• Teresa Taft, Leslie Lenert, Farrant Sakaguchi, Gregory Stoddard, and Caroline Milne.
• Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.
• J Am Med Inform Assoc. 2015 Jan 1;22(1):192-8.

BackgroundThe effects of electronic health records (EHRs) on doctor-patient communication are unclear.ObjectiveTo evaluate the effects of EHR use compared with paper chart use, on novice physicians' communication skills.DesignWithin-subjects randomized controlled trial using observed structured clinical examination methods to assess the impact of use of an EHR on communication.SettingA large academic internal medicine training program.PopulationFirst-year internal medicine residents.InterventionResidents interviewed, diagnosed, and initiated treatment of simulated patients using a paper chart or an EHR on a laptop computer. Video recordings of interviews were rated by three trained observers using the Four Habits scale.ResultsThirty-two residents completed the study and had data available for review (61.5% of those enrolled in the residency program). In most skill areas in the Four Habits model, residents performed at least as well using the EHR and were statistically better in six of 23 skills areas (p<0.05). The overall average communication score was better when using an EHR: mean difference 0.254 (95% CI 0.05 to 0.45), p = 0.012, Cohen's d of 0.47 (a moderate effect). Residents scoring poorly (>3 average score) with paper methods (n = 8) had clinically important improvement when using the EHR.LimitationsThis study was conducted in first-year residents in a training environment using simulated patients at a single institution.ConclusionsUse of an EHR on a laptop computer appears to improve the ability of first-year residents to communicate with patients relative to using a paper chart.© The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association.

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