3087 — Does Physician Electronic Medical Record Use Effect Patient Centered Communication?

Agha Z (VA San Diego Healthcare System), Roter D (Johns Hopkins University), Schapira R (Clement J. Zablocki Veterans Affairs Medical Center), Laud P (Medical College of Wisconsin)

Objectives:
To measure the quality of verbal and nonverbal physician-patient communication during EMR-based office visits, using the Roter Interaction Analysis System (RIAS) to assess communication

Methods:
We analyzed data for 105 patients who received consultation with one of nine physicians. The VA’s electronic medical records (EMR) were used during each visit. All study visits were video recorded. Verbal and non-verbal physician-patient communications were coded using the RIAS. Physician EMR use was measured as: (1) Level of Keyboarding (sporadic, periodic , and continuous typing); (2) Doctor’s computer screen gaze (occasional, intermittent, or consistent); (3) Doctor’s eye contact (toward patient, toward monitor, or away from patient and monitor); (4) Doctor’s body lean (toward patient, between monitor and patient, and toward monitor). Quality of physician-patient communication was measured by following RIAS variables (patient-centeredness score, verbal dominance, shared decision-making, physician counseling, physician rapport building, and biomedical talk). Patient and physician satisfaction were measured. Pearson’s correlation and ANOVA were conducted

Results:
Physician EMR use (keyboarding) was inversely correlated with patient eye contact (?= -0.57, p=0.09). Keyboard use was associated with a low patient-centeredness score (sporadic = score 1.1 vs. continuous = score 0.65, p=0.002). Keyboarding was inversely correlated with shared decision-making (? = -0.43, p = 0.02) and patient education on emotional/lifestyle issues (? = -0.45, p = 0.02). Level of keyboarding and gaze toward monitor had a negative effect on patient satisfaction with visit (? = -0.045, p = 0.022, and ? = -0.56, p = 0.012). Higher level of keyboard use was also associated with poor physician satisfaction with data gathering aspect of the visit (F 3.9, p=0.04)

Implications:
Office visits with EMR use add to the complexity of the patient-physician interaction and consequently can undermine patient centered care and result in poor patient and physician satisfaction. Further research is underway to identify physician factors, patient factors, and EMR interface/usability factors that may predict physician communication style

Impacts:
Given the prominence of EMR use in the VA, understanding how EMR use can affect the delivery of patient-centered care is important for VA physicians, researchers, and policy makers