Ratanawongsa Neda, Barton Jennifer L, Schillinger Dean, Yelin Edward H, Hettema Jennifer E, Lum Paula J
J Health Care Poor Underserved. 2013 Nov;24(4):1542-51. doi: 10.1353/hpu.2013.0188.
Electronic health record (EHR) implementation may affect patient-clinician communication for diverse safety-net populations. We conducted a cross-sectional survey of English-, Spanish-, and Cantonese-speaking patients in a public hospital clinic with a basic EHR. We examined multivariate associations of patient race/ethnicity, language, and education with perceptions of primary-care provider (PCP) computer use. Among 399 respondents, 25% had less than a high school education, 22% preferred Spanish, and 17% Cantonese. Asian (AOR 3.1), non-English-speakers (AOR 3.6) were more likely to report that PCPs used the computer half or more of the visit. Asians were more likely to report that computers helped PCPs remember patient concerns (AOR 5.6). Non-English-speakers had lower odds of reporting that PCPs listened less carefully to them because of computers (AOR 0.3). Patients at risk for communication barriers may perceive advantages of PCP computer use. Safety-net clinics should consider EHR impact on communication disparities.
电子健康记录（EHR）的实施可能会影响不同安全网人群的医患沟通。我们在一家配备基本电子健康记录的公立医院诊所，对说英语、西班牙语和粤语的患者进行了一项横断面调查。我们研究了患者的种族/民族、语言和教育程度与对初级保健提供者（PCP）使用电脑的看法之间的多变量关联。在399名受访者中，25%的人受教育程度低于高中，22%的人更喜欢说西班牙语，17%的人更喜欢说粤语。亚洲人（调整后比值比[AOR]为3.1）、非英语使用者（AOR为3.6）更有可能报告初级保健提供者在就诊过程中有一半或更多时间使用电脑。亚洲人更有可能报告电脑帮助初级保健提供者记住患者的问题（AOR为5.6）。非英语使用者报告初级保健提供者因使用电脑而较少认真倾听他们讲话的几率较低（AOR为0.3）。存在沟通障碍风险的患者可能会察觉到初级保健提供者使用电脑的好处。安全网诊所应考虑电子健康记录对沟通差异的影响。
