Abstract
In this paper we discuss expected and reported effects on care provider-patient relations of the introduction of electronic patient records (EPRs) in consultation settings by reviewing exemplary studies and literature on the subject from the past decade. We argue that in order for such assessments to be meaningful, talk of effects of “the” EPR needs to be replaced by an “unpacking” of EPR systems into their constituent parts and functionalities, the effects of which need to be assessed individually. Following from this principle, the paper discusses EPR systems ranging from simple data entry and retrieval systems to more sophisticated multi-user and multifunctional on-line systems. On a second level, our analysis of the literature is informed by the question which model of ideal patienthood underlies the assessment of effects of EPRs. To this end, we identify three “models of patienthood” implicit in writing about benefits and drawbacks of EPRs for patients: the autonomy, the consumer, and the holistic models, and argue that assumptions concerning these models need to be reflected upon more critically to improve understanding of what exactly EPR use does to the doctor-patient relationship.
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References
A.B Als (1997) ArticleTitleThe Desk-top Computer as a Magic Box: Patterns of Behaviour Connected with the Desk-top Computer; GPs’ and Patients’ Perceptions Family Practice 14 IssueID1 17–23 Occurrence Handle10.1093/fampra/14.1.17
M Berg. (2003) Health Information Management Routledge New York, London
J.G Beun (2003) ArticleTitleElectronic Healthcare Record; A Way to Empower the Patient International Journal of Medical Informatics 69 IssueID2–3 191–196 Occurrence Handle10.1016/S1386-5056(03)00060-1
M.E Butler (2002) ArticleTitleHome Telehealth Cuts Hospital Trips US Medicine 41 IssueIDApril 4–8
P Byrne B Long. (1976) Doctors Talking to Patients HMSO London
J.J Cimino V.L Patel et al. (2002) ArticleTitleThe Patient Clinical Information System (PatCIS): Technical Solutions for and Experience with Giving Patients Access to their Electronic Medical Records International Journal of Medical Informatics 68 IssueID1–3 113–127 Occurrence Handle10.1016/S1386-5056(02)00070-9
R.D Fletcher R.E Dayhoff et al. (2001) ArticleTitleComputerized Medical Records in the Department of Veterans Affairs Cancer Supplement 91 IssueID8 1603–6
D Greatbatch et al. (1995) ArticleTitleHow do Desk-Top Computers Affect the Doctor-Patient Interaction? Family Practice 12 32–36
C.C Heath (1986) Body Movement and Speech in Medical Interaction Cambridge University Press Cambridge
H. Langstrup Nielsen (2003) ArticleTitleSelf-Monitoring: IT and the Construction of the Competent Patient Papers in Organization 50 1–31
A. Lee (1998) ArticleTitleSeamless Health Care for Chronic Diseases in a Dual Healthcare System: Managed Care and the Role of Family Physicians Journal of Management in Medicine 12 217–226 Occurrence Handle10.1108/02689239810243904
P. Little et al. Preferences of Patients for Patient-Centred Approach to Consultation in Primary Care: Observational Study. BMJ, 322, 468, 2001.
J Mainz (2003) ArticleTitleDeveloping Evidence-Based Clinical Indicators: A State of the Art Methods Primer International Journal for Quality in Health Care 15 1–11 Occurrence Handle10.1093/intqhc/mzg081
G Makoul R.H Curry et al. (2001) ArticleTitleThe Use of Electronic Medical Records: Communication Patterns in Outpatient Encounters Journal of the American Medical Informatics Association 8 IssueID6 610–615
W.e.S Ministerie van Volksgezondheid (2000) Nota Beleidsbrief en Actieplan ICT in de Zorg Den Haag Ministerie van VWS 1–25
E Mitchell F Sullivan (2001) ArticleTitleA Descriptive Feast but an Evaluative Famine: Systematic Review of Published Articles on Primary Care Computing During 1980–1997 BMJ 322 IssueID7281 279–282 Occurrence Handle10.1136/bmj.322.7281.279
A. Mol. ‘Klant, burger, zieke. Het goede in drie talen’. Denken over zorg. Concepten en praktijken. M. Verkerk. Utrecht, Elsevier/de Tijdstroom: 139–150, 1997.
A Mol (2000) ArticleTitleWhat Diagnostic Devices Do: The Case of Blood Sugar Measurement Theoretical Medicine and Bioethics 21 9–22 Occurrence Handle10.1023/A:1009999119586
NHS (1998). Information for Health. An Information Strategy for the Modern NHS, NHS. 2004.
V.L Patel A.W Kushniruk et al. (2000) ArticleTitleImpact of a Computer-based Patient Record System on Data Collection, Knowledge Organization, and Reasoning Journal of the American Medical Informatics Association 7 IssueID6 569–585
P Pritchard J Hughes (1995) Shared Care: The future Imperative? Royal Society of Medicine Press London
Raad voor de Volksgezondheid en Zorg. E-health in zicht. Zoetermeer, Raad voor de Volksgezondheid en Zorg, 1–100, 2002.
J.R Ravetz (1971) Scientific Knowledge and its Social Problems Clarendon Press Oxford
L Ridsdale S Hudd (1997) ArticleTitleWhat do Patients Want and not Want to See About Themselves on the Computer Screen: A Qualitative Study Scand J Prim Health Care 15 IssueID4 180–3 Occurrence Handle10.3109/02813439709035024
C Safran (2001) ArticleTitleElectronic Medical Records: A Decade of Experience Medical Student JAMA 285 IssueID13 1766 Occurrence Handle10.1001/jama.285.13.1766
D Silverman. (1997) Discourses of Counseling: HIV Counseling as Social Interaction SAge London
F Sullivan E Mitchell (1995) ArticleTitleHas General Practitioner Computing Made a Difference to Patient Care? A Systematic Review of Published Reports BMJ 311 IssueID7009 848–852
Sundheds Ministeriet (1999). National Strategi for IT I Sundhedsvæsenet 2000–2002, Ministery of Health Denmark, 2004.
I.-o. Sundhedsministeriet. IT-strategi for sundhedsvæsenet 2003–2007: 1–82, 2003.
T Szasz M.H Hollender (1956) ArticleTitleA Contribution to the Philosophy of Medicine: The Basic Models of the Doctor-patient Relationship Archives of Internal Medicine 97 585–592
C.C Tsai J Starren (2001) ArticleTitlePatient Participation in Electronic Medical Records Medical Student JAMA 285 IssueID13 1765 Occurrence Handle10.1001/jama.285.13.1765
C.A. Walraven Particlevan et al. (1999) ArticleTitleDictated versus Database-Generated Discharge Summaries: A Randomised Clinical Trial Canadian Medical Association 160 381–392
S.S Warshawsky J.S Pliskin et al. (1994) ArticleTitlePhysician Use of a Computerized Medical Record System During the Patient Encounter: A Descriptive Study Computer Methods and Programs in Biomedicine 43 IssueID3–4 269–273 Occurrence Handle10.1016/0169-2607(94)90079-5
C West (1984) Routine Complications: Troubles in Talk between Doctors and Patients Indiana University Press Bloomington, In
D. Willems. Inhaling Drugs and Making Worlds: The Proliferation of Lungs and Asthmas. Differences in Medicine: Unravelling Practices, Techniques and Bodies. M. M. Berg, A. Durham and London, pp. 105–118, Duke University Press, 1998.
B. Winthereik. Connecting Practices. A Study of Electronic Patient Records at Work in Primary Health Care. Institute for Health Care Management and Policy. Rotterdam Erasmus, Medical Centre, 2004.
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van der Ploeg, I., Winthereik, B.R. & Bal, R. EPRs in the consultation room: A discussion of the literature on effects on doctor-patient relationships. Ethics Inf Technol 8, 73–83 (2006). https://doi.org/10.1007/s10676-005-0951-1
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DOI: https://doi.org/10.1007/s10676-005-0951-1