Introduction
• Open the EHR before inviting the next patient in the consultation room | |
• Explore and negotiate the patient’s agenda before using the EHR | |
• Move the computer’s screen to offer the patient a visual access to the screen/EHR during the clinical encounter (when possible) | |
• Keep a position facing the patient most of the time with hands away from the keyboard | |
• Indicate when the EHR is used and explain what is done with the EHR = signposting the use of EHR | |
• Indicate to the patient where the physician’s attention is directed (EHR or the patient) by using verbal and non-verbal clues | |
• Invite the patient to consult the information displayed on the screen | |
• Give full attention to the patient by not using the EHR when he/she expresses emotions or psychosocial issues | |
• Type during appropriate time sets (i.e., just before or after the physical examination) |
Methods
Design and Setting
Participants and Procedure
Development of Videos Displaying EHR-Related Behaviors
Video sequence (mean duration of video [s]) | EHR-related behaviors while typing | Clinical scenario | Physician | Patient | ||
---|---|---|---|---|---|---|
A1 74 | Continuous typing | Intermittent typing (while summarizing) | Handwriting | Back pain (biomedical content) | 53-year-old woman | 70-year-old man |
A2 96 | Continuous typing | Intermittent typing (while summarizing) | Handwriting | Hand injury (psychosocial content) | 35-year-old man | 30-year-old woman |
B 79 | Visual contact | Verbal contact | Visual + verbal contact | Headache | 47-year-old woman | 45-year-old woman |
C 70 | Signposting the EHR use | -- | No signposting of the EHR use | Cutaneous eruption and immunization | 55-year-old man | 18-year-old man |
D 88 | Bust towards the patient and hands on the keyboard | Bust towards the computer and hands on the keyboard | Bust towards the patient and hands away from the keyboard | Dyspepsia | 46-year-old woman | 80-year-old woman |
Procedure
Outcomes, and Other Measures
n (%) | |
---|---|
Participants • Response rate | 336 (100) (61.4) |
Gender | |
• Female | 185 (55.1) |
Age | |
• <30 | 123 (36.6) |
• 30–49 | 111 (33.0) |
• >50 | 102 (30.4) |
1st language | |
• French | 256 (76.2) |
• Other | 80 (23.8) |
Nationality | |
• Swiss | 184 (54.8) |
Level of education | |
• Obligatory | 68 (20.2) |
• Secondary | 141 (42.0) |
• Tertiary | 127 (37.8) |
Frequency of consultations/year | |
• 0-4 | 281 (83.6) |
• ≥5 | 55 (16.4) |
Computer use | |
• < 1 per week | 70 (20.8) |
• ≥ 1 per week | 266 (79.2) |
Own physician’s use of computer | |
• Yes | 226 (67.3) |
Favorable of physician’s use of computer | |
• Yes | 267 (79.5) |
Familiar with computers, tablets, or smartphone | |
• Yes | 268 (79.8) |
Sample Size Estimate
Statistical Analysis
Results
Patients’ Preferences Regarding Doctors’ EHR-Related Behaviors
Behavior and variations | Patient’s preferences | |
---|---|---|
n (%; 95% CI) | RRR (p value)* | |
Typing - Biomedical content (video A1) | ||
• Handwriting | 53 (31.6; 95% CI: 24.9–39.0) | Baseline |
• Intermittent typing | 55 (32.7; 95% CI: 26.0–40.2) | 1.04 (0.85) |
• Continuous typing | 25 (14.9; 95% CI: 10.2–21.1) | 0.47 (0.002) |
• Double choice | 35 (20.8; 95% CI: 15.3–27.7) | 0.66 (0.06) |
Handwriting or intermittent typing | 14 (8.3; 95% CI: 5.0–13.6) | |
Handwriting or continuous typing | 10 (5.9; 95% CI: 3.2–10.7) | |
Intermittent or continuous typing | 11 (6.5; 95% CI: 3.6–11.5) | |
Typing - Psychosocial content (video A2) | ||
• Handwriting | 41 (24.4; 95% CI: 18.4–31.5) | Baseline |
• Intermittent typing | 65 (38.7; 95% CI: 31.6–46.3) | 1.58 (0.02) |
• Continuous typing | 30 (17.9; 95% CI: 12.7–24.4) | 0.73 (0.19) |
• Double choice | 32 (19.0; 95% CI: 13.7–25.8) | 0.78 (0.29) |
Handwriting or intermittent typing | 12 (7.1; 95% CI: 4.1–12.2) | |
Handwriting or continuous typing | 9 (5.4; 95% CI: 2.8–10.0) | |
Intermittent or continuous typing | 11 (6.5; 95% CI: 3.6–11.5) | |
Contact (video B) | ||
• Visual contact only | 20 (11.4; 95% CI:7.5–17.1) | Baseline |
• Verbal contact only | 53 (30.3; 95% CI: 23.9–37.5) | 2.65 (<0.001) |
• Visual + verbal contact | 68 (38.9; 95% CI: 31.9–46.3) | 3.4 (<0.001) |
• Double choice | 34 (19.4; 95% CI: 14.2–26.0) | 1.7 (0.06) |
Visual + verbal or verbal contact only | 17 (9.7; 95% CI: 6.1–15.1) | |
Visual contact only or verbal contact only | 10 (5.7; 95% CI: 3.1–10.3) | |
Visual + verbal or visual contact only | 7 (4.0; 95% CI: 1.9–8.2) | |
Signposting (video C) | ||
• No signposting | 117 (34.8; 95% CI: 29.9–40.1) | Baseline |
• Signposting | 198 (58.9; 95% CI: 53.5–64.0) | 1.69 (<0.001) |
• Double choice | 21 (6.3; 95% CI: 4.1–9.4) | 0.18 (<0.001) |
Body position (video D) | ||
• Bust facing the patient and hands off the keyboard | 80 (49.7; 95% CI: 42.0–57.4) | Baseline |
• Bust facing the patient and hands on the keyboard | 32 (19.9; 95% CI: 14.4–26.8) | 0.4 (<0.001) |
• Bust facing the computer and hands on the keyboard | 21 (13.0; 95% CI: 8.6–19.2) | 0.26 (<0.001) |
• Double choice | 28 (17.4; 95% CI: 12.2–24.1) | 0.35 (<0.001) |
Bust facing the patient and hands off the keyboard or bust facing the computer and hands on the keyboard | 12 (7.4; 95% CI:4.3–12.7) | |
Bust facing the patient and hands on the keyboard or bust facing the computer and hands on the keyboard | 12 (7.4; 95% CI:4.3–12.7) | |
Bust facing the patient and hands off the keyboard or bust facing the patient and hands on the keyboard | 4 (2.5; 95% CI: 0.9–6.5) |