title: Computers in the clinical encounter: a scoping review and thematic analysis.
abstract: Patient-clinician communication has been associated with increased patient satisfaction, trust in the clinician, adherence to prescribed therapy, and various health outcomes. The impact of health information technology (HIT) on the clinical encounter in general and patient-clinician communication in particular is a growing concern. The purpose of this study was to review the current literature on HIT use during the clinical encounter to update best practices and inform the continuous development of HIT policies and educational interventions.
  
  
  
  We conducted a literature search of four databases. After removing duplicates, reviewing titles and abstracts, performing a full-text review, and snowballing from references and citations, 51 articles were included in the analysis. We employed a qualitative thematic analysis to compare and contrast the findings across studies.
  
  
  
  Our analysis revealed that the use of HIT affects consultations in complex ways, impacting eye contact and gaze, information sharing, building relationships, and pauses in the conversation. Whether these impacts are positive or negative largely depends on the combination of consultation room layout, patient and clinician styles of interaction with HIT as well as each other, and the strategies and techniques employed by clinicians to integrate HIT into consultations.
  
  
  
  The in-depth insights into the impact of HIT on the clinical encounter, especially the strategies and techniques employed by clinicians to adapt to using HIT in consultations, can inform policies, educational interventions, and research.
  
  
  
  In contrast to the common negative views of HIT, it affects the clinical encounter in multiple ways. By applying identified strategies and best practices, HIT can support patient-clinician interactions rather than interfering with them.
authors.affiliation: Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
authors.forename: Noah H
authors.initials: NH
authors.lastname: Crampton
authors.affiliation: Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Reis
authors.affiliation: Institute of Health Policy, Management & Evaluation (Dalla Lana School of Public Health) and Faculty of Information, University of Toronto, Toronto, ON, Canada aviv.shachak@utoronto.ca.
authors.forename: Aviv
authors.initials: A
authors.lastname: Shachak
mesh_terms: D003142:Communication; D003201:Computers; D057286:Electronic Health Records; D006801:Humans; D008490:Medical Informatics; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D013997:Time Factors
keywords: electronic health record; health information technology; patient-clinician communication; professional-patient relations; templates