Ambulatory Clinic Exam Room Design With Respect to Computing Devices to Enhance Patient Centeredness (Kentucky)

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Although significant research has been conducted on the impact of health information technology (IT) use on provider-patient interactions, challenges persist on how to effectively integrate these tools into healthcare environments in a patient-centered manner. Some providers worry that the use of computer documentation during patient visits negatively impacts the provider-patient relationship. However, directly involving patients with computerized applications during visits may ehance this relationship. This approach, however, is impossible with poorly placed computers.

This project, conducted at the Veterans Health Administration (VHA), investigated the impact of exam room layout on patient centeredness. Researchers created a new exam room design and tested it in a laboratory simulation study and a pilot field study. The new design included a wall-mounted monitor for ease of re-positioning. In addition, a mobile table was used as a consult surface for a keyboard or printed materials to be shared with the patient and family members. This layout change was evaluated for its impact on clinical workflow, patient engagement, and enhanced patient safety.

The specific aims of the project were as follows:

  • Prototype and evaluate a re-designed exam room layout and compare the redesigned layout to a current, typical exam room layout in the VHA.
  • Refine the redesigned exam room layout, implement it in a live clinic setting, and compare it to currently designed exam rooms in a Veterans Affairs (VA) Medical Center. 

In a lab-based experiment, 28 providers used prototypes of the new and legacy outpatient exam room layouts to conduct simulated patient encounters. In a subsequent pilot field study, researchers conducted observations and interviews with 11 primary care providers and their patients and compared the new exam room design standard with the legacy exam rooms.

For the laboratory simulation study, there were no statistically significant differences between the exam room layouts for efficiency, errors, or time spent focused on the patient. However, when using the new layout, providers spent 75 percent more time in screen sharing activities, resulting in 31 percent lower workload. Additionally, the pilot test of the new exam room layout found that providers spent a greater proportion of time focused on the patient, more time in screen-sharing activities with the patient, and had more self-reported situational awareness. Overall, providers seemed to be unwilling to compromise their focus on the patient when the computer was in a fixed position away from the patient; as a result, they experienced greater workload, lower situational awareness, and poorer workflow integration when using the legacy layout. Next steps for investigators include conducting a similar, larger study that includes more diverse settings and increases sample size.

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Ambulatory Clinic Exam Room Design With Respect to Computing Devices to Enhance Patient Centeredness - Final Report

Saleem, J. Ambulatory Clinic Exam Room Design With Respect to Computing Devices to Enhance Patient Centeredness - Final Report. (Prepared by the University of Louisville under Grant No. R03 HS024488). Rockville, MD: Agency for Healthcare Research and Quality, 2018. (PDF, 388.17 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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Using Technology to Enhance Patient Communication During Clinic Visits

Key Finding and Impact:

Leveraging clinic room configuration allows the computer to become a facilitator to the patient visit, rather than a barrier between the provider and patient.

Computers have advantages, but may interfere with patient communication.

Computer use by providers during clinical visits enhances how patient data are documented and organized; however, it may have a negative impact on the patient-provider relationship. For instance, providers documenting information in the electronic medical record during a visit may maintain less eye contact with the patient. Dr. Jason Saleem at the University of Louisville studied the impact of exam room layout on patient-centered care, with the goal of using technology as a mediating device between the patient and provider.

Assessing the impact of a redesigned clinic exam room on patient-provider communication.

“Primary care providers are incredibly overburdened: every second counts. We can find ways to improve their experience and use technology to improve their interactions with patients.”
- Dr. Jason Saleem

In collaboration with the Veterans Health Administration, Dr. Saleem tested a prototype design to better incorporate computers in the clinic exam room. New wall-mounted systems allowed providers to share the computer monitor with patients while easily orienting themselves toward the patient and keeping the computer screen in view. A new mobile computer workstation allowed providers to rearrange the clinic room, including simply pushing the computer away when not useful or needed.

Using technology to enhance and not disrupt communication.

The standard room design and the prototype were compared through a lab simulation study. Although providers were heavily focused on the patient in both study scenarios, providers using the standard room design had less situational awareness and greater cognitive workload because they needed to more frequently change their orientation between the computer and the patient. Field observations conducted by Dr. Saleem found that both providers and patients were enthusiastic about the flexibility to move and share the computer screen. In addition to increasing patient-centeredness, this study indicated the feasibility of aligning patient technology with the model of patient care.

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