The Effects of Electronic Medical Record (EMR) Use in Primary Care on the Physician-Patient Relationship

The Effects of Electronic Medical Record (EMR) Use in Primary Care on the Physician-Patient Relationship

Shira Assis-Hassid (Ben-Gurion University of the Negev, Israel), Iris Reychav (Ariel University Center, Israel), Joseph S. Pliskin (Ben-Gurion University of the Negev, Israel) and Tsipi Heart Heart (Ben-Gurion University of the Negev, Israel)
DOI: 10.4018/978-1-4666-3986-7.ch007
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The implications of the physician-patient relationship and communication on healthcare quality have been widely discussed in previous research. Communication has been characterized as one of the most powerful, encompassing, and versatile instruments available to the physician, and it has been suggested that good physician-patient communication can improve healthcare outcomes. The incorporation of ICT in healthcare and, more specifically, the introduction of EMRs in primary care provide an opportunity for improving healthcare services and quality of care. Healthcare ICT has without a doubt transformed the dynamics of the medical encounter. Implications of EMRs on the physician-patient communication, and thus on healthcare quality have not yet reached a full understanding. The authors suggest a research model based on theoretical frameworks derived from the IS and medicine disciplines, describing factors affecting appropriate use of EMR, which will lead to physician and patient satisfaction.
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The goal of this chapter is to examine the effects of Electronic Medical Records (EMR) use on the relationship between physician and patient in primary care. We explore the role of the physician-patient relationship in patient care and how this relationship is affected by the introduction of Information and Communication Technology (ICT) in the clinic as manifested by the EMR use by the physician. While it may appear that ICT provides an opportunity to improve patient-physician communication as part of the clinical practice, and hence clinical outcomes, it is surprising to find that there is scant literature on the direct effects of ICT on the physician-patient relationship (Pearce et al., 2009). This existing gap is particularly unsettling since communication has been characterized as one of the most powerful, encompassing, and versatile instruments available to the physician (Engel, 1988, 1989). As will be shown in this chapter, several studies suggest that good communication can improve healthcare outcomes from better treatment adherence and fewer interactions leading to malpractice suits (Frankel et al., 2005).

We explore the effects of Electronic Medical Records' (EMR) introduction in the clinic on the physician-patient relationship by looking into different aspects such as technology adoption and use, benefits and shortcomings of EMR use, and physical aspects such as exam room configuration and eye contact. Regarding both aspects, we seek to show the benefits and shortcomings of EMR use and their influence on the physician-patient relationship (See Figure 1). Finally, we develop a model of factors affecting the utilization of computers in the exam room based on theoretical frameworks from the information systems (IS) field, which focus on user IS adoption, long term acceptance, task-technology fit and user satisfaction.

Figure 1.

Chapter schema


This chapter attempts to extend the current understanding of physician-patient relationship within a computerized environment. We believe that the application of IS theoretical frameworks into healthcare IS can imply what needs to be done in order to minimize current obstacles of IS utilization in healthcare while improving the physician-patient relationship in a computerized environment.



The following section provides an overview of the physician-patient relationship and imperative role of communication in healthcare which have been recognized prior to the introduction of Information Communication Technology (ICT). Namely, we discuss elements of patient centered care, physicians' communication behavior and functions of the medical interview.

Key Terms in this Chapter

Primary Care: The term primary care refers to health services provided within the local community. Primary care is the patient’s first point of consultation. Primary care physicians are also referred to as General Practitioners (GPs) or family physicians. Primary care involves the widest scope of healthcare, including all ages of patients, patients of all socioeconomic and geographic origins, patients seeking to maintain optimal health, and patients with all manner of acute and chronic physical, mental, and social health issues, including multiple chronic diseases. Consequently, a primary care practitioner must possess a wide breadth of knowledge in many areas. The relationship between GPs and their patients is particularly unique since they usually have a continuous relationship, sometimes over years (as opposed to encounters with specialists, hospital physicians, etc.).

Patient Centered Care: The term ’patient centered care’ refers to medical care which focuses first and foremost on the patient (as opposed to the illness), while taking into consideration the patient’s history and psychology as part of the patient’s treatment.

Electronic Medical Record (EMR): The term EMR refers to a computerized record of a patient’s medical information and medical history in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports. The EMR has the ability to generate a complete record of a clinical patient encounter, as well as supporting other care-related activities directly or indirectly via interface—including evidence-based decision support, quality management, and outcomes reporting.

Triadic Relationship: The term ’triadic relationship’ refers to the new relationship created in the exam room, following the introduction of computers. The introduction of computers into the exam room has created many changes in the medical interview and in the physician-patient relationship. The computer is now considered a third party as the interaction no longer includes only physician and patient. Its physical presence and its effect on the physician’s cognitive load and attention during the interview make the computer a factor that cannot be ignored.

Utilization: The term utilization refers to the actual use of an Information System. Many Information System projects fail due to users refusing to utilize the system in their everyday work. In order to increase system utilization, users must be part of the design process. It is important to understand the users’ workflow, business processes and work habits in order to design an Information System that will be later on utilized.

Technology to Performance Chain: The Technology to Performance Chain (TPC) refers to the series of conditions that are necessary so that an information System affects users’ performance. Our baseline assumption is that implementation of Information Systems primary objective is to support employees at their work related tasks and as such, well designed ISs will lead to improved performance.

Physician-Patient Communication: Physician-patient communication refers to all aspects of communication and dialogue in a given social interaction. The communication process entails both verbal and non-verbal behaviors. Non-verbal behaviors may include body posture and body language, eye contact etc. Verbal behaviors include tone of voice, course of conversation, direct verbal messages etc. The General Practitioner (GP) and his patient have a unique relationship which is different than the relationship with other types of physicians, mainly because of the continuity of it.

Task-Technology Fit: Task-Technology Fit refers to the degree to which a certain Information System or technology supports the task at hand. As long as the technology fits the user’s tasks and workflow, he will use the technology during these tasks, and vice versa—if the technology interrupts the user’s workflow and tasks, he will not use it or at least try to avoid using it.

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