Use of the Electronic Health Record During Clinical Encounters: An Experience Survey

Abstract

Purpose: Use of the electronic health record (EHR) during face-to-face clinical encounters affects communication, and prior research has been inconclusive regarding its effect. This survey study assessed health care practitioner use of EHR-specific communication skills and patient and practitioner experiences and attitudes regarding EHR use during clinical encounters.

Methods: For this US-based study, we distributed previously validated surveys to practitioners and adult patients (aged >18 years) at academic primary care practices from July 1, 2018 through August 31, 2018. The electronic practitioner survey was completed first; a paper survey was administered to patients after appointments. Descriptive statistics were calculated, and the Cochran-Armitage test was used to assess for associations between key variables.

Results: The practitioner response was 72.9% (43/59); patient response, 45.2% (452/1,000). Practitioners reported maintaining less eye contact (79.1%), listening less carefully (53.5%), focusing less on patients (65.1%), and visits feeling less personal (62.8%). However, patients reported that practitioners provided sufficient eye contact (96.8%) and listened carefully (97.0%); they disagreed that practitioners focused less on them (86.7%) or that visits felt less personal (87.2%). Patients thought EHR use was positive (91.7%); only one-third of practitioners (37.2%) thought that patients would agree with that statement. Practitioners reported stress, burnout, and a lack of sufficient time for EHR documentation.

Conclusions: A discrepancy existed in this study between patient and practitioner experiences and attitudes about EHR use, which appeared to negatively affect the experience of health care practitioners but not patients. Organizations should adopt formal strategies to improve practitioner experiences with EHR use.

Keywords: communication skills; electronic health record; patient experience; primary health care.

Figure 1.

Practitioner reports of 8 behaviors specific to use of the electronic health record. EHR = electronic health record. Note: A Likert scale was used to stratify answers for the EHR-specific communication skills. Like categories were combined for the graph (n = 43).

Figure 2.

Patient reports of EHR-specific physician behaviors. EHR = electronic health record. Note: A Likert scale was used to stratify answers to the 8 EHR-specific communication skills. Like categories were combined for the graph (n = 452).

Figure 3.

Practitioner and patient experiences with electronic health record use during clinical encounters. HCP = health care practitioner; P = patient.

Figure 4.

Hours spent outside the office documenting in the electronic health record. EHR = electronic health record. Note: Data are shown as percentage of practitioners (n = 43). P value indicates trend for burnout in relation to working <2 out-of-office hours.