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Computers in the consulting room: a case study of clinician and patient perspectives

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Abstract

Few clinicians in the United States use computers during patient encounters and many still worry that computers will depersonalize their interactions with patients. This case study describes patient and clinician reactions to a computer‐based health appraisal system. Findings showed no difference in any aspect of patient satisfaction between computer and non‐computer groups. Use of a computer in the consulting room neither depersonalized nor enhanced patient satisfaction. Clinicians (in this case, nurse practitioners and physician assistants) were willing to use the system, which they perceived as having benefits for patient care, but were concerned about the increased time required for exams, effort required to learn the system while still interacting appropriately with the patient, increased monitoring of their performance, and other organizational issues. Clinicians who used the system showed a higher tolerance for uncertainty and communicated more frequently with each other and with others throughout the department. Implementation was slowed by the need to demonstrate the monetary value of the system.

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References

  1. J.G. Anderson, Computer-based patient records and changing physicians practice patterns, Topics in Health Information Management 15 (1994) 10-23.

    Google Scholar 

  2. J.G. Anderson, C.E. Aydin and S.J. Jay, Evaluating Health Care Information Systems (Sage Publications, Thousand Oaks, CA, 1994).

    Google Scholar 

  3. J.G. Anderson, S.J. Jay, H.M. Schweer and M.M. Anderson, Why doctors don't use computers: some empirical findings, Journal of the Royal Society of Medicine 79 (1986) 142-144.

    Google Scholar 

  4. J.G. Anderson, S.J. Trajkovski, R. Campbell, A. Haley and M.M. Anderson, Determining clinical practice styles from computer-based data, in: Proceedings Medinfo 92, 7th World Congress on Medical Informatics, Geneva, Switzerland (September, 1992) pp. 6-10.

  5. J.G. Anderson, H.C. Weng, C.E. Aydin, P.N. Rosen and V.J. Felitti, Computers in the examining room: Evaluating the social impact on practice patterns, in: Proceedings of the American Conference on Information Systems,15-17 August, Indianapolis, IN (Association for Information Systems, 1997) pp. 909-911.

  6. C.E. Aydin, Occupational adaptation to computerized medical information systems, Journal of Health and Social Behavior 30 (1989) 163-79.

    Article  Google Scholar 

  7. C.E. Aydin and D.E. Forsythe, Implementing computers in ambulatory care: Implications of physician practice patterns for system design, in: Proceedings of the 1997 AMIA Fall Symposium, Nashville, TN (1997) pp. 677-681. (Journal of the American Medical Informatics Association Symposium Supplement.)

  8. C.E. Aydin and R.E. Rice, Social worlds, individual differences, and implementation: predicting attitudes toward a medical information system, Information and Management 20 (1991) 119-136.

    Article  Google Scholar 

  9. C.E. Aydin and R.E. Rice, Bringing social worlds together: information systems as catalysts for interdepartmental interactions, Journal of Health and Social Behavior 33 (1992) 168-185.

    Article  Google Scholar 

  10. C.E. Aydin, P.N. Rosen and V.J. Felitti, Health Appraisal: Why do they really come?, Kaiser-Permanente Medical Care Program, San Diego (1993), unpublished manuscript.

  11. C.E. Aydin, P.N. Rosen and V.J. Felitti, Transforming information use in preventive medicine: learning to balance technology with the art of caring, in: Proceedings of the 18th Annual Symposium on Computer Applications in Medical Care, Washington, DC (1994) pp. 563-567. (Journal of the American Medical Informatics Association Symposium Supplement.)

  12. C.E. Aydin, P.N. Rosen, S.M. Jewell and V.J. Felitti, Computers in the examining room: The patient's perspective, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care, New Orleans, LA (1995) pp. 824-828. (Journal of the American Medical Informatics Association Symposium Supplement.)

  13. J.G. Baggs, S.A. Ryan, C.E. Phelps, J.F. Richeson and J.E. Johnson, The association between interdisciplinary collaboration and patient outcomes in a medical intensive care unit, Heart and Lung 21(1) (1992) 18-24.

    Google Scholar 

  14. J.E. Bailey, Development of an instrument for the management of computer user attitudes in hospitals, Methods of Information in Medicine 20 (1990) 51-56.

    Google Scholar 

  15. I. Benbasat, D.K. Goldstein and M. Mead, The case research strategy in studies of information systems, MIS Quarterly 11(3) (1987) 369- 386.

    Article  Google Scholar 

  16. L.L. Berkowitz, Breaking down the barriers: Improving physician buy-in of CPR systems, Healthcare Informatics14(10) (1997) 73-76.

    Google Scholar 

  17. H.L. Bleich et al., Clinical computing in a teaching hospital, New England Journal of Medicine 312 (1985) 756-764.

    Article  Google Scholar 

  18. P.Q. Bourie, J. Dresch and R.H. Chapman, Usability evaluation of an on-line nursing assessment, in: Proceedings of the 1997 AMIA Fall Symposium, Nashville, TN (1997) p. 914. (Journal of the American Medical Informatics Association Symposium Supplement.)

  19. P.F. Brennan and M. Anthony, Nursing practice models: Implications for IS design, in: Proceedings of the 1997 AMIA Fall Symposium, Nashville, TN (1997) p. 847. (Journal of the American Medical Informatics Association Symposium Supplement.)

  20. S.J. Brown, M.A. Cioffi, P. Schinella and A. Shaw, Evaluation of the impact of a bedside terminal system in a rapidly changing community hospital, Computers in Nursing 13 (1995) 280-284.

    Google Scholar 

  21. G. Brownbridge, M. Fitter and M. Sime, The doctor's use of a computer in the consulting room: an analysis, International Journal of Man-Machine Studies 21 (1984) 65-90.

    Article  Google Scholar 

  22. G. Brownbridge, G.A. Herzmark and T.D. Wall, Patient reactions to doctors' computer use in general practice consultations, Social Science and Medicine 20 (1985) 47-52.

    Article  Google Scholar 

  23. G. Brownbridge, E.J. Lilford and S. Tindale-Biscoe, Use of a computer to take booking histories in a hospital antenatal clinical, Medical Care 26 (1988) 474-487.

    Google Scholar 

  24. M. Burkes, Identifying and relating nurses' attitudes toward computer use, Computers in Nursing 9 (1991) 190-201.

    Google Scholar 

  25. H.L. Chin and P. McClure, Evaluating a comprehensive outpatient clinical information system: A case study and model for system evaluation, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care,New Orleans, LA (1995) pp. 717-721. (Journal of the American Medical Informatics Association Symposium Supplement.)

  26. P.J. Cruickshank, Patient stress and the computer in the consulting room, Social Science in Medicine 16 (1982) 1371-1376.

    Article  Google Scholar 

  27. Department of Health GP Computing Survey 1991, London: NHS Management Executive (1991).

  28. R.S. Dick and E.B. Steen, eds., The Computer-Based Patient Record: An Essential Technology for Health Care (National Academy Press, Washington, DC: Institute of Medicine, 1991).

    Google Scholar 

  29. W.J. Doll and G. Torkzadeh, The measurement of end-user computing satisfaction, MIS Quarterly 12 (1988) 259-274.

    Article  Google Scholar 

  30. R.B. Elson, Uniting practice management and the CPR, in: Healthcare Informatics: Uniting Practice Management and the CPR (Online, McGraw-Hill, 1997). Available: Http://www.healthcareinformatics. com/issues/1997/09 97/ss elson.htm.

  31. R.B. Elson and D.P. Connelly, Computerized patient records in primary care: Their role in mediating guideline-driven physician behavior change, Archives of Family Medicine 4 (1995) 698-705.

    Article  Google Scholar 

  32. R.B. Emerson, R.I. Fretz and L.L. Shaw, Writing Ethnographic Fieldnotes (University of Chicago Press, Chicago, 1995).

    Google Scholar 

  33. V.J. Felitti, Patient entry into a large, multi-specialty medical group, Kaiser-Permanente Medical Care Program, San Diego, CA (1983), unpublished report.

  34. A.B. Flood, The impact of organizational and managerial factors on the quality of care in health care organizations, Medical Care Review 51(4) (1994) 381-428.

    Google Scholar 

  35. R.M. Gardner and H.P. Lundsgaarde, Evaluation of user acceptance of a clinical expert system, Journal of the American Medical Informatics Association 1 (1994) 428-438.

    Google Scholar 

  36. M.S. Gerrity, R.F. DeVellis and J.A. Earp, Physicians' reactions to uncertainty in patient care, Medical Care 28 (1990) 724-736.

    Google Scholar 

  37. B.A. Happ, The effect of point of care technology on the quality of patient care, in: Proceedings of the 18th Annual Symposium on Computer Applications in Medical Care, Washington, DC (1994) pp. 183-187. (Journal of the American Medical Informatics Association Symposium Supplement.)

  38. G.M. Hayes, Computers in Consultation: The UK experience, in: Proceedings of the 17th Annual Symposium on Computer Applications in Medical Care (IEEE Computer Society Press, Washington, DC, 1993) pp. 103-106.

    Google Scholar 

  39. G. Hendrickson and C.T. Kovner, Effects of computers on nursing resource use, Computers in Nursing 8 (1990) 16-22.

    Google Scholar 

  40. G. Herzmark, G. Brownbridge, M. Fitter and A. Evans, Consultation use of a computer by general practitioners, Journal of the Royal College of General Practitioners 34 (1984) 649-654.

    Google Scholar 

  41. D.K. Hinson, S.E. Huether, J.A. Blaufuss, M. Neiswanger, A. Tinker, K.J. Meyer and R. Jensen, Measuring the impact of a clinical nursing information system on one nursing unit, in: Proceedings of the 18th Annual Symposium on Computer Applications in Medical Care,Washington, DC (1994) pp. 203-210. (Journal of the American Medical Informatics Association Symposium Supplement.)

  42. M.E. Johnston, K.B. Langton, R.B. Haynes and A. Mathieu, Effects of computer-based clinical decision support systems on clinician performance and patient outcome: A critical appraisal of research, Annals of Internal Medicine 120 (1994) 135-142.

    Google Scholar 

  43. B. Kaplan, Addressing organizational issues in the evaluation of medical systems, Journal of the American Medical Informatics Association 4 (1997) 94-100.

    Google Scholar 

  44. B. Kaplan, Objectification and negotiation in interpreting clinical images: implications for computer-based patient records, Artificial Intelligence in Medicine 7 (1995) 439-454.

    Article  Google Scholar 

  45. B. Kaplan and D. Duchon, Combining qualitative and quantitative methods in information systems research: A case study, MIS Quarterly 12(4) (1988) 571-586.

    Article  Google Scholar 

  46. J. Kincey, P. Bradshaw and P. Ley, Patients' satisfaction and reported acceptance of advice in general practice, Journal of the Royal College of General Practitioners 25 (1975) 558-566.

    Google Scholar 

  47. K.H. Kjerulff, M.A. Counte, J.S. Salloway and B.C. Campbell, Understanding employee reactions to a medical information system, in: Proceedings of the 5th Annual Symposium on Computer Applications in Medical Care (IEEE Computer Society Press, Los Angeles, CA, 1981) pp. 802-805.

    Google Scholar 

  48. W.A. Knaus, E.A. Draper, D.P. Wagner and J.E. Zimmerman, An evaluation of outcome from intensive care in major medical centers, Annals of Internal Medicine 104 (1986) 410-418.

    Google Scholar 

  49. M.A. Krall, Acceptance and performance by clinicians using an ambulatory electronic medical record in an HMO, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care,New Orleans, LA (1995) pp. 708-711. (Journal of the American Medical Informatics Association Symposium Supplement.)

  50. J.D. Legler, Computers and the physician-patient relationship: what do we know?, in: Proceedings of the 14th Annual Symposium on Computer Applications in Medical Care (IEEE Computer Society Press, Washington, DC, November 4-7, 1990) pp. 289-292.

    Google Scholar 

  51. J.D. Legler and R. Oates, Patients' reactions to physician use of a computerized medical record system during clinical encounters, The Journal of Family Practice 37(3) (1993) 241-244.

    Google Scholar 

  52. J.R. Lewis, Patient views on quality care in general practice: literature review, Social Science and Medicine 39(5) (1994) 655-670.

    Article  Google Scholar 

  53. M.T. Lush and S.B. Henry, Nurses use of health status data to plan for patient care: Implications for the development of a computer-based outcomes infrastructure, in: Proceedings of the 1997 Annual Fall Symposium,Nashville, TN (1997) pp. 136-140. (Journal of the American Medical Informatics Association Symposium Supplement.)

  54. J. McCormack, When will smaller medical groups discover computers?, Health Data Management 5(10) (1997) 50-52, 54, 56, 58, 60, 63.

    Google Scholar 

  55. M.B. Miles and A.M. Huberman, Qualitative Data Analysis (Sage Publications, Newbury Park, CA, 1984).

    Google Scholar 

  56. C.A. Murphy, M. Maynard and G. Morgan, Pretest and post-test attitudes of nursing personnel toward a patient care information system, Computers in Nursing 12 (1994) 239-244.

    Google Scholar 

  57. P.M. Ngin and L.M. Simms, Computer use for work accomplishment: A comparison between nurse managers and staff nurses, Journal of Nursing Administration 26 (1996) 47-55.

    Google Scholar 

  58. S. Ornstein and A. Bearden, Patient perspectives on computer-based medical records, The Journal of Family Practice 38(6) (1994) 606-610.

    Google Scholar 

  59. M.J. Papa, Communication network patterns and employee performance with new technology, Communication Research 17 (1990) 344-368.

    Google Scholar 

  60. I.N. Purves, Implications for family practice record systems in the USA: lessons from the United Kingdom, in: Proceedings of the American Medical Informatics Association, Spring Congress, St. Louis, MO (1993) p. 54.

    Google Scholar 

  61. J.J. Rethans, P. Hoppener, G. Wolfs and J. Diederiks, Do personal computers make doctors less personal?, British Medical Journal 296 (1988) 1446-1448.

    Google Scholar 

  62. R.E. Rice and J.G. Anderson, Social networks and health care information systems: A structural approach to evaluation, in: Evaluating Health Care Information Systems: Methods and Applications, J.G. Anderson, C.E. Aydin and S.J. Jay, eds. (Sage, Thousand Oaks, CA, 1994) pp. 135-163.

    Google Scholar 

  63. D.M. Rind and C. Safran, Real and imagined barriers to an electronic medical record, in: Proceedings of the 17th Annual Symposium on Computer Applications in Medical Care (McGraw Hill, New York, 1993) pp. 74-78.

    Google Scholar 

  64. E.M. Rogers, Diffusion of Innovations, 4th ed. (Free Press, New York, 1995).

    Google Scholar 

  65. B.L. Rotman et al., A randomized controlled trial of a computer-based physician work station in an outpatient setting: Implementation barriers to outcome evaluation, Journal of the American Medical Informatics Association 3 (1996) 340-348.

    Google Scholar 

  66. Royal College of General Practitioners, Computers in primary care: The report of the computer working party, Occasional Paper 13 (1982).

  67. D.Z. Sands, D.M. Rind, C. Vieira and C. Safran, Going paperless: Can it be done?, in: Proceedings of the 1997 AMIA Annual Fall Symposium,Nashville, TN (1997) p. 887. (Journal of the American Medical Association Symposium Supplement.)

  68. S.C. Schoenbaum and G.O. Barnett, Automated ambulatory medical records systems: An orphan technology, Journal of Technology Assessment in Health Care 8(4) (1992) 598-609.

    Article  Google Scholar 

  69. R.L. Schultz and D.P. Slevin, Implementation and organizational validity: an empirical investigation, in: Implementing Operations Research/Management Science, R.L. Schultz and D.P. Slevin, eds. (American Elsevier, New York, 1975) pp. 153-182.

    Google Scholar 

  70. Secretary of Health and Social Services, Medical and Health Insurance Information Reform Act of 1992 (HB 5464, SB 2878) Washington, DC (1992).

  71. S.M. Shortell, J.E. Zimmerman, D.M. Rousseau, R.R. Gillies, D.P. Wagner, E.A. Draper, W.A. Knaus and J. Duffy, The performance of intensive care units: Does good management make a difference?, Medical Care 32(5) (1994) 508-525.

    Google Scholar 

  72. E.H. Shortliffe, Dehumanization of patient care-are computers the problem or solution?, Journal of the American Medical Informatics Association 1 (1994) 75-76.

    Google Scholar 

  73. G.L. Solomon and M. Dechter, Are patients pleased with computer use in the examination room?, The Journal of Family Practice 41(3) (1995) 241-244.

    Google Scholar 

  74. N. Staggers, Using computers in nursing: Documented benefits and needed studies, Computers in Nursing 6 (1988) 164-170.

    Google Scholar 

  75. J.H. Stronge and A. Brodt, Assessment of nurses' attitudes toward computerization, Computers in Nursing 3 (1985) 154-158.

    Google Scholar 

  76. S. Teasdale and M. Bainbridge, Improving information management in family practice: Testing an adult learning model, in: Proceedings of the 1997 AMIA Annual Fall Symposium,Nashville, TN (1997) pp. 687-692. (Journal of the American Medical Informatics Association Symposium Supplement.)

  77. J. Urkin, S.S. Warshawsky, J.S. Pliskin, N. Cohen, A. Sharon, M. Binstok and C.Z. Marigolds, How does a computerized medical record (CMR) affect physicians' work style? A video recorded study, in: Proceedings of the American Medical Informatics Association, Spring Congress, St. Louis, MO (1993) p. 89.

    Google Scholar 

  78. J. Van Maanen, ed., Qualitative Methodology (Sage Publications, Beverly Hills, CA, 1983).

    Google Scholar 

  79. M.H. Wolf, S.M. Putnam, S.A. James and W.B. Stiles, The medical interview satisfaction scale: development of a scale to measure patient perceptions of physician behavior, Journal of Behavioral Medicine 1 (1978) 391-401.

    Article  Google Scholar 

  80. R.K. Yin, Case Study Research: Design and Methods (Sage Publications, Thousand Oaks, CA, 1984).

    Google Scholar 

  81. R.D. Zielstorff, G. Estey, A. Vickery, G. Hamilton, J.B. Fitzmaurice and G.O. Barnett, Evaluation of a decision support system for pressure ulcer prevention and management: Preliminary findings, in: Proceedings of the 1997 Annual Fall Symposium,Nashville, TN (1997) pp. 248-252. (Journal of the American Medical Informatics Association Symposium Supplement.)

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Authors and Affiliations

  1. Cedars‐Sinai Medical Center, Burns & Allen Research Institute, Los Angeles, CA, 90048, USA E-mail:

    Carolyn E. Aydin

  2. Department of Sociology and Anthropology, Purdue University, W. Lafayette, IN, 47907, USA

    James G. Anderson & Hui‐Ching Weng

  3. Kaiser‐Permanente Medical Care Program, San Diego, CA, USA

    Peter N. Rosen & Vincent J. Felitti

  4. Department of Family Practice and Preventive Medicine, University of California, San Diego, CA, 92037, USA

    Peter N. Rosen

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  1. Carolyn E. Aydin
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  2. James G. Anderson
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  4. Vincent J. Felitti
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  5. Hui‐Ching Weng
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Aydin, C.E., Anderson, J.G., Rosen, P.N. et al. Computers in the consulting room: a case study of clinician and patient perspectives. Health Care Management Science 1, 61–74 (1998). https://doi.org/10.1023/A:1019021913951

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