Provider Preference in Exam Room Layout Design and Computing

Abstract

Background The introduction of the electronic health record (EHR) has had a significant impact on provider–patient interactions, particularly revolving around patient-centeredness. More research is needed to understand the provider perspective of this interaction.

Objectives Our objective was to obtain provider feedback on a new exam room design compared with the one already in use with respect to the computing layout, which included a wall-mounted monitor for ease of (re)-positioning. An additional objective was to understand elements of exam room design and computing that were highly valued.

Methods Semistructured interviews were conducted with 28 providers from several health care organizations. Interviews were audio recorded and transcribed for analysis. We used an inductive coding approach to abstract recurrent themes from the data.

Results Our analysis revealed several themes organized around exam room layout, exam room computing, and provider workflow. We report frequency of occurrence of the coded data for computer accessories, computing usefulness, computer mobility, documentation habits, form factor, layout preference, patient interaction, screen sharing, and work habits.

Conclusion Providers in our study preferred exam room design to promote flexibility, mobility, and body orientation directed toward the patient. Providers also expressed the need for exam room design to support varying work habits and preferences, including whether to share the computer screen or not.

Keywords

human–computer interaction - computer workstations - exam room design - exam room computing - patient centeredness

Protection of Human and Animal Subjects

This study was reviewed and approved by the University of Louisville's Institutional Review Board (IRB), IRB study # 16.0749.

• References

• 1 Patel MR, Vichich J, Lang I, Lin J, Zheng K. Developing an evidence base of best practices for integrating computerized systems into the exam room: a systematic review. J Am Med Inform Assoc 2017; 24 (e1): e207-e215
• 2 Saleem JJ, Flanagan ME, Russ AL. , et al. You and me and the computer makes three: variations in exam room use of the electronic health record. J Am Med Inform Assoc 2014; 21 (e1): e147-e151
• 3 Asan O, Montague E. Technology-mediated information sharing between patients and clinicians in primary care encounters. Behav Inf Technol 2014; 33 (03) 259-270
• 4 Piper AM, Hollan JD. Supporting medical communication for older patients with a shared touch-screen computer. Int J Med Inform 2013; 82 (11) e242-e250
• 5 White A, Danis M. Enhancing patient-centered communication and collaboration by using the electronic health record in the examination room. JAMA 2013; 309 (22) 2327-2328
• 6 Asan O, Tyszka J, Fletcher KE. Capturing the patients' voices: planning for patient-centered electronic health record use. Int J Med Inform 2016; 95: 1-7
• 7 Asan O. Providers' perceived facilitators and barriers to EHR screen sharing in outpatient settings. Appl Ergon 2017; 58: 301-307
• 8 Ventres W, Kooienga S, Vuckovic N, Marlin R, Nygren P, Stewart V. Physicians, patients, and the electronic health record: an ethnographic analysis. Ann Fam Med 2006; 4 (02) 124-131
• 9 Frankel R, Altschuler A, George S. , et al. Effects of exam-room computing on clinician-patient communication: a longitudinal qualitative study. J Gen Intern Med 2005; 20 (08) 677-682
• 10 Frankel RM, Saleem JJ. “Attention on the flight deck”: what ambulatory care providers can learn from pilots about complex coordinated actions. Patient Educ Couns 2013; 93 (03) 367-372
• 11 McGrath JM, Arar NH, Pugh JA. The influence of electronic medical record usage on nonverbal communication in the medical interview. Health Informatics J 2007; 13 (02) 105-118
• 12 Alkureishi MA, Lee WW, Lyons M. , et al. Impact of electronic medical record use on the patient–doctor relationship and communication: a systematic review. J Gen Intern Med 2016; 31 (05) 548-560
• 13 Pearce C, Arnold M, Phillips C, Trumble S, Dwan K. The patient and the computer in the primary care consultation. J Am Med Inform Assoc 2011; 18 (02) 138-142
• 14 Kumarapeli P, de Lusignan S. Using the computer in the clinical consultation; setting the stage, reviewing, recording, and taking actions: multi-channel video study. J Am Med Inform Assoc 2013; 20 (e1): e67-e75
• 15 Frankel RM. Computers in the examination room. JAMA Intern Med 2016; 176 (01) 128-129
• 16 Pearce C, Dwan K, Arnold M, Phillips C, Trumble S. Doctor, patient and computer--a framework for the new consultation. Int J Med Inform 2009; 78 (01) 32-38
• 17 Booth N, Robinson P, Kohannejad J. Identification of high-quality consultation practice in primary care: the effects of computer use on doctor-patient rapport. Inform Prim Care 2004; 12 (02) 75-83
• 18 Makoul G, Curry RH, Tang PC. The use of electronicmedical records: communication patterns in outpatient encounters. J Am Med Inform Assoc 2001; 8 (06) 610-615
• 19 Shachak A, Hadas-Dayagi M, Ziv A, Reis S. Primary care physicians' use of an electronic medical record system: a cognitive task analysis. J Gen Intern Med 2009; 24 (03) 341-348
• 20 Weiler DT, Satterly T, Rehman SU. , et al. Ambulatory clinic exam room design with respect to computing devices: a laboratory simulation study. IISE Trans Occup Ergon Hum Factors 2018; 6 (3-4): 165-177
• 21 Fischer G. . Personal communication; 2016
• 22 Saleem JJ, Weiler DT, Satterly T. , et al. Field investigation of ambulatory clinic exam room design with respect to computing devices: a pilot study. Paper presented at the Proceedings of the Human Factors and Ergonomics Society Annual Meeting; 2018
• 23 Hynes DM, Perrin RA, Rappaport S, Stevens JM, Demakis JG. Informatics resources to support health care quality improvement in the Veterans Health Administration. J Am Med Inform Assoc 2004; 11 (05) 344-350
• 24 Zhang J, Chen Y, Ashfaq S. , et al. Strategizing EHR use to achieve patient-centered care in exam rooms: a qualitative study on primary care providers. J Am Med Inform Assoc 2016; 23 (01) 137-143
• 25 Asan O, Tyszka J, Crotty B. The electronic health record as a patient engagement tool: mirroring clinicians' screen to create a shared mental model. JAMIA Open. 2018; 1 (01) 42-48