Does putting a computer terminal in the exam room help the physician-patient relationship or does it add a distraction? According to Kaiser Permanente scientist John Hsu, M.D., "when used well," computers help improve patients' satisfaction and boost their understanding about their individual conditions.
Hsu's view on the matter follows his recent study of how 313 patients reacted when eight physicians at a primary-care medical office building in the Portland, Ore., area installed terminals in their exam rooms. Physician-patient encounters were videotaped and patients were interviewed before computers were added, the month they were added and seven months later.
In a report published in the Journal of the American Medical Informatics Association, Hsu stated that patients rating their satisfaction as excellent rose to 62.8% from 55.3%. "Computers in the exam room are a potential barrier: They can suck away the physician's attention and potentially slow things down as physicians enter data or document their activities," Hsu said. "Fortunately, we found that those two things did not happen."
Previous studies, most done more than 10 years ago, found that communication was hindered as physicians became preoccupied with computer tasks, Hsu said. But he added that these studies were done before systems became more user-friendly and when doctors were less computer-savvy.
Hsu said all the physicians involved in his study had computers in their offices, so the challenge was to see how they integrated them into patient visits. While recognizing that his sample may have an "early adopter bias," Hsu was pleased to report that the computer was used in 82.3% of the patient visits.
"Physicians seem to be using the tools effectively and the patients did seem to respond very well," he said, explaining that doctors used the terminal to show patients copies of their X-rays or to look at line graphs of how their blood pressure may be responding to medication.
Using the computer this way led to improved patient understanding of their conditions and treatment. According to the study, the percentage of patients reporting excellent satisfaction in the comprehension of their diagnosis or treatment rose to 57.3% from 46.4%.
The number of patients reporting excellent satisfaction in understanding how their physician reached their diagnosis or determined their treatment also rose, to 52.3% from 41%.
On the downside, however, patient understanding of potential side effects or complication dropped to 43.8% from 50.8%. "They understood the diagnosis and their prescribed treatment better-and how their doc got to that point-but not what they have to do," Hsu said.
He explained that patients were able to comprehend what was on the computer screen but had trouble comprehending concepts that were not, such as what effect an exercise program would have on their conditions.
"The computer is a great tool, but the more information you have in there the more useful it can be," Hsu said. He added that one of the things that pleased him about the study was something that he did not find: evidence that computers interfere with discussion of nonmedical concerns.
While quality-improvement efforts are good at using process measures and making sure certain patients get screened for certain diseases, they may overlook other issues that are important to patients, Hsu said. These issues include questions about how their condition or medication will affect their ability to perform activities such as participating in sports. "We didn't see greater availability of this medical information crowding out patients' psycho-social concerns," Hsu said.
Slight increases in patient satisfaction in these areas were measured: Patients reporting excellent satisfaction in their physicians' concern for their emotional and physical well-being rose to 60% from 59%; and patients reporting excellent satisfaction in how carefully their doctor listened to them went up to 64.6% from 63.6%.
Although he was able to measure increased patient satisfaction, Hsu said he did not learn what occurred that caused satisfaction to rise. That might be the basis for a follow-up study. "One of the areas we'd love to learn more about are all the ways physicians are using the computers," Hsu said. "We didn't have a measure of all the things docs are doing and which ones have the most effect on which patients. And, if we can understand what works well, how do we encourage more of that?"