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. 2016 Aug 18;24(e1):e207–e215. doi: 10.1093/jamia/ocw121

Table 1.

Evidence base for recommended behavioral and communication practices for integrating computerized systems into the exam room.

Recommended practice Total number of supporting studies Randomized controlled trials Observational studies Expert opinion Citations
A. Practices receiving strong support in the literature

  • 1. Using the computer to facilitate conversation

  • Invite the patient’s thoughts

  • Let patient know you are aware of his/her health care

  • Share decisions with the patient, for example, pharmacy choice

  • Talk to the patient about the information you are viewing and how that fits with your understanding and the patient’s understanding

 22 2 15 5 Ventres et al.,14 Al Alawi et al.,18 Almquist et al.,19 Als et al.,20 Alsos et al.,21,22 Anderson et al.,23 Baysari et al.,26 Chen et al.,27 Doyle et al.,29 Kumarapeli et al.,36 Pearce et al.,44 Piper et al.,45 Ridsdale et al.,47 Shield et al.48 Swinglehurst et al.,51 Taft et al.,52 Pearce et al.,56 Baum et al.,62 Gaffey et al.,63 Nusbaum et al.,64 White et al.65

  • 2. Adjusting room design

  • Desk surface is a shared space for clinician and patient

  • Adjustable chairs arrange the screen so patient can view the record

 17 2 13 2 Frankel et al.,3 Ventres et al.,14 Adams et al.,17 Al Alawi et al.,18 Almquist et al.,19 Barker et al.,25 Chen et al.,27 Fonville et al.,31 Gadd et al.,34 Kumarapeli et al.,36 Shield et al.,48 Swinglehurst et al.,51 Taft et al.,52 Ventres et al.,54 Shachak et al.,57 Pearce et al.,59 Baker et al.61
3. Maintaining eye contact with the patient while typing 16 1 14 1 Frankel et al.,3 Adams et al.,17 Anderson et al.,23 Chen et al.,27 Dowell et al.,28 Doyle et al.,29 Frankel et al.,32 Gibson et al.,35 Kushnir et al.,37 Margalit et al.,39 McGrath et al.,41 Montague and Asan,42 Street et al.,50 Taft et al.,52 Ventres et al.,54 Shachak et al.57

  • 4. Separating typing and patient interaction

  • Interact with EHR through brief, short typing sessions focusing solely on the EHR

  • When speaking to patients, stop typing and focus on the patient

 15 1 12 1 Frankel et al.,3 Ventres et al.,14 Adams et al.,17 Al Alawi et al.,18 Anderson et al.,23 Asan et al.,24 Chen et al.,27 Dowell et al.,28 Fiks et al.,30 Montague and Asan,42 Pearce et al.,44 Shield et al.,48 Wager et al.,55 Shachak et al.,57 Booth et al.66

  • 5. Talking to the patient while gazing at the computer

  • Use verbal and nonverbal backchannels such as affirmative speech (e.g., “ok,” “I see,” “mm-hmm”), and nodding

  • Ask the patient’s permission to type notes as you talk

 12 0 11 1 Frankel et al.,3 Al Alawi et al.,18 Asan et al.,24 Baysari et al.,26 Dowell et al.,28 Gadd et al.,34 McGrath et al.,41 Montague and Asan,42 Newman et al.,43 Shield et al.,48 Street et al.,50 Gaffrey et al.63
6. Using a postural style that allows the clinician to face the patient most of the time 12 1 7 4 Frankel et al.,3 Anderson et al.,23 Asan et al.,24 Doyle et al.,29 Frankel et al.,32 Gibson et al.,35 Rhodes et al.,46 Swinglehurst et al.,51 Theadom et al.,53 Ventres et al.,54 Pearce et al.,58 White et al.65

  • 7. Inviting the patient to look at the screen before the patient asks

  • Invite the patient to view data on screen

 11 1 7 3 Ventres et al.,14 Adams et al.,17 Al Alawi et al.,18 Almquist et al.,19 Als et al.,20 Anderson et al.,23 Chen et al.,27 Shield et al.,48 Baker et al.,61 Gaffrey et al.,63 White et al.65

  • 8. Informing the patient about the functions and role of the computer

  • Make a brief statement about the reason the computer is in the exam room (to help access medical records and results during visit)

  • Introduce the computer to the patient and tell the patient what you are doing on the computer

 11 1 7 3 Ventres et al.,14 Al Alawi et al.,18 Als et al.,20 Anderson et al.,23 Barker et al.,25 Gibson et al.,35 McCord et al.,40 Wager et al.,55 Pearce et al.,56 Baker et al.,61 Baum et al.62
9. Greeting the patient and accompanying companions before beginning the interaction 7 0 5 2 Ventres et al.,14 Anderson et al.,23 Pearce et al.,44 Strayer et al.,49 Swinglehurst et al.,51 Pearce et al.,56 Baker et al.61
10. Telling the patient the purpose of logging off/securing computer is for his/her privacy 4 0 4 0 Gadd et al.,34 Leveille et al.,38 Ridsdale et al.,47 Ventres et al.54
11. Reviewing the visit with the patient after finishing with the computer 3 0 0 3 Baker et al.,61 Baum et al.,62 Nusbaum et al.64
12. Using other aids for typing purposes (e.g., clinic staff, transcriptionist) 2 0 2 0 Asan et al.,24 Montague and Asan42