title: Do electronic health records affect the patient-psychiatrist relationship? A before & after study of psychiatric outpatients.
abstract: BACKGROUND
  A growing body of literature shows that patients accept the use of computers in clinical care. Nonetheless, studies have shown that computers unequivocally change both verbal and non-verbal communication style and increase patients' concerns about the privacy of their records. We found no studies which evaluated the use of Electronic Health Records (EHRs) specifically on psychiatric patient satisfaction, nor any that took place exclusively in a psychiatric treatment setting. Due to the special reliance on communication for psychiatric diagnosis and evaluation, and the emphasis on confidentiality of psychiatric records, the results of previous studies may not apply equally to psychiatric patients.
  
  
  METHODS
  We examined the association between EHR use and changes to the patient-psychiatrist relationship. A patient satisfaction survey was administered to psychiatric patient volunteers prior to and following implementation of an EHR. All subjects were adult outpatients with chronic mental illness.
  
  
  RESULTS
  Survey responses were grouped into categories of "Overall," "Technical," "Interpersonal," "Communication & Education,," "Time," "Confidentiality," "Anxiety," and "Computer Use." Multiple, unpaired, two-tailed t-tests comparing pre- and post-implementation groups showed no significant differences (at the 0.05 level) to any questionnaire category for all subjects combined or when subjects were stratified by primary diagnosis category.
  
  
  CONCLUSIONS
  While many barriers to the adoption of electronic health records do exist, concerns about disruption to the patient-psychiatrist relationship need not be a prominent focus. Attention to communication style, interpersonal manner, and computer proficiency may help maintain the quality of the patient-psychiatrist relationship following EHR implementation.
authors.affiliation: Health Sciences Library & Informatics Center, MSC09 5100, 1 University of New Mexico, Albuquerque, New Mexico 87131-0001, USA. randallfstewart@gmail.com
authors.forename: Randall F
authors.initials: RF
authors.lastname: Stewart
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Kroth
authors.forename: Mark
authors.initials: M
authors.lastname: Schuyler
authors.forename: Robert
authors.initials: R
authors.lastname: Bailey
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000523:psychology*; D001292:Attitude to Computers; D001294:Attitude to Health; D003142:Communication; D016494:Computer Security; D003219:Confidentiality; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D016347:Medical Records Systems, Computerized; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires