Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters.
Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters.
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DOI：
10.1016/j.pec.2014.05.004
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发表时间：
2014-09
影响因子：
3.5
通讯作者：
Agha Z
中科院分区：
文献类型：
--
作者：
Street RL Jr;Liu L;Farber NJ;Chen Y;Calvitti A;Zuest D;Gabuzda MT;Bell K;Gray B;Rick S;Ashfaq S;Agha Z
具有电子健康记录（EHR）的计算机是医疗咨询中的附加“交互物”，因为临床医生必须同时或交替地使患者和计算机参与提供医疗护理。很少有研究调查临床医生的EHR工作流程（例如，凝视、键盘活动和沉默）影响他们的交流质量、患者在就诊中的参与以及对就诊的会话控制。来自美国退伍军人管理局（VA）初级保健诊所的23名初级保健提供者（PCP）参加了这项研究。每个PCP最多招募6例患者。通过视频记录，以真实的时间记录PCP注视电脑的时间比例。通过Morae捕获鼠标点击/滚动活动，Morae是一种记录鼠标点击和滚动活动的可用性软件。谈话沉默被编码为PCP和患者不说话的时间比例。访视结束后，患者完成患者满意度测评。经过培训的编码员独立观看互动视频，并对PCP以患者为中心（信息，支持，合作）和患者参与咨询的程度进行评分。谈话控制的时间比例的PCP举行的发言权相比，病人。最终样本包括125次咨询。那些在咨询中花更多时间盯着电脑的PCP和那些有更多谈话沉默的PCP被评为较低的以病人为中心。PCP控制了更多的谈话时间，在访问中，也有更长的时间相互沉默。当PCP花更多的时间看电脑时，当他们在咨询中有更多的沉默时间时，他们被评为沟通效率较低。由于PCP越来越多地在他们的咨询中使用EHR，因此需要更多的研究来确定他们可以在口头上与患者接触的同时管理EHR中的数据的有效方法。EHR活动在咨询期间消耗了越来越多的临床医生时间。为了确保与患者的有效沟通，临床医生可能会受益于使用沟通策略，在与计算机一起工作时保持对话流，以及学习EHR管理技能，防止长时间凝视计算机和长时间沉默。下一代EHR设计必须解决更好的可用性和临床工作流程集成，包括促进患者与临床医生的沟通。
The computer with the electronic health record (EHR) is an additional ‘interactant’ in the medical consultation, as clinicians must simultaneously or in alternation engage patient and computer to provide medical care. Few studies have examined how clinicians' EHR workflow (e.g., gaze, keyboard activity, and silence) influences the quality of their communication, the patient's involvement in the encounter, and conversational control of the visit. Twenty-three primary care providers (PCPs) from USA Veterans Administration (VA) primary care clinics participated in the study. Up to 6 patients per PCP were recruited. The proportion of time PCPs spent gazing at the computer was captured in real time via video-recording. Mouse click/scrolling activity was captured through Morae, a usability software that logs mouse clicks and scrolling activity. Conversational silence was coded as the proportion of time in the visit when PCP and patient were not talking. After the visit, patients completed patient satisfaction measures. Trained coders independently viewed videos of the interactions and rated the degree to which PCPs were patient-centered (informative, supportive, partnering) and patients were involved in the consultation. Conversational control was measured as the proportion of time the PCP held the floor compared to the patient. The final sample included 125 consultations. PCPs who spent more time in the consultation gazing at the computer and whose visits had more conversational silence were rated lower inpatient-centeredness. PCPs controlled more of the talk time in the visits that also had longer periods of mutual silence. PCPs were rated as having less effective communication when they spent more time looking at the computer and when there was more periods of silence in the consultation. Because PCPs increasingly are using the EHR in their consultations, more research is needed to determine effective ways that they can verbally engage patients while simultaneously managing data in the EHR. EHR activity consumes an increasing proportion of clinicians' time during consultations. To ensure effective communication with their patients, clinicians may benefit from using communication strategies that maintain the flow of conversation when working with the computer, as well as from learning EHR management skills that prevent extended periods of gaze at computer and long periods of silence. Next-generation EHR design must address better usability and clinical workflow integration, including facilitating patient-clinician communication.
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影响因子：
3.5
作者：
Gorawara-Bhat, Rita;Cook, Mary Ann
通讯作者：
Cook, Mary Ann
DOI：
10.1111/j.1365-2753.2008.01065.x
发表时间：
2009-08-01
影响因子：
2.4
作者：
Shachak, Aviv;Reis, Shmuel
通讯作者：
Reis, Shmuel
影响因子：
3
作者：
Blanch-Hartigan, Danielle;Hall, Judith A.;Irish, Julie T.
通讯作者：
Irish, Julie T.
影响因子：
4.4
作者：
Ventres, W;Kooienga, S;Stewart, V
通讯作者：
Stewart, V
影响因子：
5.7
作者：
Frankel, R;Altschuler, A;Hsu, J
通讯作者：
Hsu, J