Computers May Help Doctors Improve Their Bedside MannerComputers May Help Doctors Improve Their Bedside Manner

Computers in medical exam rooms improve communication between doctors and patients, according to a new study by health-care provider Kaiser Permanente. It's a study likely to be looked at closely, since one worry doctors often cite about using computers is that they'll make patient-doctor communication less personal.

For the study, Kaiser Permanente surveyed 313 patients of eight doctors in Oregon and Washington three times: two months prior to computers in the exam room, one month after computers were available, and seven months later.

Patients found it easier to talk to their doctors once the computers were up and running, the study concludes. For instance, when doctors could point toward lab results displayed on a PC monitor to explain the information, patients left exams feeling more satisfied with their doctors and their care. Still, it takes training and practice for doctors to use them well. "You can't just turn your back on the patient and start typing away," says Dr. Richard Bills, a Kaiser Permanente primary-care physician in Portland, Ore.

After the computers were installed in exam rooms, 63% of patients said they had excellent discussions about their treatments with doctors, versus only 47% who said that prior to the computers. After the computers were installed, 57% of patients said they had excellent understanding of their treatments, compared with only 46% before the computer installation.

Also, after the computers were installed, 50% of patients said their doctors were very familiar with their medical histories, compared with only 42% who said that prior to the computers.

Bills, the Portland physician, has used the computer to graphically show hypertension patients the ups and downs of their blood-pressure readings, which helps them better understand if they're improving with treatment. Or, in some cases, he'll even access Web-based literature for patients to read. One menopausal patient recently asked Bills what he thought about a certain herbal remedy that she had heard about. While the patient was in the exam room, Bills went online to a menopause-related medical site to download information about the herb.

Bills also sits with the patient as he types out treatment plans and orders tests or drugs, so that the patient understands what his or her instructions will say once they're printed out. Kaiser Permanente provides all its patients with these post-visit instructions or summaries before they leave their office. Bills says this procedure of typing out the instructions with the patients also helps with individuals who have literacy problems or are so distracted by their health ailment that they don't fully comprehend spoken instructions. Talking as the doctor types out the instructions gives the patient another opportunity to ask questions, he says.

The Kaiser Permanente Northwest region has used electronic medical records for about 10 years, but computers have been added to exam rooms much more recently, a spokeswoman says.

Two years ago, Kaiser Permanente began rolling out companywide the latest version of its electronic health records systems, KP HealthConnect. Most regions are using the software, but it's still being rolled out in Kaiser facilities in California, which is one of the company's larger regions, the spokeswoman says. By summer, Hawaii will be the first region where Kaiser Permanente provides patients with online access to their medical information.