title: How physician electronic health record screen sharing affects patient and doctor non-verbal communication in primary care.
abstract: OBJECTIVE
  Use of electronic health records (EHRs) in primary-care exam rooms changes the dynamics of patient-physician interaction. This study examines and compares doctor-patient non-verbal communication (eye-gaze patterns) during primary care encounters for three different screen/information sharing groups: (1) active information sharing, (2) passive information sharing, and (3) technology withdrawal.
  
  
  METHODS
  Researchers video recorded 100 primary-care visits and coded the direction and duration of doctor and patient gaze. Descriptive statistics compared the length of gaze patterns as a percentage of visit length. Lag sequential analysis determined whether physician eye-gaze influenced patient eye gaze, and vice versa, and examined variations across groups.
  
  
  RESULTS
  Significant differences were found in duration of gaze across groups. Lag sequential analysis found significant associations between several gaze patterns. Some, such as DGP-PGD ("doctor gaze patient" followed by "patient gaze doctor") were significant for all groups. Others, such DGT-PGU ("doctor gaze technology" followed by "patient gaze unknown") were unique to one group.
  
  
  CONCLUSIONS
  Some technology use styles (active information sharing) seem to create more patient engagement, while others (passive information sharing) lead to patient disengagement.
  
  
  CONCLUSIONS
  Doctors can engage patients in communication by using EHRs in the visits. EHR training and design should facilitate this.
authors.affiliation: Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, USA. Electronic address: oasan@mcw.edu.
authors.forename: Onur
authors.initials: O
authors.lastname: Asan
authors.affiliation: College of Pharmacy, University of Georgia, Athens, USA.
authors.forename: Henry N
authors.initials: HN
authors.lastname: Young
authors.affiliation: School of Pharmacy, University of Wisconsin-Madison, Madison, USA.
authors.forename: Betty
authors.initials: B
authors.lastname: Chewning
authors.affiliation: Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA.
authors.forename: Enid
authors.initials: E
authors.lastname: Montague
mesh_terms: D000328:Adult; D003142:Communication; D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009633:Nonverbal Communication; D009819:Office Visits / Q000639:trends*; D010817:Physician-Patient Relations; D010820:Physicians; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*; D011785:Quality Assurance, Health Care; D014741:Video Recording
keywords: EHRs; Physician–EHR interaction; Physician–patient communication; Primary care