Published online September 1, 2008
PEDIATRICS Vol. 122 No. 3 September 2008, pp. 590-598 (doi:10.1542/peds.2007-3005)
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ARTICLE

Computer-Based Documentation: Effects on Parent-Provider Communication During Pediatric Health Maintenance Encounters

Kevin B. Johnson, MD, MSa,b, Janet R. Serwint, MDc, Lawrence A. Fagan, MD, PhDd, Richard E. Thompson, PhDe, Modena E. H. Wilson, MD, MPHc,f and Debra Roter, DrPHg

Departments of a Biomedical Informatics
b Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
c Department of Pediatrics, School of Medicine, and Departments of
e Biostatistics
g Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
d Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, California
f Department of Professional Standards, American Medical Association, Chicago, Illinois

OBJECTIVE. The goal was to investigate the impact of a computer-based documentation tool on parent-health care provider communication during a pediatric health maintenance encounter.

METHODS. We used a quasiexperimental study design to compare communication dynamics between clinicians and parents/children in health maintenance visits before and after implementation of the ClicTate system. Before ClicTate use, paper forms were used to create visit notes. The children examined were ≤18 months of age. All encounters were audiotaped or videotaped. A team of research assistants blinded to group assignment reviewed the audio portion of each encounter. Data from all recordings were analyzed, by using the Roter Interaction Analysis System, for differences in the open/closed question ratio, the extent of information provided by parents and providers, and other aspects of spoken and nonverbal communication (videotaped encounters).

RESULTS. Computer-based documentation visits were slightly longer than control visits (32 vs 27 minutes). With controlling for visit length, the amounts of conversation were similar during control and computer-based documentation visits. Computer-based documentation visits were associated with a greater proportion of open-ended questions (28% vs 21%), more use of partnership strategies, greater proportions of social and positive talk, and a more patient-centered interaction style but fewer orienting and transition phrases.

CONCLUSIONS. The introduction of ClicTate into the health maintenance encounter positively affected several aspects of parent-clinician communication in a pediatric clinic setting. These results support the integration of computer-based documentation into primary care pediatric visits.

Key Words: medical charts • patient-physician interaction • electronic health records • pediatrics • structured-reporting systems • computer-based documentation

Abbreviations: CBD—computer-based documentation • RIAS—Roter Interaction Analysis System

Accepted Dec 13, 2007.




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