I love information technology, and I’m a huge believer in clinical decision support as a means to improve quality. But even I recognize that the use of computers, especially in the exam room, changes the doctor-patient interaction. When I’m seeing children in clinic, I almost never, ever use the computer in the room. I check for alerts ahead of time, and I chart after. I want to appear engaged.
But maybe that changes the quality of my care for the worse. Many other doctors use the computer a lot in the room, to make sure that they miss nothing.
A study just released in JAMA Internal Medicine looked at how computer use was associated with communication. “Association Between Clinician Computer Use and Communication With Patients in Safety-Net Clinics.”
Research assistants enrolled and interviewed patients by telephone before appointments. The subsequent visit was videotaped, and patients were interviewed again after the visit. Clinicians submitted data through questionnaires.
Clinicians’ computer use was based on the following: (1) amount of review of computer data, (2) amount of typing or clicking the computer mouse, (3) lack of eye contact made with patients, and (4) noninteractive pauses caused by computer use. Higher scores corresponded to more computer use.
After each visit, patients rated the quality of the care received in the past 6 months. Researchers also analyzed communication using the Roter Interaction Analysis System by reviewing the video tapes. They took the computer use scores and divided them into three equal groups. They then conducted analyses, controlling for the length of visit, patient educational level, general quality of life, type of clinician seen, years in practice, and specialty.
Patients who had clinical encounters with high computer use were less likely to rate care as excellent compared to those who had encounters with low computer use (48% versus 83%). Clinicians in encounters with high computer use engaged in more negative rapport building.
Bottom line, here: high computer use by clinicians was associated with lower patient satisfaction and differences in communication. This shouldn’t be taken as an argument to remove computers and HIT from patient care, because there certainly are benefits, but it should be a warning to all of us to consider how we can improve our communication with patients and make sure that computer use doesn’t negatively impact our relationships with them.
Richard Frankel, a colleague of mine (and mentor), has some wise suggestions to that effect in an accompanying editorial. He’s an expert in this area, and his reading his piece is worth your time.