Conclusion
In summary, study findings indicate that (1) patients have no problem with the use of a computer in the consulting room; and (2) examiners (NPs and PAs) are willing to use a system that they perceive as having benefits for patient care (e.g., enforcing thoroughness in the exam). For systems to be enthusiastically endorsed and used by clinicians, however, they will need to go beyond the mixed benefits of systems such as CompuHx to include features that clearly make practice easier (e.g., easy retrieval of information clinicians need). Physicians in hospitals, for example, are far more likely to use computers to retrieve laboratory results needed to make clinical decisions than to enter their own orders in the computer, which requires additional work on their part. Also essential is a detailed implementation plan that includes adequate time for training and communication with other users, and addresses issues such as the role of the system champion and any performance monitoring concerns. Implementation may also be hindered by the need to identify the monetary value of the cited benefits in light of the additional time initially required to conduct exams using the system, as well as required capital expenditures. Longitudinal research should examine potential changes in clinician tolerance for uncertainty, as well as the impacts of altered communication and consultation patterns, which have been shown to improve productivity in other settings. The project also highlights the importance of research that focuses not only on system outcomes, but also examines the implementation process and includes the necessary information to evaluate factors influencing clinician usage of the system.
Access provided by Autonomous University of Puebla. Download to read the full chapter text
Chapter PDF
Similar content being viewed by others
Keywords
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
References
R.S. Dick and E.B. Steen, eds., The Computer-Based Patient Record: An Essential Technology for Healthcare (National Academy Press, Washington, DC: Institute of Medicine, 1991).
Secretary of Health and Social Services, Medical and Health Insurance Information Reform Act of 1992 (HB 5464, SB 2878), Washington, DC (1992).
J.G. Anderson, Computer-based patient records and changing physicians practice patterns, Topics in Health Information Management 15 (1994) 10–23.
R.B. Elson and D.P. Connelly, Computerized patient records in primary care: Their role in mediating guideline-driven physician behavior change, Archives of Family Medicine 4 (1995) 698–705.
M.E. Johnston, K.B. Langton, R.B. Haynes, and A. Mathieu, Effects of computer-based clinical decision support systems on clinician performance and patient outcome: A critical appraisal of research, Annals of Internal Medicine 120 (1994) 135–142.
Royal College of General Practitioners, Computers in primary care: The report of the computer working party, Occasional Paper 13 (1982).
G. Brownbridge, M. Fitter, and M. Sime, The doctor’s use of a computer in the consulting room: An analysis, International Journal of Man-Machine Studies 21 (1984) 65–90.
Department of Health GP Computing Survey 1991, London: NHS Management Executive (1991).
G.M. Hayes, Computers in Consultation: The UK experience, in: Proceedings of the 17th Annual Symposium on Computer Applications in Medical Care (IEEE Computer Society Press, Washington, DC, 1993), pp. 103–106.
G. Herzmark, G. Brownbridge, M. Fitter, and A. Evans, Consultation use of a computer by general practitioners, Journal of the Royal College of General Practitioners 34 (1984) 649–654.
I.N. Purves, Implications for family practice record systems in the USA: Lessons from the United Kingdom, in: Proceedings of the American Medical Informatics Association, Spring Congress, St. Louis, MO (1993), p. 54.
S. Teasdale and M. Bainbridge, Improving information management in family practice: Testing an adult learning model, in: Proceedings of the 1997 AMIA Annual Fall Symposium, Nashville, TN (1997), pp. 687–692. (Journal of the American Medical Informatics Association Symposium Supplement.)
G.L. Solomon and M. Dechter, Are patients pleased with computer use in the examination room? The Journal of Family Practice 41(3) (1995) 241–244.
S.C. Schoenbaum and G.O. Barnett, Automated ambulatory medical records systems: An orphan technology, Journal of Technology Assessment in Healthcare 8(4) (1992) 598–609.
J. McCormack, When will smaller medical groups discover computers?, Health Data Management 5(10) (1997) 50–52, 54, 56, 58, 60, 63.
L.L. Berkowitz, Breaking down the barriers: Improving physician buy-in of CPR systems, Healthcare Informatics 14(10) (1997) 73–76.
R.B. Elson, Uniting practice management and the CPR, in: Healthcare Informatics: Uniting Practice Management and the CPR (Online, McGraw-Hill, 1997). Available: Http://www.healthcareinformatics.com/issues/1997/09_97/ss_elson.htm.
J.D. Legler, Computers and the physician-patient relationship: What do we know?, in: Proceedings of the 14th Annual Symposium on Computer Applications in Medical Care (IEEE Computer Society Press, Washington, DC, November 4–7, 1990), pp. 289–292.
J.E. Bailey, Development of an instrument for the management of computer user attitudes in hospitals, Methods of Information in Medicine 20 (1990) 51–56.
J.G. Anderson, S.J. Jay, H.M. Schweer, and M.M. Anderson, Why doctors don’t use computers: Some empirical findings, Journal of the Royal Society of Medicine 79 (1986) 142–144.
H.L. Bleich et al., Clinical computing in a teaching hospital, New England Journal of Medicine 312 (1985) 756–764.
D.M. Rind and C. Safran, Real and imagined barriers to an electronic medical record, in: Proceedings of the 17th Annual Symposium on Computer Applications in Medical Care (McGraw Hill, New York, 1993), pp. 74–78.
D.Z. Sands, D.M. Rind, C. Vieira, and C. Safran, Going paperless: Can it be done?, in: Proceedings of the 1997 AMIA Annual Fall Symposium, Nashville, TN (1997), p. 887. (Journal of the American Medical Association Symposium Supplement.)
R.M. Gardner and H.P. Lundsgaarde, Evaluation of user acceptance of a clinical expert system, Journal of the American Medical Informatics Association 1 (1994) 428–438.
C.E. Aydin and D.E. Forsythe, Implementing computers in ambulatory care: Implications of physician practice patterns for system design, in: Proceedings of the 1997 AMIA Fall Symposium, Nashville, TN (1997), pp. 677–681. (Journal of the American Medical Informatics Association Symposium Supplement.)
B.L. Rotman et al., A randomized controlled trial of a computerbased physician work station in an outpatient setting: Implementation barriers to outcome evaluation, Journal of the American Medical Informatics Association 3 (1996) 340–348.
C.E. Aydin, Occupational adaptation to computerized medical information systems, Journal of Health and Social Behavior 30 (1989) 163–179.
M. Burkes, Identifying and relating nurses’ attitudes toward computer use, Computers in Nursing 9 (1991) 190–201.
G. Hendrickson and C.T. Kovner, Effects of computers on nursing resource use, Computers in Nursing 8 (1990) 16–22.
N. Staggers, Using computers in nursing: Documented benefits and needed studies, Computers in Nursing 6 (1988) 164–170.
J.H. Stronge and A. Brodt, Assessment of nurses’ attitudes toward computerization, Computers in Nursing 3 (1985) 154–158.
P.Q. Bourie, J. Dresch, and R.H. Chapman, Usability evaluation of an on-line nursing assessment, in: Proceedings of the 1997 AMIA Fall Symposium, Nashville, TN (1997), p. 914. (Journal of the American Medical Informatics Association Symposium Supplement.)
P.F. Brennan and M. Anthony, Nursing practice models: Implications for IS design, in: Proceedings of the 1997 AMIA Fall Symposium, Nashville, TN (1997), p. 847. (Journal of the American Medical Informatics Association Symposium Supplement.)
S.J. Brown, M.A. Cioffi, P. Schinella, and A. Shaw, Evaluation of the impact of a bedside terminal system in a rapidly changing community hospital, Computers in Nursing 13 (1995) 280–284.
B.A. Happ, The effect of point of care technology on the quality of patient care, in: Proceedings of the 18th Annual Symposium on Computer Applications in Medical Care, Washington, DC (1994), pp. 183–187. (Journal of the American Medical Informatics Association Symposium Supplement.)
D.K. Hinson, S.E. Huether, J.A. Blaufuss, M. Neiswanger, A. Tinker, K.J. Meyer and R. Jensen, Measuring the impact of a clinical nursing information system on one nursing unit, in: Proceedings of the 18th Annual Symposium on Computer Applications in Medical Care, Washington, DC (1994), pp. 203–210. (Journal of the American Medical Informatics Association Symposium Supplement.)
M.T. Lush and S.B. Henry, Nurses use of health status data to plan for patient care: Implications for the development of a computerbased outcomes infrastructure, in: Proceedings of the 1997 Annual Fall Symposium, Nashville, TN (1997), pp. 136–140. (Journal of the American Medical Informatics Association Symposium Supplement.)
C.A. Murphy, M. Maynard, and G. Morgan, Pretest and post-test attitudes of nursing personnel toward a patient care information system, Computers in Nursing 12 (1994) 239–244.
P.M. Ngin and L.M. Simms, Computer use for work accomplishment: A comparison between nurse managers and staff nurses, Journal of Nursing Administration 26 (1996) 47–55.
R.D. Zielstorff, G. Estey, A. Vickery, G. Hamilton, J.B. Fitzmaurice, and G.O. Barnett, Evaluation of a decision support system for pressure ulcer prevention and management: Preliminary findings, in: Proceedings of the 1997 Annual Fall Symposium, Nashville, TN (1997), pp. 248–252. (Journal of the American Medical Informatics Association Symposium Supplement.)
H.L. Chin and P. McClure, Evaluating a comprehensive outpatient clinical information system: A case study and model for system evaluation, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care, New Orleans, LA (1995), pp. 717–721. (Journal of the American Medical Informatics Association Symposium Supplement.)
M.A. Krall, Acceptance and performance by clinicians using an ambulatory electronic medical record in an HMO, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care, New Orleans, LA (1995), pp. 708–711. (Journal of the American Medical Informatics Association Symposium Supplement.)
G. Brownbridge, G.A. Herzmark, and T.D. Wall, Patient reactions to doctors’ computer use in general practice consultations, Social Science and Medicine 20 (1985) 47–52.
J.J. Rethans, P. Hoppener, G. Wolfs, and J. Diederiks, Do personal computers make doctors less personal? British Medical Journal 296 (1988) 1446–1448.
P.J. Cruickshank, Patient stress and the computer in the consulting room, Social Science in Medicine 16 (1982) 1371–1376.
E.H. Shortliffe, Dehumanization of patient care: Are computers the problem or solution? Journal of the American Medical Informatics Association 1 (1994) 75–76.
G. Brownbridge, E.J. Lilford, and S. Tindale-Biscoe, Use of a computer to take booking histories in a hospital antenatal clinical, Medical Care 26 (1988) 474–487.
J. Urkin, S.S. Warshawsky, J.S. Pliskin, N. Cohen, A. Sharon, M. Binstok, and C.Z. Marigolds, How does a computerized medical record (CMR) affect physicians’ work style? A video recorded study, in: Proceedings of the American Medical Informatics Association, Spring Congress, St. Louis, MO (1993), p. 89.
J.D. Legler and R. Oates, Patients’ reactions to physician use of a computerized medical record system during clinical encounters, The Journal of Family Practice 37(3) (1993) 241–244.
S. Ornstein and A. Bearden, Patient perspectives on computer-based medical records, The Journal of Family Practice 38(6) (1994) 606–610.
M.S. Gerrity, R.F. DeVellis, and J.A. Earp, Physicians’ reactions to uncertainty in patient care, Medical Care 28 (1990) 724–736.
I. Benbasat, D.K. Goldstein, and M. Mead, The case research strategy in studies of information systems, MIS Quarterly 11(3) (1987) 369–386.
B. Kaplan and D. Duchon, Combining qualitative and quantitative methods in information systems research: A case study, MIS Quarterly 12(4) (1988) 571–586.
J. Van Maanen, ed., Qualitative Methodology (Sage Publications, Beverly Hills, CA, 1983).
R.K. Yin, Case Study Research: Design and Methods (Sage Publications, Thousand Oaks, CA, 1984).
J.G. Anderson, C.E. Aydin, and S.J. Jay, Evaluating Health Care Information Systems (Sage Publications, Thousand Oaks, CA, 1994).
B. Kaplan, Addressing organizational issues in the evaluation of medical systems, Journal of the American Medical Informatics Association 4 (1997) 94–100.
V.J. Felitti, Patient entry into a large, multi-specialty medical group, Kaiser-Permanente Medical Care Program, San Diego, CA (1983), unpublished report.
C.E. Aydin, P.N. Rosen, and V.J. Felitti, Health Appraisal: Why do they really come? Kaiser-Permanente Medical Care Program, San Diego (1993), unpublished manuscript.
C.E. Aydin, P.N. Rosen, and V.J. Felitti, Transforming information use in preventive medicine: Learning to balance technology with the art of caring, in: Proceedings of the 18th Annual Symposium on Computer Applications in Medical Care, Washington, DC (1994) pp. 563–567. (Journal of the American Medical Informatics Association Symposium Supplement.)
C.E. Aydin and R.E. Rice, Bringing social worlds together: information systems as catalysts for interdepartmental interactions, Journal of Health and Social Behavior 33 (1992) 168–185.
W.J. Doll and G. Torkzadeh, The measurement of end-user computing satisfaction, MIS Quarterly 12 (1988) 259–274.
C.E. Aydin and R.E. Rice, Social worlds, individual differences, and implementation: Predicting attitudes toward a medical information system, Information and Management 20 (1991) 119–136.
K.H. Kjerulff, M.A. Counte, J.S. Salloway, and B.C. Campbell, Understanding employee reactions to a medical information system, in: Proceedings of the 5th Annual Symposium on Computer Applications in Medical Care (IEEE Computer Society Press, Los Angeles, CA, 1981), pp. 802–805.
R.L. Schultz and D.P. Slevin, Implementation and organizational validity: An empirical investigation, in: R.L. Schultz and D.P. Slevin, editors, Implementing Operations Research/Management Science (American Elsevier, New York, 1975), pp. 153–182.
R.B. Emerson, R.I. Fretz, and L.L. Shaw, Writing Ethnographic Fieldnotes (University of Chicago Press, Chicago, 1995).
M.B. Miles and A.M. Huberman, Qualitative Data Analysis (Sage Publications, Newbury Park, CA, 1984).
J.G. Anderson, H.C. Weng, C.E. Aydin, P.N. Rosen, and V.J. Felitti, Computers in the examining room: Evaluating the social impact on practice patterns, in: Proceedings of the American Conference on Information Systems, 15–17 August, Indianapolis, IN (Association for Information Systems, 1997), pp. 909–911.
R.E. Rice and J.G. Anderson, Social networks and healthcare information systems: A structural approach to evaluation, in: J.G. Anderson, C.E. Aydin, and S.J. Jay, editors, Evaluating Healthcare Information Systems: Methods and Applications (Sage, Thousand Oaks, CA, 1994), pp. 135–163.
C.E. Aydin, P.N. Rosen, S.M. Jewell, and V.J. Felitti, Computers in the examining room: The patient’s perspective, in: Proceedings of the 19th Annual Symposium on Computer Applications in Medical Care, New Orleans, LA (1995), pp. 824–828. (Journal of the American Medical Informatics Association Symposium Supplement.)
J.R. Lewis, Patient views on quality care in general practice: Literature review, Social Science and Medicine 39(5) (1994) 655–670.
M.H. Wolf, S.M. Putnam, S.A. James, and W.B. Stiles, The medical interview satisfaction scale: Development of a scale to measure patient perceptions of physician behavior, Journal of Behavioral Medicine 1 (1978) 391–401.
J. Kincey, P. Bradshaw, and P. Ley, Patients’ satisfaction and reported acceptance of advice in general practice, Journal of the Royal College of General Practitioners 25 (1975) 558–566.
J.G. Anderson, S.J. Trajkovski, R. Campbell, A. Haley, and M.M. Anderson, Determining clinical practice styles from computer-based data, in: Proceedings Medinfo 92, 7th World Congress on Medical Informatics, Geneva, Switzerland (September 1992), pp. 6–10.
B. Kaplan, Objectification and negotiation in interpreting clinical images: Implications for computer-based patient records, Artificial Intelligence in Medicine 7 (1995) 439–454.
E.M. Rogers, Diffusion of Innovations, 4th ed. (Free Press, New York, 1995).
J.G. Baggs, S.A. Ryan, C.E. Phelps, J.F. Richeson, and J.E. Johnson, The association between interdisciplinary collaboration and patient outcomes in a medical intensive care unit, Heart and Lung 21(1) (1992) 18–24.
A.B. Flood, The impact of organizational and managerial factors on the quality of care in healthcare organizations, Medical Care Review 51(4) (1994) 381–428.
W.A. Knaus, E.A. Draper, D.P. Wagner, and J.E. Zimmerman, An evaluation of outcome from intensive care in major medical centers, Annals of Internal Medicine 104 (1986) 410–418.
S.M. Shortell, J.E. Zimmerman, D.M. Rousseau, R.R. Gillies, D.P. Wagner, E.A. Draper, W.A. Knaus, and J. Duffy, The performance of intensive care units: Does good management make a difference? Medical Care 32(5) (1994) 508–525.
M.J. Papa, Communication network patterns and employee performance with new technology, Communication Research 17 (1990) 344–368.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2005 Springer Science+Business Media, Inc.
About this chapter
Cite this chapter
Aydin, C.E., Anderson, J.G., Rosen, P.N., Felitti, V.J., Weng, HC. (2005). Computers in the Consulting Room: A Case Study of Clinician and Patient Perspectives. In: Anderson, J.G., Aydin, C.E. (eds) Evaluating the Organizational Impact of Healthcare Information Systems. Health Informatics. Springer, New York, NY. https://doi.org/10.1007/0-387-30329-4_10
Download citation
DOI: https://doi.org/10.1007/0-387-30329-4_10
Publisher Name: Springer, New York, NY
Print ISBN: 978-0-387-24558-4
Online ISBN: 978-0-387-30329-1
eBook Packages: MedicineMedicine (R0)