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Computers in the clinical encounter: a scoping review and thematic analysis

Computers in the clinical encounter: a scoping review and thematic analysis. Crampton, N. H., Reis, S. & Shachak, A. Journal of the American Medical Informatics Association 23, 654–665 (2016).

OVERVIEW

The purpose of the study was to review the current literature of health information technology (HIT) use during the clinical encounter to update best practices and inform the continuous development of HIT policies and educational interventions.

KEY FEATURES

The literature review identified the effect of HIT on the clinical encounter, patient attitudes towards HIT, patients and clinician styles of interacting with HIT, and the role of the computer in shaping the clinical encounter and the silent time and pauses in the conversation as a result of HIT use.

The effect on the clinical encounter: HIT affects the clinical encounter in multiple ways – negative and positive. Strategies of patient-centeredness in computerized clinical settings are presented in Table 4.

Patient attitudes: Patient attitudes towards clinical use of HIT were mostly positive, with some studies reporting no changes in attitude. Two studies demonstrate negative impacts.

Styles of interacting with HIT in the clinical encounter: Patients show varied styles of interacting with HIT & their clinicians, & clinicians exhibit varying styles as well. Different styles are identified & discussed.

HIT shaping the clinical encounter: Passive influence vs. Active influence - the clinician works with the patient to enter data (passive), or responds to prompts (active). Silent time/pauses is another theme.

BOTTOM LINE

Effect of HIT on the clinical encounter show both negative (interference with eye-contact, negative impact on information sharing and ability to ask questions, etc.) and positive impacts (more use of partnership strategies, the ability for patients to bring the computer into the conversation via. screen sharing). Whether these potential positive impacts are realized or not depends on clinicians’ styles of interacting with and adapting to HIT and patients.

COMMENTARY

A wonderful literature review that evaluates what is known about HIT in the clinic. A good resource for informing clinical best practices, though it offers little in the way of practical recommendation for medical education. 4/5 checks.