title: Effects of electronic health record use on the exam room communication skills of resident physicians: a randomized within-subjects study.
abstract: BACKGROUND
  The effects of electronic health records (EHRs) on doctor-patient communication are unclear.
  
  
  OBJECTIVE
  To evaluate the effects of EHR use compared with paper chart use, on novice physicians' communication skills.
  
  
  METHODS
  Within-subjects randomized controlled trial using observed structured clinical examination methods to assess the impact of use of an EHR on communication.
  
  
  METHODS
  A large academic internal medicine training program.
  
  
  METHODS
  First-year internal medicine residents.
  
  
  METHODS
  Residents interviewed, diagnosed, and initiated treatment of simulated patients using a paper chart or an EHR on a laptop computer. Video recordings of interviews were rated by three trained observers using the Four Habits scale.
  
  
  RESULTS
  Thirty-two residents completed the study and had data available for review (61.5% of those enrolled in the residency program). In most skill areas in the Four Habits model, residents performed at least as well using the EHR and were statistically better in six of 23 skills areas (p<0.05). The overall average communication score was better when using an EHR: mean difference 0.254 (95% CI 0.05 to 0.45), p = 0.012, Cohen's d of 0.47 (a moderate effect). Residents scoring poorly (>3 average score) with paper methods (n = 8) had clinically important improvement when using the EHR.
  
  
  CONCLUSIONS
  This study was conducted in first-year residents in a training environment using simulated patients at a single institution.
  
  
  CONCLUSIONS
  Use of an EHR on a laptop computer appears to improve the ability of first-year residents to communicate with patients relative to using a paper chart.
authors.affiliation: Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Taft
authors.affiliation: Biomedical Informatics Center, Medical University of South Carolina, Charleston, South Carolina, USA Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Lenert
authors.affiliation: Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA Homer Warner Center, Intermountain Healthcare, Salt Lake City, Utah, USA.
authors.forename: Farrant
authors.initials: F
authors.lastname: Sakaguchi
authors.affiliation: Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Stoddard
authors.affiliation: Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Milne
mesh_terms: D003142:Communication; D057286:Electronic Health Records; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D008838:Microcomputers; D010817:Physician-Patient Relations; D014741:Video Recording
keywords: electronic health records; physicians in-training; provider-patient communication; qualitative research; simulated patients