title: Effects of exam-room computing on clinician-patient communication: a longitudinal qualitative study.
abstract: OBJECTIVE
  To evaluate the impact of exam-room computers on communication between clinicians and patients.
  
  
  METHODS
  Longitudinal, qualitative study using videotapes of regularly scheduled visits from 3 points in time: 1 month before, 1 month after, and 7 months after introduction of computers into the exam room.
  
  
  METHODS
  Primary care medical clinic in a large integrated delivery system.
  
  
  METHODS
  Nine clinicians (6 physicians, 2 physician assistants, and 1 nurse practitioner) and 54 patients.
  
  
  RESULTS
  The introduction of computers into the exam room affected the visual, verbal, and postural connection between clinicians and patients. There were variations across the visits in the magnitude and direction of the computer's effect. We identified 4 domains in which exam-room computing affected clinician-patient communication: visit organization, verbal and nonverbal behavior, computer navigation and mastery, and spatial organization of the exam room. We observed a range of facilitating and inhibiting effects on clinician-patient communication in all 4 domains. For 2 domains, visit organization and verbal and nonverbal behavior, facilitating and inhibiting behaviors observed prior to the introduction of the computer appeared to be amplified when exam-room computing occurred. Likewise, exam-room computing involving navigation and mastery skills and spatial organization of the exam-room created communication challenges and opportunities. In all 4 domains, there was little change observed in exam-room computing behaviors from the point of introduction to 7-month follow-up.
  
  
  CONCLUSIONS
  Effective use of computers in the outpatient exam room may be dependent upon clinicians' baseline skills that are carried forward and are amplified, positively or negatively, in their effects on clinician-patient communication. Computer use behaviors do not appear to change much over the first 7 months. Administrators and educators interested in improving exam-room computer use by clinicians need to better understand clinician skills and previous work habits associated with electronic medical records. More study of the effects of new technologies on the clinical relationship is also needed.
authors.affiliation: Center on Implementing Evidence-Based Practice, Roudebush, VAMC, Indianapolis, IN, USA. RFrankel@IUPUI.Edu
authors.forename: Richard
authors.initials: R
authors.lastname: Frankel
authors.forename: Andrea
authors.initials: A
authors.lastname: Altschuler
authors.forename: Sheba
authors.initials: S
authors.lastname: George
authors.forename: James
authors.initials: J
authors.lastname: Kinsman
authors.forename: Holly
authors.initials: H
authors.lastname: Jimison
authors.forename: Nan R
authors.initials: NR
authors.lastname: Robertson
authors.forename: John
authors.initials: J
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D005194:Family Practice; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D009633:Nonverbal Communication; D010353:Patient Education as Topic / Q000379:methods; D010817:Physician-Patient Relations; D011446:Prospective Studies; D012984:Software