Comparing the Impact of Double and Single Screen Electronic Health Records on Doctor-Patient Non-Verbal Communication

OCCUPATIONAL APPLICATIONS: This study demonstrates that patients view their Electronic Health Records (EHR) significantly more with a dedicated second screen during outpatient primary care visits without any decrease in mutual eye contact with the doctor, suggesting increased engagement with technology. These findings suggest that configuring examination rooms to invite patients to view their information can increase patient engagement in the EHR without taking attention away from the healthcare provider. Physical designs such as a dedicated patient screen might increase transparency in care and create an opportunity for better patient education.TECHNICAL ABSTRACT: Background: From a human factors perspective, the integration of new technologies such as EHRs into the healthcare system alters doctor-patient communication and health information exchange processes. Prior studies have explored the impact of sharing EHR screens on doctor-patient communication in primary care visits. Purpose: We compared the effects of using a single-screen and a mirrored double-screen EHR as a primary care communication tool on non-verbal doctor-patient communication, specifically eye gaze patterns. Methods: Data were collected from two primary care clinics in Wisconsin between 2012 and 2016. Participating clinicians and patients met in a video-equipped exam room in an outpatient clinic. Both clinics used the same EHR system, though one had a second screen that mirrored the doctor’s screen specifically for the patient. Visits were video recorded to quantify the use of EHR, along with eye gaze behaviors as a measure of attention and engagement. Results: Forty-eight patients and 16 doctors participated in this study. Patients in the double-screen EHR setting gazed at their doctors significantly longer than in the single-screen setting (57.2 vs. 46.7% of the visit). More importantly, patients gazed at the patient display in double-screen EHR settings significantly more than they gazed at the EHR in single-screen settings (25.9 vs. 13.7%). Conclusions: Our results indicate that sharing EHRs using a double-screen setup has the potential to enhance patient attention to visual information in primary care settings.