Electronic health records are expected to improve medical care by giving doctors greater access to patient information, but researchers say patients might want to ask their doctors to step away from the computer, at least during appointments.

Doctors who accessed electronic records during a patient visit spent a third of the appointment time gazing at a computer screen instead of interacting with their patients, according to a study by Northwestern University. The research, published online in the International Journal of Medical Informatics, analyzed 100 patient visits with primary care doctors. During the time that doctors were using the computers, patients looked around the room, sometimes trying — and failing — to get their doctor’s attention, the report found. “That’s time that they’re not engaging with the patient,” says Enid Montague, lead author of the study and an assistant professor in medicine and engineering at Northwestern University.

Typically, doctors using paper charts would quickly review a patient’s information outside of the examination room, leaving them with more time to visually examine a patient and chat about how they’re feeling, says Montague. Now, doctors using electronic records are spending a portion of the time they would normally spend with patients reviewing their medical records and typing in any relevant updates. Many patients stared at the computer screens along with their doctors, but couldn’t understand what they were looking at, she says.

While the study didn’t find that doctors skipped any steps during their examinations, Montague says some doctors may have missed out on the nonverbal cues that usually help them recognize a new health issue like depression. Those first few minutes of a doctor’s visit, typically filled with chitchat about how a patient is feeling, as well as questions about whether the person has gone on any trips recently and how his or her children are doing, are vital to helping doctors get to know their patients, says Montague. That rapport helps doctors gain their patients’ trust, which can in turn make patients more willing to take needed medications or make recommended lifestyle changes, she adds.

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The research was similar to other reports showing that the move to electronic medical records, which is being accelerated by the Affordable Care Act, can have unintended consequences. In hospitals, doctors using computers to order prescriptions risk ordering information for the wrong patient or entering medical information under the wrong name, says Heather Farley, lead author of a 2013 report on the quality and safety implications of emergency-department information systems published in the “Annals of Emergency Medicine.” Some critics of electronic medical records also warn about “alert fatigue,” where doctors receive so many updates, they risk missing an important change to a patient’s condition. “I think we are just scratching the surface,” says Dr. Farley of the issues that could arise from digital medical records.

To be sure, doctors say the move to electronic health records can improve patient safety overall by reducing paperwork and giving doctors instant access to prior test results, prescription information and records for care received in other settings, such as the emergency room, says Montague. Electronic records also remove the issue of poor handwriting, making it easier for doctors to read important information. And some systems can alert doctors to allergies or potentially risky drug interactions.

Some doctors may get more out of their electronic health systems by designing a program that allows patients to review their medical information along with the doctor during a visit, says Montague, a change that might still allow doctors to build rapport with patients while they go over necessary information. Hospitals are working to avoid mix-ups by including more identifying information in a patient’s digital chart, such as a photo or a room number. “We can improve the design so that physicians can engage in these other nonverbal communications more effectively,” says Montague.

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