EHR Impact on Patient Experience

Delivering patient‐centered care is at the core of ensuring patient engagement and active participation that will lead to positive outcomes. Physician‐patient interaction has become an area of increasing focus in an effort to optimize the patient experience. Positive patient‐provider communication has been shown to increase satisfaction,[1, 2, 3, 4] decrease the likelihood of medical malpractice lawsuits,[5, 6, 7, 8] and improve clinical outcomes.[9, 10, 11, 12, 13] Specifically, a decrease in psychological symptoms such as anxiety and stress, as well as perception of physical symptoms have been correlated with improved communication.[9, 12] Furthermore, objective health outcomes, such as improvement in hypertension and glycosylated hemoglobin, have also been correlated with improved physician‐patient communication.[10, 11, 13] The multifaceted effects of improved communication are impactful to both the patient and the physician; therefore, it is essential that we understand how to optimize this interaction.

Patient‐centered care is a critical objective for many high‐quality healthcare systems.[14] In recent years, the use of electronic health records (EHRs) has been increasingly adopted by healthcare systems nationally in an effort to improve the quality of care delivered. The positive benefits of EHRs on the facilitation of healthcare, including consolidation of information, reduction of medical errors, easily transferable medical records,[15, 16, 17] as well as their impact on healthcare spending,[18] are well‐documented and have been emphasized as reasons for adoption of EHRs by the Patient Protection and Affordable Care Act. However, EHR implementation has encountered some resistance regarding its impact on the patient experience.

As EHR implementation is exponentially increasing in the United States, there is limited literature on the consequences of this technology.[19] Barriers reported during EHR implementation include the limitations of standardization, attitudinal and organizational constraints, behavior of individuals, and resistance to change.[20] Additionally, poor EHR system design and improper use can cause errors that jeopardize the integrity of the information inputted, leading to inaccuracies that endanger patient safety or decrease the quality of care.[21]

One of the limitations of EHRs has been the reported negative impact on patient‐centered care by decreasing communication during the hospital visit.[22] Although the EHR has enhanced internal provider communication,[23] the literature suggests a lack of focus on the patient sitting in front of the provider. Due to perceived physician distraction during the visit, patients report decreased satisfaction when physicians spend a considerable period of time during the visit at the computer.[22] Furthermore, the average hospital length of stay has been increased due to the use of EHRs.[22]

Although some physicians report that EHR use impedes patient workflow and decreases time spent with patients,[23] previous literature suggests that EHRs decrease the time to develop a synopsis and improve communication efficiency.[19] Some studies have also noted an increase in the ability for medical history retrieval and analysis, which will ultimately increase the quality of care provided to the patient.[24] Physicians who use the EHR adopted a more active role in clarifying information, encouraging questions, and ensuring completeness at the end of a visit.[25] Finally, studies show that the EHR has a positive return on investment from savings in drug expenditures, radiology tests, and billing errors.[26] Given the significant financial and time commitment that health systems and physicians must invest to implement EHRs, it is vital that we understand the multifaceted effects of EHRs on the field of medicine.

METHODS

The purpose of this study was to assess the physician‐patient communication patterns associated with the implementation and use of an EHR in a hospital setting.

CI‐CARE QuestionnaireARC Survey

The CI‐CARE Questionnaire is a standardized audit tool consisting of a total of 20 questions used by the facilitators who work with ARC. There are a total of 20 items on the ARC survey, including 18 multiple‐choice, polar, and Likert‐scale questions, and 2 free‐response questions that assess the patients' overall perception of their resident physician and their hospital experience. Questions 1 and 2 pertain to the recognition of attending physicians and resident physicians, respectively. Questions 3, 4, 6, 7, and 8 are Likert‐scalebased questions assessing the residents' professionalism. Questions 9 through 14 are Likert‐scalebased items included to evaluate the quality of communication between patient and provider. We categorized questions 5 and 15 as relating to diagnostics.[27] In 2012, ARC implemented 3 additional questions that assessed residents' communication skills (question 16), level of medical expertise (question 17), and quality of medical care (question 18). We chose to examine the CI‐CARE Questionnaire instead of a standard survey such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), because it examines the physician‐patient interaction in more detail. The survey can be reviewed in Figure 1.

Figure 1

RESULTS

There were a total of 3414 interviews conducted and completed from December 1, 2012 to May 30, 2013. Altogether, 1567 surveys were collected 3 months prior to EHR implementation (DecemberFebruary), and 1847 surveys were collected 3 months following implementation (MarchMay). The survey breakdown is summarized in Table 1.

² analysis revealed that the residents received significantly better feedback in the 3 months following EHR implementation, compared to the 3 months prior to implementation on questions 3, addressing the patient by their preferred name; 4, introducing themselves and their role; 5, communicating what they will do, how long it will take, and how it will impact the patient; 7, responding to the patient's requests and questions with immediacy; 8, listening to the patient's questions and concerns; 9, doing their utmost to ensure the patient receives the best care; 10, communicating well with the patient; 11, being respectful and considerate; and 12, being sensitive to the patient's physical and emotional needs (P<0.05) (Table 2).

ARC surveyed for 10 weeks prior to our reported sample (OctoberDecember) and 22 weeks prior to EHR implementation total (OctoberMarch). To rule out resident improvement due to the confounding effects of time and experience, we compared the data from the first 11 weeks (OctoberDecember) to the second 11 weeks (DecemberMarch) prior to EHR implementation. [2] analysis revealed that only 6 of the 16 questions showed improvement in this period, and just 1 of these improvements (question 3) was significant. Furthermore, 10 of the 16 questions actually received worse responses in this period, and 2 of these declines (questions 9 and 12) were significant (Table 3).

DISCUSSION

The adoption of EHRs has been fueled by their suggested improvement on healthcare quality and spending.[15, 16, 17, 18] Few studies have investigated the patient experience and its relation to EHR implementation. Furthermore, these studies have not yielded consistent results,[19, 20, 21, 22, 23, 25] raising uncertainty about the effects of EHRs on the patient experience. Possible barriers that may contribute to the scarcity of literature include the relatively recent large‐scale implementation of EHRs and a lack of programs in place to collect extensive data on the physician‐patient relationship.

In a field with increasing demands on patient‐centered care, we need to find ways to preserve and foster the patient‐physician relationship. Given that improvements in the delivery of compassionate care can positively impact clinical outcomes, the likelihood of medical malpractice lawsuits, and patient satisfaction,[1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13] the need to improve the patient‐provider relationship is tremendously important. Following EHR implementation, residents were perceived to provide more frequent diagnostics information including the nature, impact, and treatment of conditions. Furthermore, they were perceived to provide significantly better communication quality following implementation, through care monitoring, respectful and sensitive communication, and enhanced patient and family education. Residents were also perceived as being more professional following implementation, as indicated by positive assessments of several interpersonal communication questions. These results suggest that implementing an EHR may be an effective way to meet these increasing demands on patient‐centered care.

Limitations to this study should be considered. The ARC Medical Program is primarily used as an education tool for resident physicians, so all of our data are specific to resident physicians. It would be interesting and important to observe if EHRs affect nurse or attending‐patient interactions. Furthermore, we did not have access to any patient demographic or clinical data. However, we did not anticipate a significant change in the patient population that would alter the survey responses during this 6‐month period. Patients were required to recognize their resident on a photo card presented to them by the surveyor, which likely favored patients with strong feelings toward their residents. Due to this, our population sampled may not be indicative of the entire patient population. All findings were simply correlational. Due to the nature of our data collection, we were unable to control for many confounding variables, thus causal conclusions are difficult to draw from these results.

There are a few important trends to note. No question on the ARC survey received lower scores following implementation of the EHR. Furthermore, 9 of the 16 questions under investigation received significantly higher scores following implementation. The residents largely received positive responses both before and after EHR implementation, so despite the statistically significant improvements, the absolute differences are relatively small. These significant differences were likely not due to the residents improving through time and experience. We observed relatively insignificant and nonuniform changes in responses between the two 11‐week periods prior to implementation.

One possible reason for the observed significant improvements is that EHRs may increase patient involvement in the healthcare setting,[28] and this collaboration might improve resident‐patient communication.[29] Providing patients with an interactive tablet that details their care has been suggested to increase patient satisfaction and comfort in an inpatient setting.[30] In this light, the EHR can be used as a tool to increase these interactions by inviting patients to view the computer screen and electronic charts during data entry, which allows them to have a participatory role in their care and decision‐making process.[31] Although the reasons for our observed improvements are unclear, they are noteworthy and warrant further study. The notion that implementing an EHR might enhance provider‐patient communication is a powerful concept.

This study not only suggests the improvement of resident‐patient communication due to the implementation of an EHR, but it also reveals the value of the ARC Medical Program for studying the patient experience. The controlled, prolonged, and efficient nature of the ARC Medical Program's data collection was ideal for comparing a change in resident‐patient communication before and after EHR implementation at UCLA Health. ARC and UCLA Health's EHR can serve as a model for residency programs nationwide. Future studies can assess the changes of the patient‐provider interaction for any significant event, as demonstrated by this study and its investigation of the implementation of UCLA Health's EHR.

Delivering patient‐centered care is at the core of ensuring patient engagement and active participation that will lead to positive outcomes. Physician‐patient interaction has become an area of increasing focus in an effort to optimize the patient experience. Positive patient‐provider communication has been shown to increase satisfaction,[1, 2, 3, 4] decrease the likelihood of medical malpractice lawsuits,[5, 6, 7, 8] and improve clinical outcomes.[9, 10, 11, 12, 13] Specifically, a decrease in psychological symptoms such as anxiety and stress, as well as perception of physical symptoms have been correlated with improved communication.[9, 12] Furthermore, objective health outcomes, such as improvement in hypertension and glycosylated hemoglobin, have also been correlated with improved physician‐patient communication.[10, 11, 13] The multifaceted effects of improved communication are impactful to both the patient and the physician; therefore, it is essential that we understand how to optimize this interaction.

Patient‐centered care is a critical objective for many high‐quality healthcare systems.[14] In recent years, the use of electronic health records (EHRs) has been increasingly adopted by healthcare systems nationally in an effort to improve the quality of care delivered. The positive benefits of EHRs on the facilitation of healthcare, including consolidation of information, reduction of medical errors, easily transferable medical records,[15, 16, 17] as well as their impact on healthcare spending,[18] are well‐documented and have been emphasized as reasons for adoption of EHRs by the Patient Protection and Affordable Care Act. However, EHR implementation has encountered some resistance regarding its impact on the patient experience.

As EHR implementation is exponentially increasing in the United States, there is limited literature on the consequences of this technology.[19] Barriers reported during EHR implementation include the limitations of standardization, attitudinal and organizational constraints, behavior of individuals, and resistance to change.[20] Additionally, poor EHR system design and improper use can cause errors that jeopardize the integrity of the information inputted, leading to inaccuracies that endanger patient safety or decrease the quality of care.[21]

One of the limitations of EHRs has been the reported negative impact on patient‐centered care by decreasing communication during the hospital visit.[22] Although the EHR has enhanced internal provider communication,[23] the literature suggests a lack of focus on the patient sitting in front of the provider. Due to perceived physician distraction during the visit, patients report decreased satisfaction when physicians spend a considerable period of time during the visit at the computer.[22] Furthermore, the average hospital length of stay has been increased due to the use of EHRs.[22]

Although some physicians report that EHR use impedes patient workflow and decreases time spent with patients,[23] previous literature suggests that EHRs decrease the time to develop a synopsis and improve communication efficiency.[19] Some studies have also noted an increase in the ability for medical history retrieval and analysis, which will ultimately increase the quality of care provided to the patient.[24] Physicians who use the EHR adopted a more active role in clarifying information, encouraging questions, and ensuring completeness at the end of a visit.[25] Finally, studies show that the EHR has a positive return on investment from savings in drug expenditures, radiology tests, and billing errors.[26] Given the significant financial and time commitment that health systems and physicians must invest to implement EHRs, it is vital that we understand the multifaceted effects of EHRs on the field of medicine.

METHODS

The purpose of this study was to assess the physician‐patient communication patterns associated with the implementation and use of an EHR in a hospital setting.

CI‐CARE QuestionnaireARC Survey

The CI‐CARE Questionnaire is a standardized audit tool consisting of a total of 20 questions used by the facilitators who work with ARC. There are a total of 20 items on the ARC survey, including 18 multiple‐choice, polar, and Likert‐scale questions, and 2 free‐response questions that assess the patients' overall perception of their resident physician and their hospital experience. Questions 1 and 2 pertain to the recognition of attending physicians and resident physicians, respectively. Questions 3, 4, 6, 7, and 8 are Likert‐scalebased questions assessing the residents' professionalism. Questions 9 through 14 are Likert‐scalebased items included to evaluate the quality of communication between patient and provider. We categorized questions 5 and 15 as relating to diagnostics.[27] In 2012, ARC implemented 3 additional questions that assessed residents' communication skills (question 16), level of medical expertise (question 17), and quality of medical care (question 18). We chose to examine the CI‐CARE Questionnaire instead of a standard survey such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), because it examines the physician‐patient interaction in more detail. The survey can be reviewed in Figure 1.

Figure 1

RESULTS

There were a total of 3414 interviews conducted and completed from December 1, 2012 to May 30, 2013. Altogether, 1567 surveys were collected 3 months prior to EHR implementation (DecemberFebruary), and 1847 surveys were collected 3 months following implementation (MarchMay). The survey breakdown is summarized in Table 1.

² analysis revealed that the residents received significantly better feedback in the 3 months following EHR implementation, compared to the 3 months prior to implementation on questions 3, addressing the patient by their preferred name; 4, introducing themselves and their role; 5, communicating what they will do, how long it will take, and how it will impact the patient; 7, responding to the patient's requests and questions with immediacy; 8, listening to the patient's questions and concerns; 9, doing their utmost to ensure the patient receives the best care; 10, communicating well with the patient; 11, being respectful and considerate; and 12, being sensitive to the patient's physical and emotional needs (P<0.05) (Table 2).

ARC surveyed for 10 weeks prior to our reported sample (OctoberDecember) and 22 weeks prior to EHR implementation total (OctoberMarch). To rule out resident improvement due to the confounding effects of time and experience, we compared the data from the first 11 weeks (OctoberDecember) to the second 11 weeks (DecemberMarch) prior to EHR implementation. [2] analysis revealed that only 6 of the 16 questions showed improvement in this period, and just 1 of these improvements (question 3) was significant. Furthermore, 10 of the 16 questions actually received worse responses in this period, and 2 of these declines (questions 9 and 12) were significant (Table 3).

DISCUSSION

The adoption of EHRs has been fueled by their suggested improvement on healthcare quality and spending.[15, 16, 17, 18] Few studies have investigated the patient experience and its relation to EHR implementation. Furthermore, these studies have not yielded consistent results,[19, 20, 21, 22, 23, 25] raising uncertainty about the effects of EHRs on the patient experience. Possible barriers that may contribute to the scarcity of literature include the relatively recent large‐scale implementation of EHRs and a lack of programs in place to collect extensive data on the physician‐patient relationship.

In a field with increasing demands on patient‐centered care, we need to find ways to preserve and foster the patient‐physician relationship. Given that improvements in the delivery of compassionate care can positively impact clinical outcomes, the likelihood of medical malpractice lawsuits, and patient satisfaction,[1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13] the need to improve the patient‐provider relationship is tremendously important. Following EHR implementation, residents were perceived to provide more frequent diagnostics information including the nature, impact, and treatment of conditions. Furthermore, they were perceived to provide significantly better communication quality following implementation, through care monitoring, respectful and sensitive communication, and enhanced patient and family education. Residents were also perceived as being more professional following implementation, as indicated by positive assessments of several interpersonal communication questions. These results suggest that implementing an EHR may be an effective way to meet these increasing demands on patient‐centered care.

Limitations to this study should be considered. The ARC Medical Program is primarily used as an education tool for resident physicians, so all of our data are specific to resident physicians. It would be interesting and important to observe if EHRs affect nurse or attending‐patient interactions. Furthermore, we did not have access to any patient demographic or clinical data. However, we did not anticipate a significant change in the patient population that would alter the survey responses during this 6‐month period. Patients were required to recognize their resident on a photo card presented to them by the surveyor, which likely favored patients with strong feelings toward their residents. Due to this, our population sampled may not be indicative of the entire patient population. All findings were simply correlational. Due to the nature of our data collection, we were unable to control for many confounding variables, thus causal conclusions are difficult to draw from these results.

There are a few important trends to note. No question on the ARC survey received lower scores following implementation of the EHR. Furthermore, 9 of the 16 questions under investigation received significantly higher scores following implementation. The residents largely received positive responses both before and after EHR implementation, so despite the statistically significant improvements, the absolute differences are relatively small. These significant differences were likely not due to the residents improving through time and experience. We observed relatively insignificant and nonuniform changes in responses between the two 11‐week periods prior to implementation.

One possible reason for the observed significant improvements is that EHRs may increase patient involvement in the healthcare setting,[28] and this collaboration might improve resident‐patient communication.[29] Providing patients with an interactive tablet that details their care has been suggested to increase patient satisfaction and comfort in an inpatient setting.[30] In this light, the EHR can be used as a tool to increase these interactions by inviting patients to view the computer screen and electronic charts during data entry, which allows them to have a participatory role in their care and decision‐making process.[31] Although the reasons for our observed improvements are unclear, they are noteworthy and warrant further study. The notion that implementing an EHR might enhance provider‐patient communication is a powerful concept.

This study not only suggests the improvement of resident‐patient communication due to the implementation of an EHR, but it also reveals the value of the ARC Medical Program for studying the patient experience. The controlled, prolonged, and efficient nature of the ARC Medical Program's data collection was ideal for comparing a change in resident‐patient communication before and after EHR implementation at UCLA Health. ARC and UCLA Health's EHR can serve as a model for residency programs nationwide. Future studies can assess the changes of the patient‐provider interaction for any significant event, as demonstrated by this study and its investigation of the implementation of UCLA Health's EHR.

Delivering patient‐centered care is at the core of ensuring patient engagement and active participation that will lead to positive outcomes. Physician‐patient interaction has become an area of increasing focus in an effort to optimize the patient experience. Positive patient‐provider communication has been shown to increase satisfaction,[1, 2, 3, 4] decrease the likelihood of medical malpractice lawsuits,[5, 6, 7, 8] and improve clinical outcomes.[9, 10, 11, 12, 13] Specifically, a decrease in psychological symptoms such as anxiety and stress, as well as perception of physical symptoms have been correlated with improved communication.[9, 12] Furthermore, objective health outcomes, such as improvement in hypertension and glycosylated hemoglobin, have also been correlated with improved physician‐patient communication.[10, 11, 13] The multifaceted effects of improved communication are impactful to both the patient and the physician; therefore, it is essential that we understand how to optimize this interaction.

Patient‐centered care is a critical objective for many high‐quality healthcare systems.[14] In recent years, the use of electronic health records (EHRs) has been increasingly adopted by healthcare systems nationally in an effort to improve the quality of care delivered. The positive benefits of EHRs on the facilitation of healthcare, including consolidation of information, reduction of medical errors, easily transferable medical records,[15, 16, 17] as well as their impact on healthcare spending,[18] are well‐documented and have been emphasized as reasons for adoption of EHRs by the Patient Protection and Affordable Care Act. However, EHR implementation has encountered some resistance regarding its impact on the patient experience.

As EHR implementation is exponentially increasing in the United States, there is limited literature on the consequences of this technology.[19] Barriers reported during EHR implementation include the limitations of standardization, attitudinal and organizational constraints, behavior of individuals, and resistance to change.[20] Additionally, poor EHR system design and improper use can cause errors that jeopardize the integrity of the information inputted, leading to inaccuracies that endanger patient safety or decrease the quality of care.[21]

One of the limitations of EHRs has been the reported negative impact on patient‐centered care by decreasing communication during the hospital visit.[22] Although the EHR has enhanced internal provider communication,[23] the literature suggests a lack of focus on the patient sitting in front of the provider. Due to perceived physician distraction during the visit, patients report decreased satisfaction when physicians spend a considerable period of time during the visit at the computer.[22] Furthermore, the average hospital length of stay has been increased due to the use of EHRs.[22]

Although some physicians report that EHR use impedes patient workflow and decreases time spent with patients,[23] previous literature suggests that EHRs decrease the time to develop a synopsis and improve communication efficiency.[19] Some studies have also noted an increase in the ability for medical history retrieval and analysis, which will ultimately increase the quality of care provided to the patient.[24] Physicians who use the EHR adopted a more active role in clarifying information, encouraging questions, and ensuring completeness at the end of a visit.[25] Finally, studies show that the EHR has a positive return on investment from savings in drug expenditures, radiology tests, and billing errors.[26] Given the significant financial and time commitment that health systems and physicians must invest to implement EHRs, it is vital that we understand the multifaceted effects of EHRs on the field of medicine.

METHODS

The purpose of this study was to assess the physician‐patient communication patterns associated with the implementation and use of an EHR in a hospital setting.

CI‐CARE QuestionnaireARC Survey

The CI‐CARE Questionnaire is a standardized audit tool consisting of a total of 20 questions used by the facilitators who work with ARC. There are a total of 20 items on the ARC survey, including 18 multiple‐choice, polar, and Likert‐scale questions, and 2 free‐response questions that assess the patients' overall perception of their resident physician and their hospital experience. Questions 1 and 2 pertain to the recognition of attending physicians and resident physicians, respectively. Questions 3, 4, 6, 7, and 8 are Likert‐scalebased questions assessing the residents' professionalism. Questions 9 through 14 are Likert‐scalebased items included to evaluate the quality of communication between patient and provider. We categorized questions 5 and 15 as relating to diagnostics.[27] In 2012, ARC implemented 3 additional questions that assessed residents' communication skills (question 16), level of medical expertise (question 17), and quality of medical care (question 18). We chose to examine the CI‐CARE Questionnaire instead of a standard survey such as the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), because it examines the physician‐patient interaction in more detail. The survey can be reviewed in Figure 1.

Figure 1

RESULTS

There were a total of 3414 interviews conducted and completed from December 1, 2012 to May 30, 2013. Altogether, 1567 surveys were collected 3 months prior to EHR implementation (DecemberFebruary), and 1847 surveys were collected 3 months following implementation (MarchMay). The survey breakdown is summarized in Table 1.

² analysis revealed that the residents received significantly better feedback in the 3 months following EHR implementation, compared to the 3 months prior to implementation on questions 3, addressing the patient by their preferred name; 4, introducing themselves and their role; 5, communicating what they will do, how long it will take, and how it will impact the patient; 7, responding to the patient's requests and questions with immediacy; 8, listening to the patient's questions and concerns; 9, doing their utmost to ensure the patient receives the best care; 10, communicating well with the patient; 11, being respectful and considerate; and 12, being sensitive to the patient's physical and emotional needs (P<0.05) (Table 2).

ARC surveyed for 10 weeks prior to our reported sample (OctoberDecember) and 22 weeks prior to EHR implementation total (OctoberMarch). To rule out resident improvement due to the confounding effects of time and experience, we compared the data from the first 11 weeks (OctoberDecember) to the second 11 weeks (DecemberMarch) prior to EHR implementation. [2] analysis revealed that only 6 of the 16 questions showed improvement in this period, and just 1 of these improvements (question 3) was significant. Furthermore, 10 of the 16 questions actually received worse responses in this period, and 2 of these declines (questions 9 and 12) were significant (Table 3).

DISCUSSION

The adoption of EHRs has been fueled by their suggested improvement on healthcare quality and spending.[15, 16, 17, 18] Few studies have investigated the patient experience and its relation to EHR implementation. Furthermore, these studies have not yielded consistent results,[19, 20, 21, 22, 23, 25] raising uncertainty about the effects of EHRs on the patient experience. Possible barriers that may contribute to the scarcity of literature include the relatively recent large‐scale implementation of EHRs and a lack of programs in place to collect extensive data on the physician‐patient relationship.

In a field with increasing demands on patient‐centered care, we need to find ways to preserve and foster the patient‐physician relationship. Given that improvements in the delivery of compassionate care can positively impact clinical outcomes, the likelihood of medical malpractice lawsuits, and patient satisfaction,[1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13] the need to improve the patient‐provider relationship is tremendously important. Following EHR implementation, residents were perceived to provide more frequent diagnostics information including the nature, impact, and treatment of conditions. Furthermore, they were perceived to provide significantly better communication quality following implementation, through care monitoring, respectful and sensitive communication, and enhanced patient and family education. Residents were also perceived as being more professional following implementation, as indicated by positive assessments of several interpersonal communication questions. These results suggest that implementing an EHR may be an effective way to meet these increasing demands on patient‐centered care.

Limitations to this study should be considered. The ARC Medical Program is primarily used as an education tool for resident physicians, so all of our data are specific to resident physicians. It would be interesting and important to observe if EHRs affect nurse or attending‐patient interactions. Furthermore, we did not have access to any patient demographic or clinical data. However, we did not anticipate a significant change in the patient population that would alter the survey responses during this 6‐month period. Patients were required to recognize their resident on a photo card presented to them by the surveyor, which likely favored patients with strong feelings toward their residents. Due to this, our population sampled may not be indicative of the entire patient population. All findings were simply correlational. Due to the nature of our data collection, we were unable to control for many confounding variables, thus causal conclusions are difficult to draw from these results.

There are a few important trends to note. No question on the ARC survey received lower scores following implementation of the EHR. Furthermore, 9 of the 16 questions under investigation received significantly higher scores following implementation. The residents largely received positive responses both before and after EHR implementation, so despite the statistically significant improvements, the absolute differences are relatively small. These significant differences were likely not due to the residents improving through time and experience. We observed relatively insignificant and nonuniform changes in responses between the two 11‐week periods prior to implementation.

One possible reason for the observed significant improvements is that EHRs may increase patient involvement in the healthcare setting,[28] and this collaboration might improve resident‐patient communication.[29] Providing patients with an interactive tablet that details their care has been suggested to increase patient satisfaction and comfort in an inpatient setting.[30] In this light, the EHR can be used as a tool to increase these interactions by inviting patients to view the computer screen and electronic charts during data entry, which allows them to have a participatory role in their care and decision‐making process.[31] Although the reasons for our observed improvements are unclear, they are noteworthy and warrant further study. The notion that implementing an EHR might enhance provider‐patient communication is a powerful concept.

This study not only suggests the improvement of resident‐patient communication due to the implementation of an EHR, but it also reveals the value of the ARC Medical Program for studying the patient experience. The controlled, prolonged, and efficient nature of the ARC Medical Program's data collection was ideal for comparing a change in resident‐patient communication before and after EHR implementation at UCLA Health. ARC and UCLA Health's EHR can serve as a model for residency programs nationwide. Future studies can assess the changes of the patient‐provider interaction for any significant event, as demonstrated by this study and its investigation of the implementation of UCLA Health's EHR.