The widespread implementation of electronic heath records (EHRs) has changed the healthcare environment from a system of paper to one more reliant on digital information. Some physicians, however, feel this change has negatively affected the quality of care. In a recent study, published by JAMA Internal Medicine, researchers evaluated how physicians use EHRs during office visits and the impacts on patient satisfaction.
Patients hope to be the center of attention in the office, yet many feel left out due to the physician-EHR relationship. Physicians multitasking during visits has increased rates of error. Physicians can also alienate a patient by silently focusing on EHR input.
The study included statistics from five primary and specialty safety-net clinics that had transitioned to a fully functioning EHR systems. Visits from a total of 25 clinicians and 25 patients were evaluated by researchers. Researchers examined the rates of multitasking EHR use (when the clinicians or patient spoke), silent EHR use (a silence of three or more seconds), non-EHR multitasking and focused patient clinician talk.
Overall, a total of 35 visits, which averaged 20.6 minutes in length, were included in the study. Multitasking EHR use encompassed 30.5 percent of the time of the visits, silent EHR use accounted for 4.6 percent, non-EHR multitasking measured 4.3 percent and focused patient-clinician talk was 33.1 percent. Patients rated care “excellent” in 66.7 percent of low-multitasking visits and 76.5 percent in high-multitasking visits.
“Safety net patients could benefit from silence, since clinician talk typically dominates visits and imposes literacy burdens,” concluded Neda Ratanawongsa, MD, MPH, first author on the study, and colleagues. “However, clinicians must attend to emerging patient concerns and decide whether to address those concerns, defer them to complete EHR tasks safely, or attempt to complete both, despite multitasking risks. Studies should explore strategies for negotiating multitasking and silent EHR use, engaging patients “actively” during silent EHR use, and ensuring clinicians detect emerging patient concerns.”