title: Impact of Electronic Medical Record Use on the Patient-Doctor Relationship and Communication: A Systematic Review.
abstract: BACKGROUND
  While Electronic Medical Record (EMR) use has increased dramatically, the EMR's impact on the patient-doctor relationship remains unclear. This systematic literature review sought to understand the impact of EMR use on patient-doctor relationships and communication.
  
  
  METHODS
  Parallel searches in Ovid MEDLINE, PubMed, Scopus, PsycINFO, Cochrane Library, reference review of prior systematic reviews, meeting abstract reviews, and expert reviews from August 2013 to March 2015 were conducted. Medical Subject Heading terms related to EMR use were combined with keyword terms identifying face-to-face patient-doctor communication. English language observational or interventional studies (1995-2015) were included. Studies examining physician attitudes only were excluded. Structured data extraction compared study population, design, data collection method, and outcomes.
  
  
  RESULTS
  Fifty-three of 7445 studies reviewed met inclusion criteria. Included studies used behavioral analysis (28) to objectively measure communication behaviors using video or direct observation and pre-post or cross-sectional surveys to examine patient perceptions (25). Objective studies reported EMR communication behaviors that were both potentially negative (i.e., interrupted speech, low rates of screen sharing) and positive (i.e., facilitating questions). Studies examining overall patient perceptions of satisfaction, communication or the patient-doctor relationship (n = 22) reported no change with EMR use (16); a positive impact (5) or showed mixed results (1). Study quality was not assessable. Small sample sizes limited generalizability. Publication bias may limit findings.
  
  
  CONCLUSIONS
  Despite objective evidence that EMR use may negatively impact patient-doctor communication, studies examining patient perceptions found no change in patient satisfaction or patient-doctor communication. Therefore, our findings should encourage providers to adopt the EMR as a communication tool. Future research is needed to better understand how to enhance patient-doctor- EMR communication. This research should correlate observed physician behavior to patient satisfaction, focus on physician communication skills training, and explore inpatient experiences.
authors.affiliation: Department of Academic Pediatrics, University of Chicago, Chicago, IL, USA. malkureishi@peds.bsd.uchicago.edu.
authors.forename: Maria Alcocer
authors.initials: MA
authors.lastname: Alkureishi
authors.affiliation: Section of General Internal Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: Wei Wei
authors.initials: WW
authors.lastname: Lee
authors.affiliation: Section of General Internal Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Lyons
authors.affiliation: Section of Hospital Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: Valerie G
authors.initials: VG
authors.lastname: Press
authors.affiliation: College of the University of Chicago, Chicago, IL, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Imam
authors.affiliation: College of the University of Chicago, Chicago, IL, USA.
authors.forename: Akua
authors.initials: A
authors.lastname: Nkansah-Amankra
authors.affiliation: John Crerar Library, University of Chicago, Chicago, IL, USA.
authors.forename: Deb
authors.initials: D
authors.lastname: Werner
authors.affiliation: Section of General Internal Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: Vineet M
authors.initials: VM
authors.lastname: Arora
mesh_terms: D003142:Communication; D057286:Electronic Health Records; D006801:Humans; D017060:Patient Satisfaction; D010817:Physician-Patient Relations
keywords: EMR; communication; electronic medical records; patient–doctor relationship