title: "Attention on the flight deck": what ambulatory care providers can learn from pilots about complex coordinated actions.
abstract: OBJECTIVE
  Technical and interpersonal challenges of using electronic health records (EHRs) in ambulatory care persist. We use cockpit communication as an example of highly coordinated complex activity during flight and compare it with providers' communication when computers are used in the exam room.
  
  
  METHODS
  Maximum variation sampling was used to identify two videotapes from a parent study of primary care physicians' exam room computer demonstrating the greatest variation. We then produced and analyzed visualizations of the time providers spent looking at the computer and looking at the patient.
  
  
  RESULTS
  Unlike the cockpit which is engineered to optimize joint attention on complex coordinated activities, we found polar extremes in the use of joint focus of attention to manage the medical encounter.
  
  
  CONCLUSIONS
  We conclude that there is a great deal of room for improving the balance of interpersonal and technical attention that occurs in routine ambulatory visits in which computers are present in the exam room.
  
  
  CONCLUSIONS
  Using well-known aviation practices can help primary care providers become more aware of the opportunities and challenges for enhancing the physician patient relationship in an era of exam room computing.
authors.affiliation: VA Health Services Research & Development (HSR&D) Center on Implementing Evidence-Based Practice, Roudebush VA Medical Center, Indianapolis, USA; Indiana University (IU) Center for Health Services & Outcomes Research, Indianapolis, USA; Regenstrief Institute, Inc., Indianapolis, USA; Department of Medicine, IU School of Medicine, Indianapolis, USA. Electronic address: RFrankel@IUPUI.Edu.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Frankel
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Saleem
mesh_terms: D000553:Ambulatory Care; D001288:Attention; D001292:Attitude to Computers; D003142:Communication; D057286:Electronic Health Records; D006801:Humans; D016347:Medical Records Systems, Computerized; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D014743:Videotape Recording
keywords: Electronic health records; Person/machine interaction; Situation awareness; Social interaction