Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 13, 2018
Date Accepted: Apr 24, 2019
(closed for review but you can still tweet)
Perspectives on Best Practices for Clinician Computer Use from English, Chinese, and Spanish-Speaking Safety-Net Patients: A Qualitative Analysis
ABSTRACT
Background:
Safety-net systems serve patients with limited health literacy and limited English proficiency (LEP) who face communication barriers. However, little is known about how diverse safety-net patients feel about increasing clinician electronic health record (EHR) use.
Objective:
The aim of this study was to better understand how safety-net patients, including those with LEP, view clinician EHR use.
Methods:
We conducted focus groups in English, Spanish, and Cantonese (n=37) to elicit patient perspectives on how clinicians use EHRs during clinic visits. Using a grounded theory approach, we coded transcripts to identify key themes.
Results:
Across all language groups, participants accepted multitasking and silent clinician EHR use if focused on their care. However, participants desired more screen share and eye contact, especially when demonstrating physical concerns. From a 65-year-old English-speaking woman: “If I have a sore throat, don’t just put it in the computer—look!” All participants, including LEP participants, wanted clinicians to include them in EHR use. From a 58-year-old Cantonese-speaking woman: “When the doctor is typing...can I look at it at the same time?”
Conclusions:
Linguistically diverse patients accept the value of EHR use during outpatient visits but desire more eye contact, verbal warnings before EHR use, and screen-sharing. Safety-net health systems should support clinicians in completing EHR-related tasks during the visit using patient-centered strategies for all patients.
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