Perspectives of English, Chinese, and Spanish-Speaking Safety-Net Patients on Clinician Computer Use: Qualitative Analysis

J Med Internet Res. 2019 May 22;21(5):e13131. doi: 10.2196/13131.


Background: Safety-net systems serve patients with limited health literacy and limited English proficiency (LEP) who face communication barriers. However, little is known about how diverse safety-net patients feel about increasing clinician electronic health record (EHR) use.

Objective: The aim of this study was to better understand how safety-net patients, including those with LEP, view clinician EHR use.

Methods: We conducted focus groups in English, Spanish, and Cantonese (N=37) to elicit patient perspectives on how clinicians use EHRs during clinic visits. Using a grounded theory approach, we coded transcripts to identify key themes.

Results: Across multiple language groups, participants accepted multitasking and silent clinician EHR use if focused on their care. However, participants desired more screen share and eye contact, especially when demonstrating physical concerns. All participants, including LEP participants, wanted clinicians to include them in EHR use.

Conclusions: Linguistically diverse patients accept the value of EHR use during outpatient visits but desire more eye contact, verbal warnings before EHR use, and screen-sharing. Safety-net health systems should support clinicians in completing EHR-related tasks during the visit using patient-centered strategies for all patients.

Keywords: attitude to computers; communication barriers; electronic health records; physician-patient relations; vulnerable populations.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Ambulatory Care
  • Asian People
  • Communication Barriers*
  • Communication*
  • Computers
  • Electronic Health Records / trends*
  • Female
  • Health Literacy / trends*
  • Hispanic or Latino
  • Humans
  • Language
  • Male
  • Physician-Patient Relations*
  • Safety-net Providers / trends*