Researchers from the University of California-San Diego have published the first findings from their "lab-in-a-box" project, in which a suitcase-sized container of software and sensors measures the way physicians interact with their patients and their electronic health records.

The goal of the project, funded by the Agency for Healthcare Research and Quality, is to analyze the physician’s behavior and better understand the dynamics of the interactions of the doctor with the electronic medical records and the patients in front of them. The eventual goal is to provide useful input on how to run the medical practice more efficiently.

As EHRs become more central to medical practice, many physicians say they are having a hard time satisfying the need to enter information into the EHR while also maintaining meaningful contact with the patient.

“With the heavy demand that current medical records put on the physician, doctors look at the screen instead of looking at their patients,” lead author Nadir Weibel said. “Important clues such as facial expression, and direct eye-contact between patient and physician are therefore lost.”

The compact suitcase contains a set of tools to record activity in the office. A depth camera from a Microsoft Kinect device records body and head movements. An eye tracker follows where the doctor is looking. A special 360-degree microphone records audio in the room. The box is also linked to the doctor’s computer, so it can keep track of keyboard strokes, movements of the mouse, and pop-up menus that may divert the doctor’s attention.

Researchers say the greatest value of the lab-in-a-box, however, is in the software designed to merge, synchronize and segment data streams from the various sensors – assessing the extent to which a certain confluence of activity may lead to distraction on the part of the physician. For example, Weibel said, lots of head and eye movement would suggest that the doctor is multitasking between the computer and the patient.

The researchers will compare data from different settings and different types of medical practice to pinpoint those factors that lead to distraction across the board, or that affect only specific medical specialties. Their findings could help software developers write less-disruptive medical software. They envision also deploying the box permanently in a doctor’s office to provide real-time prompts to warn the physician that he or she is not paying enough attention to a patient.

“In order to intervene effectively, we need to first understand the complex system composed by patients, doctors, and the electronic medical record in depth, and this is what our study will finally yield,” Weibel said.

The initial findings, published in Personal and Ubiquitous Computing, are available here.

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