Department of Computer and Information Science, Norwegian University of Science and Technology, N-7491 Trondheim, Norway.
Int J Med Inform. 2012 Jan;81(1):12-28. doi: 10.1016/j.ijmedinf.2011.09.004. Epub 2011 Oct 13.
Introducing computers into primary care can have negative effects on the doctor-patient dialogue. Little is known about such effects of mobile health IT in point-of-care situations.
To assess how different mobile information devices used by physicians in point-of-care situations support or hinder aspects of doctor-patient communication, such as face-to-face dialogue, nonverbal communication, and action transparency.
The study draws on two different experimental simulation studies where 22 doctors, in 80 simulated ward rounds, accessed patient-related information from a paper chart, a PDA, and a laptop mounted on a trolley. Video recordings from the simulations were analyzed qualitatively. Interviews with clinicians and patients were used to triangulate the findings and to verify the realism and results of the simulations.
The paper chart afforded smooth re-establishment of eye contact, better verbal and non-verbal contact, more gesturing, good visibility of actions, and quick information retrieval. The digital information devices lacked many of these affordances; physicians' actions were not visible for the patients, the user interfaces required much attention, gesturing was harder, and re-establishment of eye contact took more time. Physicians used the devices to display their actions to the patients. The analysis revealed that the findings were related to the user interface and form factor of the information devices, as well as the personal characteristics of the physician.
When information is needed and has to be located at the point-of-care, the user interface and the physical form factor of the mobile information device are influential elements for successful collaboration between doctors and patients. Both elements need to be carefully designed so that physicians can use the devices to support face-to-face dialogue, nonverbal communication, and action visibility. The ability to facilitate and support the doctor-patient collaboration is a noteworthy usability factor in the design of mobile EPR systems. The paper also presents possible design guidelines for mobile point-of-care systems for improved doctor-patient communication.
将计算机引入基层医疗会对医患对话产生负面影响。移动医疗信息技术在即时护理情境中产生此类影响的情况知之甚少。
评估医生在即时护理情境中使用的不同移动信息设备如何支持或阻碍医患沟通的各个方面，例如面对面的对话、非言语交流和操作透明度。
本研究借鉴了两项不同的实验模拟研究，其中 22 名医生在 80 次模拟查房中从纸质图表、PDA 和安装在推车上的笔记本电脑中获取患者相关信息。对模拟视频记录进行了定性分析。对临床医生和患者的访谈用于对研究结果进行三角验证，并验证模拟的真实性和结果。
纸质图表便于重新建立顺畅的眼神交流，促进更好的言语和非言语交流，更多的手势，良好的动作可见度，以及快速的信息检索。数字信息设备缺乏许多这些功能；患者无法看到医生的操作，用户界面需要大量关注，手势操作更加困难，重新建立眼神接触需要更多时间。医生使用这些设备向患者展示他们的操作。分析表明，这些发现与信息设备的用户界面和物理形式因素以及医生的个人特征有关。
当需要信息并必须在即时护理点定位时，移动信息设备的用户界面和物理形式因素是医生和患者之间成功协作的重要影响因素。这两个因素都需要精心设计，以便医生能够使用这些设备来支持面对面的对话、非言语交流和操作可见性。促进和支持医患协作的能力是移动电子病历系统设计中的一个值得注意的可用性因素。本文还提出了移动即时护理系统的可能设计指南，以改善医患沟通。
