The Impact of Electronic Health Records on Family Physicians During Simulated Virtual Encounters: Exploratory Mixed Methods Study

Clinical Snapshot

Key Findings

• P Value: Not significant after family-wise error rate correction

• Effect Size: Not reported

• Primary Outcome: Patient-centeredness scores higher in staff physicians vs residents, but not statistically significant after multiple comparison correction

• Nnt Or Sensitivity: Proportion of time showing nonverbal stress signs calculated for subset (6 residents, 3 staff)

• Confidence Interval: Not reported

Clinical Application

Findings suggest need for EHR training and clear documentation protocols during patient encounters, particularly for trainees Relevant to Australian telehealth expansion post-COVID-19 and Medicare Benefits Schedule telehealth items. May inform RACGP training curricula for digital health competencies Family medicine trainees and practicing physicians using EHR systems during telemedicine consultations

Abstract

BACKGROUND: This exploratory study investigated the impact of computer use on physician performance during clinical simulations. Standardized patient (SP) scenarios used in family practice certification examinations were adapted to include the use of the electronic health record (EHR). OBJECTIVE: The goal was to compare the impact of EHR use during simulated virtual patient encounters on resident physicians' and staff physicians' patient-centeredness (PC) and overall clinical performance, as well as to measure the cognitive load (CL) imposed by EHR use. METHODS: Sixteen participants each completed 2 video telemedicine simulations with SPs. One simulation case included limited past medical history for the SP in the EHR, while the other did not. Participants were instructed to completely document the encounter using the EHR. Participants' self-perceived CL was measured using the raw National Aeronautics and Space Administration Task Load Index (NASA-TLX). Video recordings were analyzed for participant PC and overall clinical performance. In addition to interacting with the EHR, multiple participants also conducted internet searches. The proportion of time that participants spent interacting with the computer, either using the EHR or searching the internet, was calculated. Inductive qualitative coding of a subset of video recordings (18 of 32 encounters) was performed, with a focus on signs of stress/CL. All videos were assessed for usability problems. RESULTS: Staff physicians (n=6) scored higher on PC compared to resident physicians (n=10) for both cases, though differences were not statistically significant after correction for multiple comparisons (family-wise error rate). Physicians' overall CL, as measured by the raw NASA-TLX, was not significantly correlated with computer use. Exploratory qualitative data analysis found both verbal and nonverbal signs of stress/CL due to computer use while interacting with the SPs. The proportion of time displaying nonverbal signs of stress/CL was calculated for a subset of participants (6 resident physicians and 3 staff physicians). Participant interpretations of instructions to completely document the encounter using the EHR varied widely. It is likely that participants' usual style of documenting, either primarily during or after patient encounters, impacted their use of the EHR while SPs were present. CONCLUSIONS: Use of the computer during video telemedicine appointments may negatively impact physician PC and overall clinical performance. Exploratory qualitative coding identified both verbal and nonverbal signs of stress/CL when participants interacted with the computer and the patient simultaneously. Increased clinical experience helped to mitigate the negative impact of computer use. If the use of the EHR is included in physician certification examinations, clear instructions regarding which tasks must be completed in the EHR during interactions with SPs should be provided.

References

1. 1.Shah, L., Monkman, H., Kushniruk, A., Noel, K., Archibald, D., Motamedi, F., & Viner, G. (2026). The Impact of Electronic Health Records on Family Physicians During Simulated Virtual Encounters: Exploratory Mixed Methods Study. JMIR Medical Informatics. https://doi.org/10.2196/84916