Health IT adoption has revolutionized patient care across the healthcare spectrum, from the exam room and diagnostics to the surgery departments, laboratories, and billing. EHR systems surpass the use of paper charts, but one team of researchers wondered how EHRs facilitate communication skills of resident physicians.
In a study published by the Journal of the American Medical Informatics Association (JAMIA), the researchers looked at how physician-patient communication was fostered by EHR use versus paper charts. The residents participating in the study came from the University of Utah, School of Medicine and were followed for three months in 2012.
Resident physicians examined patients and treated them using either paper charts or EHR systems and video was taken of the interaction. Three trained observers used the Four Habits scale to determine the communication skills of the doctors based on both video and audio recordings.
Some of the habits of physicians were subpar, such as failing to communicate what they were carrying out when typing or writing. Other items were accomplished effectively such as developing a plan for follow up and framing the dialogue toward the patient’s perspective.
The results show that, when physicians used EHR systems, they score statistically better in six out of 23 skilled areas as compared to the paper chart. Most other communication factors are very similar between use of paper-based records or EHR technology. The researchers conclude that using electronic records via a laptop computer instead of paper charts seems to enhance the communication skills of first-year residents when meeting with patients.
Recently, a follow-up by Drs. David Hanauer and Kai Zheng published in JAMIA mentions that there may be other factors influencing physicians in the study to show better communication when utilizing laptop computers to record patient data.
First it is important to establish that EHRs vary drastically from paper records. Health IT systems include e-prescribing and drug alerts, coding for billing requirements, and reminders for immunizations and age-based preventive measures. In EHRs, there are a variety of dropdown menus, text entries, checkboxes, and other documentation functionalities.
The additional data entry tasks of EHR systems as well as a multitude of allergy and drug alerts do pose other challenges for physicians, according to Hanauer and Zheng. Time constraints may actually bring doctors to fill out much of the additional information while a patient is in the exam room, which may limit patient-doctor dialogue in the healthcare setting.
The authors wonder whether the outcomes of the study would be the same if the observers rating the interaction were not given video access. They postulate the observers were affected by the benefits of electronic records and knowledge about the study’s purpose.