Implementing the Electronic Medical Record in the Exam Room: The Effect on Physician-Patient Communication and Patient Satisfaction


Vivian Tong Nagy, PhD; Michael H Kanter, MD

Spring 2007 - Volume 11 Number 2


With the implementation of the electronic medical record--called HealthConnect--in all exam rooms throughout the Kaiser Permanente health care delivery system, how computers in the exam room affects physician-patient communication is a new concern. Patient satisfaction scores were obtained for all primary and specialty care physicians in a large medical center in Southern California to determine how scores changed as physicians started using HealthConnect in the exam room. Results show no significant changes in patient satisfaction for these physicians. Although concerns were not realized that patient satisfaction might decrease after HealthConnect was introduced, there was also no evidence that introducing an electronic medical record in outpatient clinics increased patient satisfaction.

Early research in Kaiser Permanente's (KP's) Northwest and Colorado Regions examined the impact of exam room computers on member satisfaction with their care experience. Results showed that integration of computers into the delivery of care resulted in improvements in patient satisfaction and patients' opinions of exam room computers were mostly positive. Patient satisfaction improved after physician training and steady-state use was reached.1 Concerns that patient satisfaction would deteriorate with the introduction of computers generally did not materialize. In the literature, a number of studies have been published regarding the effect of a computerized medical record on the physician­patient interaction. Overall, results are generally inconclusive because of methodologic limitations.2-9 For the most part, results were obtained in studies involving computers used by a limited number of clinicians and on the basis of feedback from small samples of patients. In addition, previous studies included primary care physicians. There is little information about patient satisfaction with the interaction with specialty care physicians after computers are introduced in the exam room.

What effect are computers in the exam room having on physician­patient communication and patient satisfaction as HealthConnect is being implemented throughout KP? The magnitude of this intervention is huge. HealthConnect significantly changes the work processes of physicians while the patient is in the exam room. These changes can potentially affect the communication between physician and patient as well as patients' overall satisfaction. When introduced broadly throughout KP, computers in the exam room may have a far-reaching and significant effect on patient perceptions of their outpatient visits. Given the importance of this issue and some methodologic issues with previous studies, we were motivated to study the effect of implementation of a computerized medical record in the exam room with a large number of providers in multiple specialties.


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