More screen time, less face time - implications for EHR design

J Eval Clin Pract. 2014 Dec;20(6):896-901. doi: 10.1111/jep.12182. Epub 2014 May 19.


Rationale, aims and objectives: Understanding the impact of health information technology on doctor-patient interaction is vital to designing better electronic health records (EHRs). This article quantitatively examines and compares clinically experienced physicians' interactions with patients using paper or EHRs in ambulatory primary care settings.

Methods: Clinical encounters using paper or EHRs were recorded with high-resolution video cameras to capture physicians' interactions with the health records and patients. All videos were coded using quantified video coding methodology to understand how physicians interacted with EHRs and patients through measuring eye gaze durations. Statistical analysis was conducted to compare the results of the paper and EHR visits.

Results: Eight experienced family medicine physicians and 80 patients participated in the study. A total of 80 visits, 40 with paper and 40 with EHRs were recorded. The proportion of time physicians spent gazing at medical records during EHR visits was significantly more than in paper chart visits (35.2 versus 22.1%, P = 0.001). A significantly smaller proportion of physician time was spent gazing at the patient when using an EHR compared with when using a paper chart (52.6 versus 45.6%, P = 0.041).

Conclusions: For this group of family medicine physicians, more time was spent looking at the EHR screen than paper records and a little less time looking at the patient. These findings may negatively affect the patient perception of the visit with the physician and have implications for the design of future EHRs.

Keywords: EHR training; EHRs; paper charts; physician-EHR interaction; physician-patient interaction; primary care.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Ambulatory Care Facilities
  • Cross-Sectional Studies
  • Electronic Health Records / statistics & numerical data*
  • Family Practice / methods*
  • Family Practice / trends
  • Female
  • Humans
  • Male
  • Medical Informatics
  • Medical Records / statistics & numerical data
  • Middle Aged
  • Needs Assessment
  • Office Visits
  • Paper
  • Physical Examination / methods
  • Physician-Patient Relations*
  • Practice Patterns, Physicians'
  • Quality Assurance, Health Care*
  • Risk Factors
  • Time Factors