Normal Limits

"Chance is the very guide of life"

"In practical medicine the facts are far too few for them to enter into the calculus of probabilities... in applied medicine we are always concerned with the individual" -- S. D. Poisson

November 02, 2005

JAMIA - Health IT and Physician-Patient Interactions: Impact of Computers on Communication during Outpatient Primary Care Visits

(via Dr. Barron Lerner of NYT - The Computer Will See You Now (Feel Better?))
From the Journal of the American Medical Informatics Association:
The examination room computers appeared to have positive effects on physician-patient interactions related to medical communication without significant negative effects on other areas such as time available for patient concerns. Further study is needed to better understand [health information technology] use during outpatient visits.

This is a single-center, before-and-after comparison of patient perception, at 2 months before, 1 month after, and 7 months after installation of an electronic health medical records in the exam room. 8 physicians at the center, a part of the Kaiser Permanente-Northwest system, took part. 4 were FPs and 4 were IMs. 313 patients completed the questionnaires. This longitudinal data was analyzed using Generalized Estimating Equations (GEE).
The EHR appears to be a custom job by Epic Systems.
At 7 months, there were significant increases in
  1. patient overall satisfaction (OR=1.5, 1.01-2.22)

  2. patients' satisfaction with physician's familarity with patients (OR=1.60, 1.01-2.52)

  3. comprehension with decisions made during the visit (OR=1.63, 1.06-2.50)

At 7 months, no significant changes in
  1. patient satisfaction with comprehension of self-care responsibilities
  2. communication about psychosocial issues

  3. available visit time

It's somewhat curious that the ORs of some or these findings are barely and marginally statistically significant. But no matter. This is the most important finding:
By seven months post-introduction, patients were more likely to report that the computer helped the visit run in a more timely manner (OR = 1.76; 95% CI: 1.28�2.42) compared with the first month after introduction.

The Association of Medical Directors of Medical Informatics (AMDIS):
Since its founding in 1997, the Association of Medical Directors of Information Systems is the premier professional organization for physicians interested in and responsible for healthcare information technology.

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