More screen time, less face time - implications for EHR design.

Area of Science:

• Health Informatics
• Human-Computer Interaction
• Primary Care Medicine

Background:

• Health information technology, specifically electronic health records (EHRs), is increasingly integrated into clinical practice.
• Understanding the impact of EHRs on the doctor-patient dynamic is crucial for optimizing their design and implementation.
• Physician interaction with medical records and patients is a key component of the clinical encounter.

Purpose of the Study:

• To quantitatively compare physician interactions with patients and medical records (paper vs. EHR) in ambulatory primary care settings.
• To analyze how the use of EHRs affects physician eye gaze patterns during clinical visits.
• To provide insights for designing more patient-centered EHR systems.

Main Methods:

• Video recording of clinical encounters involving physicians using either paper charts or EHRs.
• Quantified video coding methodology to measure eye gaze durations towards patients and medical records.
• Statistical analysis to compare time spent on different interaction modalities between paper and EHR groups.

Main Results:

• Physicians spent a significantly greater proportion of time gazing at EHRs (35.2%) compared to paper charts (22.1%).
• Physicians spent a significantly smaller proportion of time gazing at patients when using EHRs (45.6%) versus paper charts (52.6%).
• The study included 8 family medicine physicians and 80 patient visits (40 paper, 40 EHR).

Conclusions:

• Family medicine physicians using EHRs allocate more time to screen interaction and less to direct patient engagement.
• The observed shift in physician attention may negatively influence patient perception of care.
• Findings highlight the need for EHR design improvements to support better doctor-patient interaction.