• Jing Zhang, Yunan Chen, Shazia Ashfaq, Kristin Bell, Alan Calvitti, Neil J Farber, Mark T Gabuzda, Barbara Gray, Lin Liu, Steven Rick, Richard L Street, Kai Zheng, Danielle Zuest, and Zia Agha.
• Department of Biomedical Informatics, University of California, San Diego, San Diego, CA, USA Health Services Research & Development, VA San Diego Healthcare System, San Diego, CA, USA.
• J Am Med Inform Assoc. 2016 Jan 1; 23 (1): 137-43.

ObjectiveElectronic health records (EHRs) have great potential to improve quality of care. However, their use may diminish "patient-centeredness" in exam rooms by distracting the healthcare provider from focusing on direct patient interaction. The authors conducted a qualitative interview study to understand the magnitude of this issue, and the strategies that primary care providers devised to mitigate the unintended adverse effect associated with EHR use.Methods And MaterialsSemi-structured interviews were conducted with 21 healthcare providers at 4 Veterans Affairs (VAs) outpatient primary care clinics in San Diego County. Data analysis was performed using the grounded theory approach.ResultsThe results show that providers face demands from both patients and the EHR system. To cope with these demands, and to provide patient-centered care, providers attempt to perform EHR work outside of patient encounters and create templates to streamline documentation work. Providers also attempt to use the EHR to engage patients, establish patient buy-in for EHR use, and multitask between communicating with patients and using the EHR.Discussion And ConclusionThis study has uncovered the challenges that primary care providers face in integrating the EHR into their work practice, and the strategies they use to overcome these challenges in order to maintain patient-centered care. These findings illuminate the importance of developing "best" practices to improve patient-centered care in today's highly "wired" health environment. These findings also show that more user-centered EHR design is needed to improve system usability.© The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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