The effect of Electronic Health Records on the medical professional identity of physicians:a systematic literature review

Electronic Health Records (EHR) have become standard practice and have altered the way physicians work and communicate with their patients. This changing work environment may subsequently influence the perceived professional identity of physicians. In this study, we aim to understand the impact of EHR use on the medical professional identity of physicians. We conducted a systematic literature review which resulted in the analysis of 34 papers that met inclusion quality criteria. The literature suggests that EHRs make the interaction between patients and physicians more formal and standardized. In addition, physicians experience a decrease in their autonomy which negatively influences their experienced professional identity. Based on these findings, we recommend examining how EHRs can allow physicians to focus more on medical work and communication with their patients and be less distracted by EHR requirements so that their medical professional identity can be restored or enhanced

The computerized medical record as a tool for clinical governance in australian primary care

Background: Computerized medical records (CMR) are used in most Australian general practices. Although CMRs have the capacity to amalgamate and provide data to the clinician about their standard of care, there is little research on the way in which they may be used to support clinical governance: the process of ensuring quality and accountability that incorporates the obligation that patients are treated according to best evidence. Objective: The objective of this study was to explore the capability, capacity, and acceptability of CMRs to support clinical governance. Methods: We conducted a realist review of the role of seven CMR systems in implementing clinical governance, developing a four-level maturity model for the CMR. We took Australian primary care as the context, CMR to be the mechanism, and looked at outcomes for individual patients, localities, and for the population in terms of known evidence-based surrogates or true outcome measures. Results: The lack of standardization of CMRs makes national and international benchmarking challenging. The use of the CMR was largely at level two of our maturity model, indicating a relatively simple system in which most of the process takes place outside of the CMR, and which has little capacity to support benchmarking, practice comparisons, and population-level activities. Although national standards for coding and projects for record access are proposed, they are not operationalized. Conclusions: The current CMR systems can support clinical governance activities; however, unless the standardization and data quality issues are addressed, it will not be possible for current systems to work at higher levels

Ambulatory Clinic Exam Room Design with respect to Computing Devices: A Laboratory Simulation Study

Background—Challenges persist regarding how to integrate computing effectively into the exam room, while maintaining patient-centered care. Purpose—Our objective was to evaluate a new exam room design with respect to the computing layout, which included a wall-mounted monitor for ease of (re)-positioning. Methods—In a lab-based experiment, 28 providers used prototypes of the new and older “legacy” outpatient exam room layouts in a within-subject comparison using simulated patient encounters. We measured efficiency, errors, workload, patient-centeredness (proportion of time the provider was focused on the patient), amount of screen sharing with the patient, workflow integration, and provider situation awareness. Results—There were no statistically significant differences between the exam room layouts for efficiency, errors, or time spent focused on the patient. However, when using the new layout providers spent 75% more time in screen sharing activities with the patient, had 31% lower workload, and gave higher ratings for situation awareness (14%) and workflow integration (17%). Conclusions—Providers seemed to be unwilling to compromise their focus on the patient when the computer was in a fixed position in the corner of the room and, as a result, experienced greater workload, lower situation awareness, and poorer workflow integration when using the old “legacy” layout. A thoughtful design of the exam room with respect to the computing may positively impact providers’ workload, situation awareness, time spent in screen sharing activities, and workflow integration

Electronic Health Record's Effects on the Outpatient Office Visit and Clinical Education

Background: During an office visit, the provider has the important cognitive task of attending to the patient while actively using the electronic health record (EHR).  Prior literature suggests that EHR may have a positive effect on simple tasks, but a negative effect on tasks that require complex cognitive processes.  No study has examined the provider’s perception of EHR on multiple distinct aspects of the office visit.Methods: We surveyed providers/preceptors regarding their perception of EHR on multiple aspects of the office visit.  We summarized their EHR utilization history and their perceptions of the EHR during the visit using descriptive statistics.  We tested for associations between time spent using the EHR and distinct aspects of the visit using Chi-square tests of association.Results: In total, 83 providers/preceptors reported use of EHR (response rate 52%). Provider/preceptors reported an overall negative effect of EHR on the patient-provider connection, but an overall positive effect on the review of medications/medical records, communication between providers, review of results with patients and review of follow-up to testing results with patients. The effect of EHR on history taking and teaching students was neutral.  We observed no correlation between the provider’s time spent using the EHR and their perception of its effectiveness.Conclusions:  Providers reported a positive perception of EHR on aspects of the office visit that involved a single cognitive task.  However, providers reported a negative perception of EHR on patient-provider connection, which involves a high degree of cognitive processing

The Medical Authority of AI: A Study of AI-enabled Consumer-facing Health Technology

Recently, consumer-facing health technologies such as Artificial Intelligence (AI)-based symptom checkers (AISCs) have sprung up in everyday healthcare practice. AISCs solicit symptom information from users and provide medical suggestions and possible diagnoses, a responsibility that people usually entrust with real-person authorities such as physicians and expert patients. Thus, the advent of AISCs begs a question of whether and how they transform the notion of medical authority in everyday healthcare practice. To answer this question, we conducted an interview study with thirty AISC users. We found that users assess the medical authority of AISCs using various factors including automated decisions and interaction design patterns of AISC apps, associations with established medical authorities like hospitals, and comparisons with other health technologies. We reveal how AISCs are used in healthcare delivery, discuss how AI transforms conventional understandings of medical authority, and derive implications for designing AI-enabled health technology

SERIES: eHealth in primary care. Part 3: eHealth education in primary care

Background: Education is essential to the integration of eHealth into primary care, but eHealth is not yet embedded in medical education. Objectives: In this opinion article, we aim to support organisers of Continuing Professional Development (CPD) and teachers delivering medical vocational training by providing recommendations for eHealth education. First, we describe what is required to help primary care professionals and trainees learn about eHealth. Second, we elaborate on how eHealth education might be provided. Discussion: We consider four essential topics. First, an understanding of existing evidence-based eHealth applications and conditions for successful development and implementation. Second, required digital competencies of providers and patients. Third, how eHealth changes patient-provider and provider-provider relationships and finally, understanding the handling of digital data. Educational activities to address these topics include eLearning, blended learning, courses, simulation exercises, real-life practice, supervision and reflection, role modelling and community of practice learning. More specifically, a CanMEDS framework aimed at defining curriculum learning goals can support eHealth education by

El ordenador como barrera comunicativa en la consulta médica.

Treball Final de Grau en Medicina. Codi: MD1158. Curs acadèmic: 2017/2018Objectives: Technological development has incorporated the computer to the medical consultation, which implies a change in doctor - patient interaction. This study analyzes perception of computer use, its impact o n comm u nication, as well as the degree of satisfaction from the perspective of the patient and the professional, investigating differences between both . It also proposes strategies to improve the implementation of information technology in the consultation. Methods: Initially, a literature review was carried out i n international databases (Pubmed ) and various medical journals. Subsequently, field work was carried out in the primary care centers of the city of Castellón, consisting of collecting two types of surveys created ad hoc , one for patients and another for family practitioner s. Result s : Patients and professionals share the approval of the use of the computer, although the physicians perceive a greater impact on the doctor - patient relationship and the emotional connection with the patient. Conclusions: We confirmed in our environment the greatest concern of professionals for the interference of the computer in the doctor - patient relationship, compared to the users of health services.Objetivos : El desarrollo tecnológico de nuestra sociedad ha incorporado el ordenador a la consulta médica, lo que implica un cambio en la interacción médico /a - paciente . Este estudio analiza la percepción del uso del ordenador, su impacto en la comunicación, así como el grado de satisfacción desde la perspectiva del paciente y del profesional, indagando diferencias entre ambos. Asimismo, propone estrategias para mejorar la implementación de la informática en la consulta. Métodos: Inicialmente se realizó una revisión bibliográfica sobre el tema en bases de datos internacionales ( Pubmed ) y diversas revistas de medicina . Posteriormente se llevó a cabo un trabajo de campo en l os centros de atención primaria de la ciudad de Castellón, consistente en la recogida de dos tipos de encuestas creadas ad hoc , una dirigida a pacientes y otra a facultativos de medicina de familia . Resultados: Pacientes y profesionales aprueban el uso de l ordenador , aunque el personal facultativo percibe mayor impacto en la relación médico - paciente y la conexión emocional con el enfermo . Conclusiones : Se confirma en nuestro medio la mayor preocupación de los y las profesionales por la interferencia del ordenador en la relación médico - paciente, en comparación con los usuarios de los servicios sanitarios