title: EHR use and patient satisfaction: What we learned.
abstract: OBJECTIVE
  Few studies have quantitatively examined the degree to which the use of the computer affects patients' satisfaction with the clinician and the quality of the visit. We conducted a study to examine this association.
  
  
  METHODS
  Twenty-three clinicians (21 internal medicine physicians, 2 nurse practitioners) were recruited from 4 Veteran Affairs Medical Center (VAMC) clinics located in San Diego, Calif. Five to 6 patients for most clinicians (one patient each for 2 of the clinicians) were recruited to participate in a study of patient-physician communication. The clinicians' computer use and the patient-clinician interactions in the exam room were captured in real time via video recordings of the interactions and the computer screen, and through the use of the Morae usability testing software system, which recorded clinician clicks and scrolls on the computer. After the visit, patients were asked to complete a satisfaction survey.
  
  
  RESULTS
  The final sample consisted of 126 consultations. Total patient satisfaction (beta=0.014; P=.027) and patient satisfaction with patient-centered communication (beta=0.02; P=.02) were significantly associated with higher clinician “gaze time” at the patient. A higher percentage of gaze time during a visit (controlling for the length of the visit) was significantly associated with greater satisfaction with patient-centered communication (beta=0.628; P=.033).
  
  
  CONCLUSIONS
  Higher clinician gaze time at the patient predicted greater patient satisfaction. This suggests that clinicians would be well served to refine their multitasking skills so that they communicate in a patient-centered manner while performing necessary computer-related tasks. These findings also have important implications for clinical training with respect to using an electronic health record (EHR) system in ways that do not impede the one-on-one conversation between clinician and patient.
authors.affiliation: University of California, San Diego, CA, USA. Email: nfarber@ucsd.edu.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Farber
authors.affiliation: University of California, San Diego, CA, USA.
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.affiliation: University of California, Irvine, CA, USA.
authors.forename: Yunan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: University of California, San Diego, CA, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Calvitti
authors.affiliation: Texas A&M University, Dallas, TX, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Street
authors.affiliation: Veterans Medical Research Foundation, La Jolla, CA, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Zuest
authors.affiliation: VA San Diego Healthcare System, CA, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Bell
authors.affiliation: VA San Diego Healthcare System, CA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Gabuzda
authors.affiliation: Veterans Medical Research Foundation, La Jolla, CA, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Gray
authors.affiliation: VA San Diego Healthcare System, CA, USA.
authors.forename: Shazia
authors.initials: S
authors.lastname: Ashfaq
authors.affiliation: University of California, San Diego, CA, USA.
authors.forename: Zia
authors.initials: Z
authors.lastname: Agha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D002140:California; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires