Frankel Richard, Altschuler Andrea, George Sheba, Kinsman James, Jimison Holly, Robertson Nan R, Hsu John
Center on Implementing Evidence-Based Practice, Roudebush, VAMC, Indianapolis, IN, USA.
J Gen Intern Med. 2005 Aug;20(8):677-82. doi: 10.1111/j.1525-1497.2005.0163.x.
To evaluate the impact of exam-room computers on communication between clinicians and patients.
Longitudinal, qualitative study using videotapes of regularly scheduled visits from 3 points in time: 1 month before, 1 month after, and 7 months after introduction of computers into the exam room.
Primary care medical clinic in a large integrated delivery system.
Nine clinicians (6 physicians, 2 physician assistants, and 1 nurse practitioner) and 54 patients.
The introduction of computers into the exam room affected the visual, verbal, and postural connection between clinicians and patients. There were variations across the visits in the magnitude and direction of the computer's effect. We identified 4 domains in which exam-room computing affected clinician-patient communication: visit organization, verbal and nonverbal behavior, computer navigation and mastery, and spatial organization of the exam room. We observed a range of facilitating and inhibiting effects on clinician-patient communication in all 4 domains. For 2 domains, visit organization and verbal and nonverbal behavior, facilitating and inhibiting behaviors observed prior to the introduction of the computer appeared to be amplified when exam-room computing occurred. Likewise, exam-room computing involving navigation and mastery skills and spatial organization of the exam-room created communication challenges and opportunities. In all 4 domains, there was little change observed in exam-room computing behaviors from the point of introduction to 7-month follow-up.
Effective use of computers in the outpatient exam room may be dependent upon clinicians' baseline skills that are carried forward and are amplified, positively or negatively, in their effects on clinician-patient communication. Computer use behaviors do not appear to change much over the first 7 months. Administrators and educators interested in improving exam-room computer use by clinicians need to better understand clinician skills and previous work habits associated with electronic medical records. More study of the effects of new technologies on the clinical relationship is also needed.
评估诊室电脑对临床医生与患者之间沟通的影响。
纵向定性研究，使用在三个时间点（引入电脑到诊室前1个月、引入后1个月和引入后7个月）定期安排就诊的录像带。
大型综合医疗系统中的基层医疗诊所。
9名临床医生（6名医生、2名医师助理和1名执业护士）和54名患者。
将电脑引入诊室影响了临床医生与患者之间的视觉、言语和姿势联系。在不同就诊过程中，电脑影响的程度和方向存在差异。我们确定了诊室电脑使用影响临床医生与患者沟通的4个领域：就诊组织、言语和非言语行为、电脑操作与掌握以及诊室的空间组织。我们在所有4个领域都观察到了对临床医生与患者沟通的一系列促进和抑制作用。对于其中2个领域，即就诊组织以及言语和非言语行为，在引入电脑之前观察到的促进和抑制行为在诊室使用电脑时似乎被放大了。同样，涉及操作与掌握技能以及诊室空间组织的诊室电脑使用带来了沟通挑战和机遇。在所有4个领域，从引入电脑到7个月随访期间，诊室电脑使用行为几乎没有变化。
在门诊诊室有效使用电脑可能取决于临床医生的基线技能，这些技能会被延续，并在对临床医生与患者沟通的影响中得到正向或负向放大。在最初的7个月里，电脑使用行为似乎变化不大。有兴趣改善临床医生在诊室使用电脑情况的管理人员和教育工作者需要更好地了解与电子病历相关的临床医生技能和以往工作习惯。还需要更多地研究新技术对临床关系的影响。
