Technology mediated information sharing (monitor sharing) in primary care encounters.

摘要

The aim of this dissertation study was to identify and describe the use of electronic health records (EHRs) for information sharing between patients and clinicians in primary-care encounters and to understand work system factors influencing information sharing. Ultimately, this will promote better design of EHR technologies and effective training suggestions to incorporate EHRs into overall communication during patient visit, and overall work system design. This topic is particularly important as computers and other technologies are increasingly implemented in multi-user health-care settings where interactions and communication between patients and clinicians are integral to interpersonal and organizational outcomes. A sequential mixed method was used in the overall study. First, an ethnographic approach was used to classify the encounters into distinct technology-use patterns based on clinicians' interactions with the technology and patients. Each technology-use pattern was quantitatively including sequential analysis and descriptive statistics analyzed to assist with comparison. Quantitative analysis was based on duration of patient and clinician gaze at EHR. Then, a qualitative approach was employed to understand work system factors related to organization, individual, environment, task and technology, which influence technology- mediated information sharing (monitor sharing) behaviors of physicians in primary care encounters. This qualitative approach explored work systems factors with a content analysis of semi-structured interviews, which was conducted with primary care physicians. Results showed that physicians employed three different styles to share information using EHRs: (1) active information sharing, in which a clinician turns the monitor towards the patient and uses the computer to actively share information with the patient; (2) passive information sharing, when a clinician does not move the monitor, but the patient might see the monitor by leaning in if they choose and (3) technology withdrawal, when a clinician does not share the monitor with the patient. In addition, interview results also indicated several factors which influence physicians' decisions to decide which style to follow. In conclusion, a variety of technology-mediated information-sharing styles may be effective in providing patient-centered care. New EHR designs may be needed to facilitate information sharing between patients and clinicians.