Patients note benefits from exam room computer

Patients' understanding of their medical conditions, communication with physicians about medical issues and overall satisfaction surged after doctors installed and used computers in examination rooms to access patients' health information, says a study at Kaiser Permanente.

Responses from 313 participating patients in Oregon and Washington, found 57% said they had an excellent understanding of their treatments after the computers were installed, compared with 46% who said that before the computers were installed.

Patients were surveyed in 2001 and 2002, a month before computers were installed in the exam room and then one month and seven months after.

The study, which has been accepted for publication this summer in the Journal of the American Medical Informatics Assn. and is posted on the journal's Web site, also found that:

• 61% of patients reported excellent satisfaction with discussions about their treatments, compared with 47% before computers.
• 50% said their physicians were very familiar with their medical histories, compared with 42%.
• 63% reported excellent overall satisfaction, compared with 55%.

"The patients felt their communication with the doctor about medical issues was markedly better. They also felt the improved discussion didn't crowd out time for their concerns," said John Hsu, MD, the lead author of the study. Dr. Hsu is a physician scientist at Kaiser Permanente's Division of Research, Oakland, Calif.

"By making the data collection process more efficient, the computer use can free up time for discussion about what the information means for the patient or any additional questions," Dr. Hsu said.

Having a computer in the room also makes it easier for doctors to educate patients, he said. For example, Dr. Hsu said, doctors can electronically chart and show the patient's high blood pressure if they notice that the patient didn't refill a prescription. That way, he said, physicians can show patients the effect of their actions on their health.

Susan Blake, MD, a family physician at Kaiser in Tualatin, Ore., agreed. "The nice thing about our computer system is that there's a lot of graphing functions ... the visuals often make a big impact," she said. "My experience has been that virtually all of the patients like having [the computer in the room]. I can order prescriptions right there and that always impresses them. They say, 'Wow, you already ordered that?' "

When she first began using a computer in the exam room in 2001, Dr. Blake initially feared it would be too distracting. But her concern turned out be unfounded, she said.

One reason is that she uses a flat-screen computer that sits on a moveable arm. "It's amazing how much eye contact you can maintain with the patient as long as you're kind of facing and explaining to them what you're doing," said Dr. Blake, whose patients were not among those who participated in the study.