Simulated medical Encounters to Analyze Patient-physician communication During Electronic Medical Records Use in Primary Care

The implications of the patient-physician relationship and communication on healthcare quality have been widely discussed in previous research. Communication has been characterized as one of the most powerful, encompassing, and versatile instruments available to the physician and it has been suggested that good patient-physician communication can improve healthcare outcomes. The incorporation of Electronic Medical Records (EMRs) in primary care provides an opportunity for improving healthcare services and quality of care. EMRs have, without a doubt, transformed the dynamics of the medical encounter. Implications of EMRs on the patient-physician communication, and thus on healthcare quality, have not yet reached a full understanding. Existing physician communication skills assessment tools do not take into account the physician's need to divert his/her attention from the patient to the computer, and vise versa. One such tool is the SEGUE. This research-in-progress paper aims to describe the preliminary steps taken to assess the adequacy of the existing SEGUE tool in evaluating physicians' communication skills in a computerized environment based on simulated medical encounters. Assuming that the existing SEGUE tool does not capture the new dynamics of the medical encounter; we suggest that it should be enhanced to include best-practices for physicians' EMR use while maintaining effective communication with patients. We intend to develop a set of items which reflect recommendations for EMR use aimed at maintaining effective communication with the patient. These new items will be formulated based on an extant literature review and experts panel, and will eventually be incorporated into the existing SEGUE tool to provide a comprehensive tool for analyzing physicians' communication skills in the computerized clinic.