How Do Patients Want Us to Use the Computer During Medical Encounters?-A Discrete Choice Experiment Study

Cédric Lanier; Melissa Dominicé Dao; Dave Baer; Dagmar M Haller; Johanna Sommer; Noëlle Junod Perron

doi:10.1007/s11606-021-06753-1

How Do Patients Want Us to Use the Computer During Medical Encounters?-A Discrete Choice Experiment Study

J Gen Intern Med. 2021 Jul;36(7):1875-1882. doi: 10.1007/s11606-021-06753-1. Epub 2021 Apr 26.

Authors

Cédric Lanier¹, Melissa Dominicé Dao², Dave Baer³, Dagmar M Haller⁴, Johanna Sommer⁴, Noëlle Junod Perron⁵

Affiliations

¹ Primary Care unit (UIGP), BFM local 4091, Centre Médical Universitaire de Genève, University of Geneva, Geneva, Switzerland. cedric.lanier@unige.ch.
² Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
³ Cité Générations, Onex, Switzerland.
⁴ Primary Care unit (UIGP), BFM local 4091, Centre Médical Universitaire de Genève, University of Geneva, Geneva, Switzerland.
⁵ Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland.

Abstract

Background: Primary care physicians (PCPs) now widely use electronic health records (EHRs) during medical encounters. Experts in clinical communication issued recommendations for a patient-centered use of EHRs. However, they have never been validated by patients themselves.

Objective: To explore patients' preferences regarding physicians' EHR-related behaviors.

Design: Discrete choice experiment study.

Patients: French-speaking patients waiting for a medical consultation at two outpatient clinics in Geneva, Switzerland.

Main measures: We invited patients to watch videos displaying 2 or 3 variations of four specific EHR-related behaviors and asked them to indicate which one they preferred. EHR-related behaviors were (1) typing: continuous/intermittent/handwriting in biomedical or psychosocial focused consultations; (2) maintaining contact while typing: visual/verbal/both; (3) signposting the use of EHR: with/without; (4) position of physicians' hands and bust: on the keyboard and towards the patient/away from the keyboard and towards the patient/on the keyboard and towards the screen.

Key results: Three hundred thirty-six patients participated (response rate 61.4%). They preferred intermittent typing versus handwriting or continuous typing for biomedical issues (32.7%; 95% CI: 26.0-40.2% vs 31.6%; 95% CI: 24.9-39.0% or 14.9%; 95% CI: 10.2-21.1%) and psychosocial issues (38.7%; 95% CI: 31.6-46.3% vs 24.4% 95% CI: 18.4-31.5% or 17.9%; 95% CI; 12.7-24.4%). They favored visual and verbal contact (38.9%; 95% CI: 31.9-46.3%) over verbal (30.3%; 95% CI: 23.9-37.5%) or visual contact only (11.4%; 95% CI: 7.5-17.1%) while the doctor was typing. A majority preferred signposting the use of EHR versus no signposting (58.9%; 95% CI: 53.5-64.0% vs 34.8%; 95% CI: 29.9-40.1%). Finally, half of the patients (49.7%; 95% CI: 42.0-57.4%) favored the position with the physician's bust towards the patient and hands away from the keyboard.

Conclusions: Our study shows that patients' preferences regarding EHR-related behaviors are in line with most experts' recommendations. Such recommendations should be more consistently integrated into under- and postgraduate communication skills training.

Keywords: Communication skills; Computer use; Electronic health record; Patient-physician relation; Primary care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Communication
Computers
Electronic Health Records
Humans
Physician-Patient Relations*
Physicians, Primary Care*
Switzerland