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

Abstract

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.