title: Developing an evidence base of best practices for integrating computerized systems into the exam room: a systematic review.
abstract: OBJECTIVE
  The introduction of health information technology systems, electronic health records in particular, is changing the nature of how clinicians interact with patients. Lack of knowledge remains on how best to integrate such systems in the exam room. The purpose of this systematic review was to (1) distill "best" behavioral and communication practices recommended in the literature for clinicians when interacting with patients in the presence of computerized systems during a clinical encounter, (2) weigh the evidence of each recommendation, and (3) rank evidence-based recommendations for electronic health record communication training initiatives for clinicians.
  
  
  METHODS
  We conducted a literature search of 6 databases, resulting in 52 articles included in the analysis. We extracted information such as study setting, research design, sample, findings, and implications. Recommendations were distilled based on consistent support for behavioral and communication practices across studies.
  
  
  RESULTS
  Eight behavioral and communication practices received strong support of evidence in the literature and included specific aspects of using computerized systems to facilitate conversation and transparency in the exam room, such as spatial (re)organization of the exam room, maintaining nonverbal communication, and specific techniques that integrate the computerized system into the visit and engage the patient. Four practices, although patient-centered, have received insufficient evidence to date.
  
  
  CONCLUSIONS
  We developed an evidence base of best practices for clinicians to maintain patient-centered communications in the presence of computerized systems in the exam room. Further work includes development and empirical evaluation of evidence-based guidelines to better integrate computerized systems into clinical care.
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI.
authors.forename: Minal R
authors.initials: MR
authors.lastname: Patel
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Vichich
authors.affiliation: Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI.
authors.forename: Ian
authors.initials: I
authors.lastname: Lang
authors.affiliation: Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI.
authors.forename: Jessica
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California Irvine, Irvine, CA, USA.
authors.forename: Kai
authors.initials: K
authors.lastname: Zheng
mesh_terms: D003142:Communication; D057286:Electronic Health Records; D055317:Evidence-Based Practice; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000458:organization & administration; D010817:Physician-Patient Relations; D011216:Practice Management, Medical / Q000458:organization & administration*
keywords: electronic health records; evidence-base; health information technology; patient-clinician communication