Physicians, patients split on how EHR detracts or enhances primary care office visits

Spending time on the computer during patient visits may not be as bad as physicians think.

Practitioners and patients split on whether time spent using electronic health records (EHR) detracted from office visits, according to a new study based on surveys of both groups. The results could be helpful in improving patient experiences and controlling time physicians spend documenting conditions – a cause of burnout.

The study, “Use of Electronic Health Record During Clinical Encounters: An Experience Survey,” was published in the Annals of Family Medicine. Researchers used surveys to gauge satisfaction among 43 practitioners, including 27 physicians, 10 nurse practitioners, and five physician assistants, along with 452 patients of the family medicine and internal medicine primary care practices at the Mayo Clinic in Scottsdale, Arizona.

Less than half the practitioners – 48.8% – thought the computer was a positive factor in the visit. Among patients, 91.7% agreed EHR was a positive part of their visit, but just 37.2% of practitioners thought patients would agree with that statement.

A solution to alleviate physicians’ negative attitudes toward EHR might be found by talking to patients about the computerized systems.

“Most notably, we identified a discrepancy that exists between patient and practitioner experiences with the EHR during clinical encounters,” the study said. “Patients largely had a favorable experience with practitioner use of the EHR during the clinical encounter, whereas practitioners did not. With patient permission, practitioners might feel more empowered to use the EHR and adopt a more positive attitude about it, one that most patients in the present study had.”

Among the findings:

• Practitioners reported they never or rarely explained how the computer helps them take care of patients (60.5%) or asked the patient permission to use the computer (86%).
• Practitioners fairly often, very often or always asked patients the reason for their visits before turning to the computer (65.1%) and positioned the computer so patients could see the screen (73.8%).
• Nearly all practitioners showed patients results or information on the computer (90.7%).
• Practitioners reported maintaining less eye contact (79.1%), listening less carefully (53.5%), focusing less on patients (65.1%), and that visits felt less personal (62.8%). Patients reported practitioners provided sufficient eye contact (96.8%) and listened carefully (97%), and they disagreed practitioners focused less on them (86.7%) and visits felt less personal (87.2%), according to the study.

Although EHR may not create negative patient experiences, it is not perfect. The practitioners suggested using more efficient and consistent EHR systems, with assistance with inbox and message management and for a scribe to be present during clinical encounters, allowing practitioners to focus fully on patients, the study said.

The authors noted the study’s limitations. Surveys were anonymous, but practitioners were aware of it and so might have changed practice behaviors. The surveys were at a single academic institution with a largely White, college-educated patient population and largely White practitioner group, so results might not reflect attitudes in other locations.