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Developing an evidence base of best practices for integrating computerized systems into the exam room: a systematic review.

ABSTRACT: Objective:The introduction of health information technology systems, electronic health records in particular, is changing the nature of how clinicians interact with patients. Lack of knowledge remains on how best to integrate such systems in the exam room. The purpose of this systematic review was to (1) distill "best" behavioral and communication practices recommended in the literature for clinicians when interacting with patients in the presence of computerized systems during a clinical encounter, (2) weigh the evidence of each recommendation, and (3) rank evidence-based recommendations for electronic health record communication training initiatives for clinicians. Methods:We conducted a literature search of 6 databases, resulting in 52 articles included in the analysis. We extracted information such as study setting, research design, sample, findings, and implications. Recommendations were distilled based on consistent support for behavioral and communication practices across studies. Results:Eight behavioral and communication practices received strong support of evidence in the literature and included specific aspects of using computerized systems to facilitate conversation and transparency in the exam room, such as spatial (re)organization of the exam room, maintaining nonverbal communication, and specific techniques that integrate the computerized system into the visit and engage the patient. Four practices, although patient-centered, have received insufficient evidence to date. Discussion and Conclusion:We developed an evidence base of best practices for clinicians to maintain patient-centered communications in the presence of computerized systems in the exam room. Further work includes development and empirical evaluation of evidence-based guidelines to better integrate computerized systems into clinical care.

SUBMITTER: Patel MR

PROVIDER: S-EPMC7651892 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Developing an evidence base of best practices for integrating computerized systems into the exam room: a systematic review.

Patel Minal R MR Vichich Jennifer J Lang Ian I Lin Jessica J Zheng Kai K

Journal of the American Medical Informatics Association : JAMIA 20170401 e1

<h4>Objective</h4>The introduction of health information technology systems, electronic health records in particular, is changing the nature of how clinicians interact with patients. Lack of knowledge remains on how best to integrate such systems in the exam room. The purpose of this systematic review was to (1) distill "best" behavioral and communication practices recommended in the literature for clinicians when interacting with patients in the presence of computerized systems during a clinica ...[more]

PMID: 27539198

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Project description:Evidence-based teaching practices are associated with improved student academic performance. However, these practices encompass a wide range of activities and determining which type, intensity or duration of activity is effective at improving student exam performance has been elusive. To address this shortcoming, we used a previously validated classroom observation tool, Practical Observation Rubric to Assess Active Learning (PORTAAL) to measure the presence, intensity, and duration of evidence-based teaching practices in a retrospective study of upper and lower division biology courses. We determined the cognitive challenge of exams by categorizing all exam questions obtained from the courses using Bloom's Taxonomy of Cognitive Domains. We used structural equation modeling to correlate the PORTAAL practices with exam performance while controlling for cognitive challenge of exams, students' GPA at start of the term, and students' demographic factors. Small group activities, randomly calling on students or groups to answer questions, explaining alternative answers, and total time students were thinking, working with others or answering questions had positive correlations with exam performance. On exams at higher Bloom's levels, students explaining the reasoning underlying their answers, students working alone, and receiving positive feedback from the instructor also correlated with increased exam performance. Our study is the first to demonstrate a correlation between the intensity or duration of evidence-based PORTAAL practices and student exam performance while controlling for Bloom's level of exams, as well as looking more specifically at which practices correlate with performance on exams at low and high Bloom's levels. This level of detail will provide valuable insights for faculty as they prioritize changes to their teaching. As we found that multiple PORTAAL practices had a positive association with exam performance, it may be encouraging for instructors to realize that there are many ways to benefit students' learning by incorporating these evidence-based teaching practices.

Dataset Information

Developing an evidence base of best practices for integrating computerized systems into the exam room: a systematic review.

Publications

Developing an evidence base of best practices for integrating computerized systems into the exam room: a systematic review.

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