title: Computers in the examination room and the electronic health record: physicians' perceived impact on clinical encounters before and after full installation and implementation.
abstract: OBJECTIVE
  We compared physicians' self-reported attitudes and behaviours regarding electronic health record (EHR) use before and after installation of computers in patient examination rooms and transition to full implementation of an EHR in a family medicine training practice to identify anticipated and observed effects these changes would have on physicians' practices and clinical encounters.
  
  
  METHODS
  We conducted two individual qualitative interviews with family physicians. The first interview was before and second interview was 8 months later after full implementation of an EHR and computer installation in the examination rooms. Data were analysed through project team discussions and subsequent coding with qualitative analysis software.
  
  
  RESULTS
  At the first interviews, physicians frequently expressed concerns about the potential negative effect of the EHR on quality of care and physician-patient interaction, adequacy of their skills in EHR use and privacy and confidentiality concerns. Nevertheless, most physicians also anticipated multiple benefits, including improved accessibility of patient data and online health information. In the second interviews, physicians reported that their concerns did not persist. Many anticipated benefits were realized, appearing to facilitate collaborative physician-patient relationships. Physicians reported a greater teaching role with patients and sharing online medical information and treatment plan decisions.
  
  
  CONCLUSIONS
  Before computer installation and full EHR implementation, physicians expressed concerns about the impact of computer use on patient care. After installation and implementation, however, many concerns were mitigated. Using computers in the examination rooms to document and access patients' records along with online medical information and decision-making tools appears to contribute to improved physician-patient communication and collaboration.
authors.affiliation: Department of Family Medicine, Warren Alpert School of Medicine of Brown University, Providence, RI 02908, USA. richard_doyle@brown.edu
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Doyle
authors.forename: Nina
authors.initials: N
authors.lastname: Wang
authors.forename: David
authors.initials: D
authors.lastname: Anthony
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Borkan
authors.forename: Renee R
authors.initials: RR
authors.lastname: Shield
authors.forename: Roberta E
authors.initials: RE
authors.lastname: Goldman
mesh_terms: D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D057286:Electronic Health Records; D005194:Family Practice; D006801:Humans; D010808:Physical Examination; D010817:Physician-Patient Relations; D010824:Physicians' Offices; D036301:Qualitative Research; D011787:Quality of Health Care; D014481:United States