EHRs divert docs' attention during exams

Doctors who use electronic health records in the exam room spend about one-third of their time looking at the screen, which might detract from patient communication, according to new research from Northwestern University.

The research, published in the International Journal of Medical Informatics, used video to track physicians' gaze during 100 doctor-patient visits involving EHRs. The researchers analyzed doctors' eye-gaze patterns to determine how they affect communication with the patient.

"When doctors spend that much time looking at the computer, it can be difficult for patients to get their attention," Enid Montague, first author of the study, said in an announcement. "It's likely that the ability to listen, problem-solve and think creatively is not optimal when physicians' eyes are glued to the screen."

Not only might physicians miss non-verbal clues by not looking at the patient, patients tend to be looking at the screen as well, whether or not they can read or understand what they see there, according to Montague.

Understanding how EHRs affect communication with patients could lead to more effective training guidelines and better-designed technology, Montague said. For instance, more interactive screen sharing might be built into future systems.

One study found that patients see doctors as less capable if they look up information during a consultation, rather than if they do so out of sight or via a colleague consult.

The way a physician handles the disruption caused by consulting an EHR "can absolutely make or break the relationship between doctor and patient," Larry Garber, an internist and medical director of informatics at the Reliant Medical Group in Worcester, Mass., told American Medical News in July 2012.

It stresses that the patient should be the doctor's focus – warning against turning away from the patient to consult the computer. Instead, it recommends a triangle design that allows the physician to face the patient and still see the computer.

A report published last May by the AMA suggests allowing patients to look on and explaining what you're doing, which also urges doing as much data entry as possible outside the exam room.

To learn more:
- find the announcement
- here's the abstract

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