Primary Care Physicians’ Use of an Electronic Medical Record System: A Cognitive Task Analysis

Galil Center for Telemedicne, Medical informatics and Personalized Medicine, The R&B Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Journal of General Internal Medicine (Impact Factor: 3.42). 02/2009; 24(3):341-8. DOI: 10.1007/s11606-008-0892-6
Source: PubMed

ABSTRACT To describe physicians' patterns of using an Electronic Medical Record (EMR) system; to reveal the underlying cognitive elements involved in EMR use, possible resulting errors, and influences on patient-doctor communication; to gain insight into the role of expertise in incorporating EMRs into clinical practice in general and communicative behavior in particular.
Cognitive task analysis using semi-structured interviews and field observations.
Twenty-five primary care physicians from the northern district of the largest health maintenance organization (HMO) in Israel.
The comprehensiveness, organization, and readability of data in the EMR system reduced physicians' need to recall information from memory and the difficulty of reading handwriting. Physicians perceived EMR use as reducing the cognitive load associated with clinical tasks. Automaticity of EMR use contributed to efficiency, but sometimes resulted in errors, such as the selection of incorrect medication or the input of data into the wrong patient's chart. EMR use interfered with patient-doctor communication. The main strategy for overcoming this problem involved separating EMR use from time spent communicating with patients. Computer mastery and enhanced physicians' communication skills also helped.
There is a fine balance between the benefits and risks of EMR use. Automaticity, especially in combination with interruptions, emerged as the main cognitive factor contributing to errors. EMR use had a negative influence on communication, a problem that can be partially addressed by improving the spatial organization of physicians' offices and by enhancing physicians' computer and communication skills.

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Available from: Shmuel Reis, Jun 26, 2014
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    • "The application presents the user with screen captures from the EMR that can be enlarged by hovering a mouse over a magnifying glass image, dialogue texts, and decision buttons (Figure 1). The scenarios captured such issues as dealing with privacy and safety concerns related to documenting information in the wrong patient's chart [7], communicating with a triadic patient who may be distracted by the computer "
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    ABSTRACT: We previously developed a prototype computer-based simulation to teach residents how to integrate better EMR use in the patient-physician interaction. To evaluate the prototype, we conducted usability tests with three non-clinician students, followed by a pilot study with 16 family medicine residents. The pilot study included pre- and post-test surveys of competencies and attitudes related to using the EMR in the consultation and the acceptability of the simulation, as well as 'think aloud' observations. After using the simulation prototypes, the mean scores for competencies and attitudes improved from 14.88/20 to 15.63/20 and from 22.25/30 to 23.13/30, respectively; however, only the difference for competencies was significant (paired t-test; t=-2.535, p=0.023). Mean scores for perceived usefulness and ease of use of the simulation were good (3.81 and 4.10 on a 5-point scale, respectively). Issues identified in usability testing include confusing interaction with some features, preferences for a more interactive representation of the EMR, and more options for shared decision making. In conclusion, computer-based simulation may be an effective and acceptable tool for teaching residents how to better use EMRs in clinical encounters.
    Studies in health technology and informatics 08/2015; 216:506-510.
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    • "How will healthcare providers respond to these challenges and what will the nature of conversations be in the brave new digital world? While very prominent in lay discourse about healthcare there is surprisingly little dialog about meeting these challenges in health professions education and practice [4]. As a result, healthcare providers are actually at risk of being relegated to a back seat in the digital healthcare revolution. "
    Patient Education and Counseling 12/2013; 93(3):359-62. DOI:10.1016/j.pec.2013.10.007 · 2.20 Impact Factor
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    • "Typing skills, in particular, emerged as a key enabler of doctor–patient communication in computerized primary care settings. Blind (touch) typing greatly reduced the need to divide attention between the patient, monitor, and keyboard thereby allowing physicians to allocate more time and attention resources to the patient [6] [9]. Finally, a number of strategies and best practices that facilitate doctor–patient communication in computerized primary care settings have been identified. "
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    ABSTRACT: Even though Electronic Medical Records (EMRs) are increasingly used in healthcare organizations there is surprisingly little theoretical work or educational programs in this field. This study is aimed at comparing two training programs for doctor-patient-computer communication (DPCC). 36 Family Medicine Residents (FMRs) participated in this study. All FMRs went through twelve identical simulated encounters, six pre and six post training. The experiment group received simulation based training (SBT) while the control group received traditional lecture based training. Performance, attitude and sense of competence of all FMRs improved, but no difference was found between the experiment and control groups. FMRs from the experiment group evaluated the contribution of the training phase higher than control group, and showed higher satisfaction. We assume that the mere exposure to simulation served as a learning experience and enabled deliberate practice that was more powerful than training. Because DPCC is a new field, all participants in such studies, including instructors and raters, should receive basic training of DPCC skills. Simulation enhances DPCC skills. Future studies of this kind should control the exposure to simulation prior to the training phase. Training and assessment of clinical communication should include EMR related skills.
    Patient Education and Counseling 08/2013; 93(3). DOI:10.1016/j.pec.2013.08.007 · 2.20 Impact Factor
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