Observational studyJournal of general internal medicine2018
Keystrokes, Mouse Clicks, and Gazing at the Computer: How Physician Interaction with the EHR Affects Patient Participation.
Observational study in Journal of general internal medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
28 citing papers in PubMed, 1 synthesis or guideline pooled it, 50 citations in OpenAlex.
- Interaction Time with Electronic Health Records: A Systematic Review.Applied clinical informatics · 2021Pooled it
- Impact of Emerging Technologies on Outpatient Care Quality: Mixed Methods Study.JMIR rehabilitation and assistive technologies · 2026Review
- The Impact of Electronic Health Records on Family Physicians During Simulated Virtual Encounters: Exploratory Mixed Methods Study.JMIR medical informatics · 2026Article
- Ambient technology in epilepsy clinical practice.Epilepsia open · 2025Article
- Electronic health records tools for treating obesity among adult patients in primary care: A scoping review.Obesity pillars · 2025Article
- Exploring Patient Involvement in Treatment Decision-Making for Diabetic Retinopathy: A COM-B Model-Based Cross-Sectional Survey.Patient preference and adherence · 2025Article
- I'm not burned out. This is how I write notes.JAMIA open · 2023Article
- Evaluation of Eye Gaze Dynamics During Physician-Patient-Computer Interaction in Federally Qualified Health Centers: Systematic Analysis.JMIR human factors · 2023Article
- Expanding Narrative Medicine through the Collaborative Construction and Compelling Performance of Stories.The Journal of medical humanities · 2023Article
- Patient-provider communication while using a clinical decision support tool: explaining satisfaction with shared decision making for mammography screening.BMC medical informatics and decision making · 2022Article
- A brief pre-visit educational video improved patient engagement after telehealth visits; results from a randomized controlled trial.PEC innovation · 2022Article
- Quantifying the Electronic Health Record Burden in Head and Neck Cancer Care.Applied clinical informatics · 2022Article
- Automatic Classification of Screen Gaze and Dialogue in Doctor-Patient-Computer Interactions: Computational Ethnography Algorithm Development and Validation.Journal of medical Internet research · 2021Article
- Patient Portal Use, Perceptions of Electronic Health Record Value, and Self-Rated Primary Care Quality Among Older Adults: Cross-sectional Survey.Journal of medical Internet research · 2021Article
- An interview study with medical scribes on how their work may alleviate clinician burnout through delegated health IT tasks.Journal of the American Medical Informatics Association : JAMIA · 2021Article
- While the Chatbot's Away, the Mice Will Play.Frontiers in digital health · 2021Article
- Assessing Patients' Perceptions of Clinician Communication: Acceptability of Brief Point-of-Care Surveys in Primary Care.Journal of general internal medicine · 2020Article
- Association of Electronic Health Record Use Above Meaningful Use Thresholds With Hospital Quality and Safety Outcomes.JAMA network open · 2020Article
- Assessment of Electronic Health Record Search Patterns and Practices by Practitioners in a Large Integrated Health Care System.JAMA network open · 2020Article
- Perspectives of English, Chinese, and Spanish-Speaking Safety-Net Patients on Clinician Computer Use: Qualitative Analysis.Journal of medical Internet research · 2019Article
Corrections and comments
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Authors and funding
12 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundEvidence is mixed regarding how physicians' use of the electronic health record (EHR) affects communication in medical encounters.
objectiveTo investigate whether the different ways physicians interact with the computer (mouse clicks, key strokes, and gaze) vary in their effects on patient participation in the consultation, physicians' efforts to facilitate patient involvement, and silence.
designCross-sectional, observational study of video and event recordings of primary care and specialty consultations.
participantsThirty-two physicians and 217 patients. MAIN MEASURES: Predictor variables included measures of physician interaction with the EHR (mouse clicks, key strokes, gaze). Outcome measures included active patient participation (asking questions, stating preferences, expressing concerns), physician facilitation of patient involvement (partnership-building and supportive talk), and silence. KEY
resultsPatients were less active participants in consultations in which physicians engaged in more keyboard activity (b = -0.002, SE = 0.001, p = 0.02). More physician gaze at the computer was associated with more silence in the encounter (b = 0.21, SE = 0.09, p = 0.02). Physicians' facilitative communication, which predicted more active patient participation (b = 0.65, SE = 0.14, p < 0.001), was not related to EHR activity measures.
conclusionsPatients may be more reluctant to actively participate in medical encounters when physicians are more physically engaged with the computer (e.g., keyboard activity) than when their behavior is less demonstrative (e.g., gazing at EHR). Using easy to deploy communication tactics (e.g., asking about a patient's thoughts and concerns, social conversation) while working on the computer can help physicians engage patients as well as maintain conversational flow.
Indexed as
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.