physician–patient eye-gaze patterns are different during a visit in which electronic health records versus a paper-chart visit are used," Montague said. "Not only does the doctor spend less time looking at the patient, the patient also almost always looks at the computer screen, whether or not the patient can see or understand what is on the screen."

However, a report released last year from the American Medical Association (AMA) indicated that although the introduction of computers does influence the encounter between patient and physician, for the most part the feared negative effects of exam room computing have not materialized.

"Physicians with good baseline communication skills tend to integrate exam room computing into their relationship with patients whereas physicians with poor baseline skills tend to create communication barriers when using computers in the exam room," the report noted.

Among the most important factors are physicians’ communication skills and their individual style of interacting with patients. In addition, the culture of the health care organization can affect implementation and use of EHRs in patient-physician interactions.

Removing spatial barriers, such as installing mobile monitors or configuring examination rooms to enable physicians to maintain eye contact while using the computer and allow patients to view the computer screen easily can help promote "inclusive" use of computers in clinical encounters, the report concluded.