Use of computers in an examination room clearly affects a clinical encounter, but it does not inevitably disrupt or undermine patient-physician communication, according to a new report from the American Medical Association.

For the most part, feared negative effects of an in-room electronic health record have not materialized, the report notes. “Technical improvements in EHRs that focus required computer tasks on activities that meaningfully influence patient outcomes, or that streamline data input and reduce the time needed to complete common tasks in clinical work and decrease the potential for distraction, will help minimize the possibility for disruption.”

An AMA committee developed the report, based in large part on findings in 14 previously published studies of the introduction of EHRs into the exam room. Report authors found that physicians’ communication skills and style of interacting with patients influences how complementary or distracting the EHR can be. Doctors skilled in collecting data during patient interviews and recording it in the paper chart before EHRs were better able to integrate use of the computer into the visit. Another finding: The physician’s perceived attitude toward the computer can influence patients’ perceptions, but some patients view the EHR as improving care regardless of the physician’s attitude.

The report includes five communication behaviors learned at Kaiser Permanente that ease integration of a computer into the exam room: Greet the patient with eye contact and maintain the contact, move the screen so the patient can view/verify information and ask questions, explain how the computer improves care, explain what you are doing such as ordering a lab test, and tell the patient you are logging off to safeguard their information.

The report is available here.

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