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Background. Despite emerging interest in computer-based patient records (CPRs), less than 1% of medical records in the United States are stored electronically. Some physicians may be reluctant to implement CPR system because of fear that the physician-patient relationship would be adversely affected. This study ascertained the attitudes of patients regarding the use of CPR systems.

Methods. This study was an in-depth interview survey of 16 patients concerning the CPR system used at the family medicine department at the Medical University of South Carolina. Interview topics included patient knowledge, perceived advantages and disadvantages, and the impact of the CPR system on their relationship with their physician.

Results. Most patients were informed about the nature of the CPR system and had positive attitudes toward it. Common perceptions were that CPR provides physicians with easy access to information, facilitates clinical encounters, and improves physician-patient relationship and the quality of care delivered. Although confidentiality was the major concern expressed about the CPR system, only one respondent indicated that this factor limited his interaction with his physician.

Conclusions. This study demonstrated patient acceptance and support for the CPR system in use at the study site. These findings should encourage physicians to use CPRs.

Key words. Medical records systems, computerized; physician-patient relations; patient satisfaction. (J Fam Pract 1994; 38:606-610)

Despite emerging interest in computer-based patient records (CPRs),(1)(2)(3)(4) less than 1% of medical records in the United States are stored electronically. There are numerous barriers to wider dissemination of CPR systems, one of which is physician reluctance. This barrier to the implementation of CPR systems may stem from physicians' fear that their relationships with their patients would be adversely affected. In view of this concern, it is necessary to ascertain the attitudes of patients toward the use of CPR systems.

The available literature on patient perspectives about CPR systems(5)(6)(7)(8)(9)(10)(11)(12)(13) is limited, inconsistent, and may represent societal attitudes toward computers in general. There seems to be a tendency toward greater patient acceptance of CPRs in recent years, a trend anticipated by Cruickshank(8) in 1984. The increase in personal and occupational use of computers over time may have played a large role in this attitude change. Another major theme present in this body of reserch is that patients actually exposed to CPR systems have more favorable attitudes toward them(6)(7) than do those who are asked for their theoretical opinion about CPRs.(8) Confidentiality is another aspect of CPR systems that affects patient attitudes about them. This concern is shared by patients contemplating CPR use by their physicians(9)(10) and those who have actual experience with the systems.(7)

There are several limitations to the studies published to date. Only three have reported on the perspectives of patients who have had actual experience with comprehensive CPR systems.(6)(7)(11) With one exception,(11) which reported the opinions of patients of only one American physician, the published studies are all from Europe. In addition, all published studies to date have used traditional quantitative survey techniques, which may have limited the scope of the findings.

This study expands on the CPR systems research base by reporting the results of an in-depth interview survey among patients at a medical university family medicine department. The site chosen for this study is ideal for studying patient perspectives in CPR systems because a computerized patient record system has been in place for more than 20 years and computers have been located in each examination room for more than 2 years. The CPR system used at the study site is a fully automated, paperless patient record, which has been described extensively elsewhere.(3)(14)

Methods

This study included an in-depth interview survey of 16 patients of the 8 faculty physicians at the medical university where the study took place. Purposeful random sampling was used in the recruitment process to ensure participation by patients of all 8 faculty physicians. Eligible patients included those 18 to 65 years of age whose appointments with their primary physician took place between April 1, 1993, and July 7, 1993, and were coded "medical exam." Patients of faculty physicians were chosent to minimize the effect of clinical and computer inexperience among residents that might have influenced responses to the survey. The code "medical exam" was chosen because this type of visit would give physicians an opportunity to use many features of the CPR system. Only patients with recent vists were eligible, so that the experience would be relatively fresh in their minds. Random sampling of every 5th eligible patient was employed to derive a final sample of 16 patients. Patients were excluded if they were an employee of the medical university, if they could not be contacted, if they refused to be interviewed, or if two of their physician's patients had already been interviewed.

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