Increased Use of Electronic Health Records: A Study Overview

Introduction to Electronic Health Records

A recent study highlights the growing reliance on electronic health records (EHR) by clinicians during patient consultations. While the EHR system offers innovative benefits, it poses risks that may diminish patient satisfaction and increase errors due to multitasking. Over the past few years, EHRs have become essential within healthcare, serving as a modern alternative to traditional paper-based patient information storage. These electronic records encompass a patient’s medical history, physical examinations, diagnostic investigations, and management plans. EHRs enhance data security and accessibility for healthcare professionals and facilitate seamless information transfer between facilities.

Study Details and Methodology

Conducted under the approval of the institutional review board at the University of California, San Francisco, the study was published in JAMA Internal Medicine. This observational research spanned from 2013 to 2015 and focused on clinics that had transitioned from non-electronic systems to fully functional EHRs. The selected clinics included primary care offices and specialty health centers, with participants comprising patients, clinicians, and nurse practitioners. Eligible participants underwent training to utilize EHRs effectively, enabling them to communicate using the tools provided while research assistants recorded interactions on video. Participants consented to the study and communicated in either English or Spanish. The analysis included data from 25 health professionals and 25 patients.

Data Coding and Categories

Data collected from participants were categorized into several key areas:
1. Multitasking EHR use (during clinician-patient conversations)
2. Silent EHR use (3-second pauses within interactions)
3. Education with EHR (enhancing patient understanding of disease, procedures, and treatments)
4. Education with paper (utilizing paper resources to aid patient understanding)
5. Physical examination processes
6. Focused clinician-patient dialogue

Results and Observations

The findings revealed that clinicians often multitasked during patient interactions. Clinicians transitioned to silent EHR use for documentation, with varying degrees of communication about this shift. Some clinicians informed patients of their transition, while others did not, leading to moments where patients attempted to engage the clinician, discussing a mix of social and medical topics.

Although certain elements of using EHRs require clinician focus, this emphasis can detract from patient engagement. The research indicated that multitasking during these interactions heightened the risk of errors in patient data entry, potentially overlooking critical patient concerns. Many clinician-patient interactions showed a tendency for the clinician to dominate discussions when not engaged with the EHR system. Other studies have suggested that this behavior can diminish patient satisfaction, leaving individuals feeling unheard.

Conclusion and Recommendations

While the advantages of the EHR system are evident, it is crucial to address the need for improved patient engagement during its use. Clinicians should be encouraged to develop strategies that allow adequate time for addressing patient concerns, thereby fostering a more effective and satisfying healthcare experience.

Author Information

Written by Dr. Apollina Sharma, MBBS, GradDip EXMD.
Reference: Ratanawongsa Neda, et al. “Multitasking and Silent Electronic Health Record Use in Ambulatory Visits.” JAMA Internal Medicine (2017).