Reply to “Health Information Technology and Physician-Patient Interactions: Impact of Computers on Communication During Outpatient Primary Care Visits”
- Affiliation of the author: Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA
- Received 10 November 2005
- Accepted 15 November 2005
We thank Ms. Heidt for her thoughtful comments and agree that the type of electronic medical record (EMR) used and the physical setup of the room are both important factors that might influence the impact of examination room computer use.
Important EMR system characteristics that could be relevant to physician and patient perceptions of examination room computers include the number and types of available functions, the “user-friendliness” of the hardware interface and software, and the level of data integration across applications.1 All physicians in this study used the same integrated EMR, EpicCare© developed by Epic Systems, which permitted documentation of clinical encounters (i.e., recording visit progress notes), order entry and transmission, decision support, and creation of clinical summaries for patients. All examination rooms had flat screen monitors mounted on multidirectional arms, keyboards, and either a trackball or mouse. In addition, the health system had adapted the commercially available system with input from physicians. Because all subjects used a single system, we did not attempt to assess potential associations between the EMR characteristics and our outcomes.
We also agree that the position of the computer in the examination room is an important factor that can facilitate or impede physician-patient communication. As described in the paper, the location of the computer varied by examination room, with the adjustable monitors allowing physicians a limited amount of flexibility. In addition, the predominant location of the physician and patient within the examination room also varied across and within visits. Due to limited information about relevant location characteristics, including the lack of standardized or validated measures that capture aspects of spatial orientation or physicians' physical use of computers, we did not attempt to examine these factors in our quantitative analyses; however, a more detailed discussion of the potential effects of spatial organization can be found in a companion manuscript that reported on qualitative findings of examination room computers in the same setting.2
In conclusion, we agree with Ms. Heidt's call for more research on these important factors.
