The impact of electronic medical records on patient-doctor communication during consultation: a narrative literature review.
OBJECTIVE
The effect of Electronic Medical Record (EMR) use on Patient-Doctor Communication (PDC) has rarely been studied. As data accumulate, the purpose of this article is to review the literature on EMR effect on PDC, to identify recurring themes and to offer preliminary guidelines and future directions for medical education and research.


METHODS
A database search was conducted and 14 articles that met inclusion criteria (published in the past 10 years, empirical investigations, direct assessment of the EMR impact on patient-doctor communication) were selected for review. A qualitative, grounded theory-like approach was employed to analyse the data.


RESULTS
EMR use often has a positive impact on information exchange, but exerts a negative influence on patient centredness. Some physician characteristics such as their computer skills and behavioural style assist in overcoming this negative influence.


CONCLUSIONS
The use of EMR exerts both positive and negative impacts on physician-patient relationships. The negative impacts can be overcome by some simple means as well as better designs of EMR systems and medical education interventions. Physicians' everyday practices of integrating EMR use into the clinical encounter as well as better design of EMR systems and EMR and communication training may facilitate PDC in computerized settings.
Shachak
Aviv
A
Galil Center for Medical Informatics, Telemedicine and Personalized Medicine, The R&B Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. aviv.shachak@utoronto.ca
Reis
Shmuel
S
D003142:Communication; D017050:Episode of Care; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000458:organization & administration; D010817:Physician-Patient Relations; D012017:Referral and Consultation