title: Work system factors influencing physicians' screen sharing behaviors in primary care encounters.
abstract: OBJECTIVE
  While the use of electronic health records (EHRs) in primary care has increased dramatically, its potential benefits need to be considered in light of potential negative impacts on physician-patient interactions and the increase in physician cognitive workload. This study aims to understand work system factors contributing to physicians' use of the EHR as a communication tool during primary-care encounters.
  
  
  METHODS
  We interviewed 14 primary care physicians on their use of EHRs as a communication tool in patient visits. A qualitative content analysis guided by the work system model identified factors influencing physicians' decisions to share or not share the computer screen with their patients.
  
  
  RESULTS
  The analysis revealed 26 factors that influenced physicians' decisions to share the screen, most related to the "task" (reviewing lab records), "tools and technology" (using algorithm calculators for risk prediction), or "individual" (patient interest) elements of the work system. The analysis revealed 15 factors that influenced physicians' decisions not to share the screen, most related to the "individual" (patient's acute pain), "organization" (insufficient time), or "task" (documenting embarrassing information) elements of the work system.
  
  
  CONCLUSIONS
  Eleven physicians made individual decisions to share or not to share the screen in a particular visit based on work-system related factors. Three doctors always shared the screen, based on the idea that it is polite and builds trust. However, several physicians also reported that it was time consuming and caused unnecessary distractions. Understanding these factors is essential to effective EHR redesign and training for improving physician-patient communication.
authors.affiliation: Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic address: oasan@mcw.edu.
authors.forename: Onur
authors.initials: O
authors.lastname: Asan
authors.affiliation: Center for Productivity and Productivity Improvement, Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Pascale
authors.initials: P
authors.lastname: Carayon
authors.affiliation: School of Medicine and Public Health, Department of Family Medicine, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Beasley
authors.affiliation: Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Enid
authors.initials: E
authors.lastname: Montague
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D014584:User-Computer Interface; D014600:Utilization Review; D014922:Wisconsin; D057188:Workflow; D016526:Workload / Q000706:statistics & numerical data*
keywords: EHRs; Physician–EHR interaction; Physician–patient communication; Primary care; Works system model