We wish to note particularly the remarkable diligence and devotion to our task of our Executive Director, David B. The contributions of individuals who served as our immediate staff are acknowledged in the Preface to the report. We wish to thank everyone at HEW who helped us. Our undertaking has required the cooperation of many agencies and organizations and the assistance of many individuals. We have greatly appreciated the opportunity to be of service to you and the Department, and, we hope, to all our fellow citizens. Both you and former Secretary Richardson deserve praise for responding to public concern about the issues posed by automation of personal-data record- keeping operations. We are grateful for the interest that you have expressed in our work. Our recommendations provide the framework for general solutions and also specify actions to be taken both within HEW and by the Federal government as a whole. The Committee believes that the report makes a significant contribution toward understanding many of the problems arising from the application of computer technology to record keeping about people. It is a privilege for me to submit this report to you on behalf of the Secretary's Advisory Committee on Automated Personal Data Systems. In addition, doctors can look up frequently and make eye contact to reestablish the relationship, Frankel said.Secretary of Health, Education, and Welfare If possible, it can be arranged so both doctor and patient can see the screen, he said. They should introduce the patient to the computer and explain how and why they will be using it. âTechnology in the exam room is neither good nor bad inherently,â but doctors can use specific techniques to help patients get comfortable with it, he said. âWhen people are paying attention to the same thing at the same time, you get the best transmission of information,â Frankel told Reuters Health by phone. Frankel of the Indiana University School of Medicine, Indianapolis, who wrote an editorial accompanying the story. âOn the other hand, maybe patients sense that their clinicians arenât listening as carefully to them,â she said.Äoctors who spend most of the time looking at the computer may miss out on an emotional connection with the patient, said Richard M. Problems in care may lead to more computer use, which would explain the link between computer use and lower patient satisfaction, she said. âElectronic health records give important health information to clinicians, which may help safety net patients with communication barriers like limited health literacy and limited English proficiency.â âFor example, a primary care provider says, âNo, the cardiologist actually wants you to stop taking that medication,ââ she said. Thatâs not necessarily a bad thing, Ratanawongsa said. In the post-appointment interview the patients rated the quality of their care over the past six months.ÄȘbout half of the 25 encounters with high computer use were rated as âexcellent careâ by the patients, compared to more than 80 percent of the 19 encounters with low computer use, as reported in JAMA Internal Medicine.Äoctors who spent more time using the computer spent less time making eye contact with patients and tended to engage in more ânegative rapport building,â correcting patients about their medical history or drugs theyâve taken based on information in the electronic record. The electronic health records could be used to review test results, track health care maintenance, prescribe medications and refer patients to specialists. Using the tapes, the researchers rated how much each physician used the computer during the appointment on a scale from one to 12. Researchers interviewed them by phone before their appointment, videotaped the appointment, and interviewed the patients again after their visit. The patients had type 2 diabetes, rheumatoid arthritis or congestive heart failure, and sometimes more than one of those chronic conditions. The researchers used data from encounters between 47 patients and 39 doctors at a public hospital between 20. âSo itâs not surprising that we found differences in the way clinicians and patients talk to each other,â she said.Ä«ut doctors who used the computer more also spent more time correcting or disagreeing with patients, she told Reuters Health by email. Neda Ratanawongsa of the University of California, San Francisco, who co-authored the research letter. âMany clinicians worry that electronic health records keep them from connecting with their patients,â said Dr. (Reuters Health) - Doctors who entered data into computerized health records during patientsâ appointments did less positive communicating, and patients rated their care excellent less often, in a recent study.
