How EHRs Ruin Patient-Physician Interaction

While EHRs can make care more effective, efficient and coordinated, a new study has found just how the technology changes the physician-patient dynamic in the exam room.

Technology in medicine has many pros and cons. On the one hand it can reduce workloads and increase care efficiency, but on the other it can increase costs and possibly malpractice cases, as well.

And now a study has found that electronic health records change the physician-patient dynamic in one important way: eye gaze patterns.

The Northwestern University study, published online in Medical Informatics, found that doctors using EHRs spend a third of the patient visit looking at a computer screen.

Eye gaze is an indication of physician attention to the patient, and in particular physician-initiated gaze is important. But the study found that when physicians spend that much time looking at a computer in the exam room, patients have difficulty getting their attention.

“We found that physician—patient eye-gaze patterns are different during a visit in which electronic health records versus a paper-chart visit are used,” first author Enid Montague, PhD, told Northwestern University. “Not only does the doctor spend less time looking at the patient, the patient also almost always looks at the computer screen, whether or not the patient can see or understand what is on the screen.”

The researchers observed and video recorded 100 patient visits in a primary care clinic. The videos were then analyzed to see how eye-gaze patterns affected communication between the patient and the clinician.

Montague pointed out that while EHRs should enable physicians to provide more effective, efficient and coordinated care; in reality they are affecting the physician’s communication quality and ability to build rapport with a patient.

Another Northwestern University study indicated that physicians who do make the effort to make frequent eye contact are the ones who receive high empathy ratings from their patients.

Since eye contact is important in the physician-patient interaction, Montague believes the findings of her study can contribute to new training guidelines and computer systems that could include screen sharing so that physicians and patients are interacting more with one another.