Electronic medical record use in pediatric primary care

Area of Science:

• Pediatric Primary Care
• Health Informatics
• Clinical Communication

Background:

• Electronic Medical Records (EMR) are increasingly integrated into pediatric primary care.
• Understanding EMR usage patterns is crucial for optimizing clinical workflows and patient interactions.
• Previous research has not fully characterized EMR use during acute pediatric visits.

Purpose of the Study:

• To characterize the patterns of electronic medical record (EMR) use during pediatric primary care acute visits.
• To assess the relationship between EMR use and clinician-patient communication.
• To identify factors influencing EMR usage during these visits.

Main Methods:

• A direct observational study involving 529 acute visits with 27 experienced pediatric clinicians.
• Data collected via the Davis Observation Code at 20-second intervals, noting communication and EMR use.
• Regression models used to analyze visit length, family interaction time, and computer use.

Main Results:

• EMR was used during 27% of exam room time, across all visit stages except physical examination.
• Communication accompanied 70% of EMR use.
• Documentation outside the exam room was linked to 11% longer visits; female clinicians spent more time using computers while communicating.

Conclusions:

• Pediatric clinicians with EMR experience integrate computer use with patient communication.
• Enhancing EMR usability and clinician training focused on communication context is recommended.
• Further research on the impact of in- versus out-of-exam room documentation on productivity is needed.