Interoperable Computing

Impact of EHRs in the Exam Room — AMA Report

At the American Medical Association’s 2012 Annual Meeting, a resolution was passed to review the effect of computers in the exam room on the patient-physician relationship. The AMA has just published a report on the findings and the results are encouraging. The report is based on an analysis of 14 prior studies on the use of computers and EHRs in the exam room. Anticipated negative effects such as shifting attention away from the patient, disruption to clinical workflow, and increases in the physician’s workload have generally not materialized.

Findings include:

  • Research over the past two decades indicates that patient satisfaction does not appear to be adversely impacted by the use of computers in the exam room.
  • The factor that most affected patients’ perception of computer use in the exam room was their physician’s attitude towards the computer and whether the physician was “positive” in his/her use of computers.
  • Some patients viewed computer use by their physician as an indication that they were receiving better care.
  • Observational studies have identified several factors that influence physician-patient interactions including ability to use the computer, typing skills, and comfort when navigating the EHR.
  • The most important factors were identified as the physician’s communication skills and style of interaction with patients. Those physicians who were able to skillfully collect and record patient data in the paper chart prior to the introduction of the EHR were most adept at integrating the computer into the patient encounter.
  • Exam room layouts that allowed patients to easily view the computer screen were most effective at “including” the patient in the encounter.

Whether exam room computers had a negative or positive effect depended to a significant degree on the perspectives and skills of physicians who used computers during encounters with patients. Those with good communication skills were able to effectively integrate computers into exam room consultations, whereas those with poor baseline communication skills tended to create communication barriers.

Both Kaiser Permanente and Family Practice Management publish tips to improve the effective integration of computers into the patient encounter. Download a copy of the AMA report for further details.

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