Titre: "Use of Electronic Health Record (EHR) in the consultation: the impact of a training intervention on physician-patient interactions"
Authors:
- C.Lanier1, M. Dominicé Dao1, P. Hudelson1, B. Cerutti2², N. Junod Perron1
1Geneva University Hospitals, ² Geneva Faculty of Medicine
Introduction:
Electronic health records (EHR) are now widely used in outpatient medical settings. Although the first minutes of the consultation are considered essential to establish a good physician- patient relationship, little is known about how doctors use EHR while initiating the
consultation. The aim of the study was first to evaluate EHR use in terms of physician-patient interaction and second to assess the impact of training on how to use computer/EHR during clinical encounters during the first 10 minutes of the consultation.
Methods: A pre-post study was conducted at the Division of primary care of the Geneva University Hospitals. 24 residents were invited to take part in a 3-month training program focusing on how to use computer/EHR during clinical encounters. The intervention included two group training sessions and 2-4 individual supervisions based on residents’ own
videotaped encounters. Residents were asked to videotape 3-4 encounters before and after the intervention. Outcomes measures were objective analysis of computer use with or without eye gazing or verbal interaction in relationship with the content of the interaction (using the Roter interaction analysis system).
Results: 17 residents took part in the study (61% female). Before the intervention, the first 10 minutes of the physician-patient interaction included the following contents: 29%
emotional, 17% medical, 11% therapeutic and 6.6% psychosocial. Residents used the EHR more often with new patients than in follow-up encounters (31.5% vs 25.7% p < 0.0001). The time spent using EHR during each type of discourse was: 29.8% medical, 26.6% therapeutic, 24.5% psychosocial and 21.1% emotional. After the intervention, the overall proportion of time using EHRs decreased significantly (53.2 vs 49.8% p < 0.0001) and more specifically during psychosocial discourse (24.5% vs 9.76% p<0.0001). These changes occurred both with or without eye gazing or verbal interaction.
Conclusion:
Residents use the EHR between 20 and 30% of the time during the first 10 minutes of
consultation. The intervention had a positive impact on physician-patient relationship since it reduced residents’ use of EHR during sensitive issues such as psychosocial discourse.
