During Pediatric Health Maintenance Encounters Computer-Based Documentation: Effects on Parent-Provider Communication

ABSTRACT OBJECTIVE. The goal was to investigate the impact of a computer-based documentationtool on parent-health care provider communication during a pediatric health main-tenance encounter. METHODS. We used a quasiexperimental study design to compare communicationdynamics between clinicians and parents/children in health maintenance visits be-fore and after implementation of the ClicTate system. Before ClicTate use, paperforms were used to create visit notes. The children examined were 18 months ofage. All encounters were audiotaped or videotaped. A team of research assistantsblinded to group assignment reviewed the audio portion of each encounter. Datafrom all recordings were analyzed, by using the Roter Interaction Analysis System,for differences in the open/closed question ratio, the extent of information providedby parents and providers, and other aspects of spoken and nonverbal communication(videotaped encounters). RESULTS. Computer-based documentation visits were slightly longer than control visits(32 vs 27 minutes). With controlling for visit length, the amounts of conversationwere similar during control and computer-based documentation visits. Computer-based documentation visits were associated with a greater proportion of open-endedquestions (28% vs 21%), more use of partnership strategies, greater proportions ofsocial and positive talk, and a more patient-centered interaction style but fewerorienting and transition phrases.