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01-04-2018 | Original Research

Keystrokes, Mouse Clicks, and Gazing at the Computer: How Physician Interaction with the EHR Affects Patient Participation

Authors: Richard L. Street Jr, PhD, Lin Liu, PhD, Neil J. Farber, PhD, Yunan Chen, PhD, Alan Calvitti, PhD, Nadir Weibel, PhD, Mark T. Gabuzda, MD, Kristin Bell, MD, Barbara Gray, MD, Steven Rick, PhD, Shazia Ashfaq, MD, Zia Agha, MD

Published in: Journal of General Internal Medicine | Issue 4/2018

Abstract

Background

Evidence is mixed regarding how physicians' use of the electronic health record (EHR) affects communication in medical encounters.

Objective

To investigate whether the different ways physicians interact with the computer (mouse clicks, key strokes, and gaze) vary in their effects on patient participation in the consultation, physicians’ efforts to facilitate patient involvement, and silence.

Design

Cross-sectional, observational study of video and event recordings of primary care and specialty consultations.

Participants

Thirty-two physicians and 217 patients.

Main Measures

Predictor variables included measures of physician interaction with the EHR (mouse clicks, key strokes, gaze). Outcome measures included active patient participation (asking questions, stating preferences, expressing concerns), physician facilitation of patient involvement (partnership-building and supportive talk), and silence.

Key Results

Patients were less active participants in consultations in which physicians engaged in more keyboard activity (b = −0.002, SE = 0.001, p = 0.02). More physician gaze at the computer was associated with more silence in the encounter (b = 0.21, SE = 0.09, p = 0.02). Physicians’ facilitative communication, which predicted more active patient participation (b = 0.65, SE = 0.14, p < 0.001), was not related to EHR activity measures.

Conclusions

Patients may be more reluctant to actively participate in medical encounters when physicians are more physically engaged with the computer (e.g., keyboard activity) than when their behavior is less demonstrative (e.g., gazing at EHR). Using easy to deploy communication tactics (e.g., asking about a patient’s thoughts and concerns, social conversation) while working on the computer can help physicians engage patients as well as maintain conversational flow.

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Title: Keystrokes, Mouse Clicks, and Gazing at the Computer: How Physician Interaction with the EHR Affects Patient Participation
Authors: Richard L. Street Jr, PhD
Lin Liu, PhD
Neil J. Farber, PhD
Yunan Chen, PhD
Alan Calvitti, PhD
Nadir Weibel, PhD
Mark T. Gabuzda, MD
Kristin Bell, MD
Barbara Gray, MD
Steven Rick, PhD
Shazia Ashfaq, MD
Zia Agha, MD
Publication date: 01-04-2018
Publisher: Springer US
Published in: Journal of General Internal Medicine / Issue 4/2018
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-017-4228-2

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Abstract

Background

Objective

Design

Participants

Main Measures

Key Results

Conclusions

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