Hsu J et al. 2005 "Health information technology and physician-patient interactions: impact of computers on communication during outpatient primary care visits."

Hsu J, Huang J, Fung V, et al. Health information technology and physician-patient interactions: impact of computers on communication during outpatient primary care visits. J Am Med Inform Assoc 2005;12(4):474-480.
"Objective: The aim of this study was to evaluate the impact of introducing health information technology (HIT) on physician-patient interactions during outpatient visits. Design: This was a longitudinal pre-post study: two months before and one and seven months after introduction of examination room computers. Patient questionnaires (n = 313) after primary care visits with physicians (n = 8) within an integrated delivery system. There were three patient satisfaction domains: (1) satisfaction with visit components, (2) comprehension of the visit, and (3) perceptions of the physician’s use of the computer. Results: Patients reported that physicians used computers in 82.3% of visits. Compared with baseline, overall patient satisfaction with visits increased seven months after the introduction of computers (odds ratio [OR] = 1.50; 95% confidence interval [CI]: 1.01-2.22), as did satisfaction with physicians' familiarity with patients (OR = 1.60, 95% CI: 1.01-2.52), communication about medical issues (OR = 1.61; 95% CI: 1.05-2.47), and comprehension of decisions made during the visit (OR = 1.63; 95% CI: 1.06-2.50). In contrast, there were no significant changes in patient satisfaction with comprehension of self-care responsibilities, communication about psychosocial issues, or available visit time. Seven months post-introduction, patients were more likely to report that the computer helped the visit run in a more timely manner (OR = 1.76; 95% CI: 1.28-2.42) compared with the first month after introduction. There were no other significant changes in patient perceptions of the computer use over time.
Conclusion: The examination room computers appeared to have positive effects on physician-patient interactions related to medical communication without significant negative effects on other areas such as time available for patient concerns. Further study is needed to better understand HIT use during outpatient visits."
"To evaluate the impact of introducing [examination room computers] on physician-patient interactions during outpatient visits."
Tools Used
Type Clinic
Primary care
Type Specific
Internal medicine and family practice.
Other Information
The study was conducted "in one freestanding medical office building of Kaiser Permanente-Northwest, Portland, Oregon."
Type of Health IT
Electronic health records (EHR)
Type of Health IT Functions
The electronic health record included an order entry system.
Context or other IT in place
The clinic had used a commercially available electronic health record (EHR) for the prior six years. They had to use the EHR to enter progress notes and order medications and laboratory tests, but the EHR was only available in their offices.
Workflow-Related Findings
Patients questioned 7 months after introduction of the health IT system were more likely to be satisfied with the level of communication about their care as compared to the pre-implementation period.
There were no significant differences in patient satisfaction regarding communication about psychosocial concerns with their providers or with how carefully the physician listened to them between pre-implementation and seven months post-implementation.
Patients in the 7-month post-implementation group reported greater comprehension regarding their medical care versus the pre-implementation group.
There was no significant difference between the pre and post implementation groups in comprehension regarding medical advice.
"Patients reported positive overall impressions of examination room computer use during the visit. The majority of patients (85.4%) reported that they totally agreed (51.4%) or agreed (34.0%) that they liked the way that their PCP used the computer during the visit. In contrast, only 6.2% of patients reported that the computer use created a distraction during the visit; 3.8% and 7.7% in P2 and P3, respectively."
Patients in the 7-month post-implementation group suggested that physicians were both more familiar with them as individuals as well as their medical history, compared to the pre-implementation group.
Patients were equally satisfied with the time spent discussing the main reason for the visit, discussing their emotional concerns, and the total time available to address all concerns before and after the technology implementation.
Between 1 month after implementation and 7 months after implementation, patients became more satisfied "with the computer's effect on the timeliness of visit activities."
Study Design
Pre-postintervention (no control group)
Study Participants
Eight primary care physicians participated. Of 313 patients participating, 107 participated in the period before health IT implementation, 81 in the first month after health IT implementation, and 125 in the seventh month after health IT was introduced. All patients were attending regularly scheduled appointments.