title: Enhancing patient-doctor-computer communication in primary care: towards measurement construction.
abstract: OBJECTIVE
  The traditional dyadic dynamics of the medical encounter has been altered into a triadic relationship by introducing the computer into the examination room. This study defines Patient-Doctor-Computer Communication (PDCC) as a new construct and provides an initial validation process of an instrument for assessing PDCC in the computerized exam room: the e-SEGUE.
  
  
  METHODS
  Based on the existing literature, a new construct, PDCC, is defined as the physician's ability to provide patient-centered care while using the computer during the medical encounter. This study elucidates 27 PDCC-related behaviors from the relevant literature and state of the art models of PDCC. These were embedded in the SEGUE communication assessment framework to form the e-SEGUE, a communication skills assessment tool that integrates computer-related communication skills. Based on Mackenzie et al.'s methodological approach of measurement construction, we conducted a two-phased content validity analysis by a general and expert panels of the PDCC behaviors represented in the e-SEGUE. This study was carried out in an environment where EMR use is universal and fully integrated in the physicians' workflow.
  
  
  RESULTS
  The panels consisted of medical students, residents, primary care physicians, healthcare leaders and faculty of medicine members, who rated and provided input regarding the 27 behaviors. Overall, results show high level of agreement with 23 PDCC-related behaviors.
  
  
  CONCLUSIONS
  The PDCC instrument developed in this study, the e-SEGUE, fared well in a rigorous, albeit initial, validation process has a unique potential for training and enhancing patient-doctor communication (PDC) in the computerized examination room pending further development.
authors.affiliation: Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel ; Department of Industrial Engineering and Management, Ariel University, Ariel, Israel.
authors.forename: Shiri
authors.initials: S
authors.lastname: Assis-Hassid
authors.affiliation: Department of Industrial Engineering and Management, Ariel University, Ariel, Israel.
authors.forename: Iris
authors.initials: I
authors.lastname: Reychav
authors.affiliation: Department of Business Administration, Ono Academic College, Kiryat Ono, Israel.
authors.forename: Tsipi
authors.initials: T
authors.lastname: Heart
authors.affiliation: Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel ; Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Pliskin
authors.affiliation: Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Reis
keywords: Communication skills; Electronic medical record; Patient-doctor-computer communication; Primary care