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The Cost of Technology
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Shanafelt, T. D., Dyrbye, L. N., Sinsky, C., Hasan, O., Satele, D., Sloan, J., & West, C. P. (2016) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2016.05.007 · Cited by 1,086
“Electronic health records have increased the clerical burden on physicians,(1-3) altered the patient-physician interaction, and can distract from the more meaningful aspects of medical practice.(1-3,7,8,21,22) In many medical centers, EHRs have been paid for by the elimination of transcription services and the impleme…”
BackgroundPhysician stress and burnout: the impact of health information technology
Gardner, R. L., Cooper, E., Haskell, J., Harris, D. A., Poplau, S., Kroth, P. J., & Linzer, M. (2019) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocy145 · Cited by 566
Report of the AMIA EHR-2020 Task Force on the status and future direction of EHRs
Payne, T. H., Corley, S., Cullen, T. A., Gandhi, T. K., Harrington, L., Kuperman, G. J., Mattison, J. E., McCallie, D. P., McDonald, C. J., Tang, P. C., et al. (2015) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocv066 · Cited by 220
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Computers in the clinical encounter: a scoping review and thematic analysis
Crampton, N. H., Reis, S. P., & Shachak, A. (2016) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocv178 · Cited by 153
“80 However, our findings suggest that, in contrast to this view as well as common criticism of HIT, 13,14 the impact of HIT on the clinical encounter is complex and not all negative.”
BackgroundPatient-centered communication in the era of electronic health records: What does the evidence say?
Rathert, C., Mittler, J., Banerjee, S., & McDaniel, J. A. (2016) · Patient Education and Counseling · doi:10.1016/j.pec.2016.07.031 · Cited by 149
Electronic health record functionality needed to better support primary care
Krist, A. H., Beasley, J. W., Crosson, J. C., Kibbe, D. C., Klinkman, M. S., Lehmann, C. U., Fox, C. H., Mitchell, J., Mold, J. W., Pace, W. D., et al. (2014) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2013-002229 · Cited by 134
Expanding Primary Care Capacity By Reducing Waste And Improving The Efficiency Of Care
Shipman, S. A., & Sinsky, C. A. (2013) · Health Affairs · doi:10.1377/hlthaff.2013.0539 · Cited by 120
Seven years after Meaningful Use: Physicians’ and nurses’ experiences with electronic health records
Rathert, C., Porter, T. H., Mittler, J., & Fleig-Palmer, M. M. (2017) · Health Care Management Review · doi:10.1097/hmr.0000000000000168 · Cited by 120
Electronic health records for the diagnosis of rare diseases
Garcelon, N., Burgun, A., Salomon, R., & Neuraz, A. (2020) · Kidney International · doi:10.1016/j.kint.2019.11.037 · Cited by 99
Time requirements for electronic health record use in an academic ophthalmology center
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Electronic Health Record Training in Undergraduate Medical Education
Wald, H. S., George, P., Reis, S. P., & Taylor, J. S. (2014) · Academic Medicine · doi:10.1097/acm.0000000000000131 · Cited by 90
Yim, W.-W., Fu, Y., Ben Abacha, A., Snider, N., Lin, T., & Yetisgen, M. (2023) · Scientific Data · doi:10.1038/s41597-023-02487-3 · Cited by 64
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“Furthermore, EHRs in their current form physically obstruct and separate the clinician and patient, denying patients time with their clinician as well as compromising communication and human connection by distracting and decreasing eye contact and touch [20-23].”
Electronic Health Records: Design, Implementation, and Policy for Higher-Value Primary Care
Sinsky, C. A., Beasley, J. W., Simmons, G. E., & Baron, R. J. (2014) · Annals of Internal Medicine · doi:10.7326/m13-2589 · Cited by 55
“Those responsible for complex cognitive work should not also be responsible for routine tasks, such as order entry, billing, and documentation, because they may interfere with higher-level tasks, including synthesizing and interpreting information, balancing risks and benefits, guiding patients in shared decision maki…”
BackgroundRefocusing Medical Education in the EMR Era
Pageler, N. M., Friedman, C. P., & Longhurst, C. (2013) · JAMA · doi:10.1001/jama.2013.282326 · Cited by 48
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Kirkendall, E. S., Goldenhar, L. M., Simon, J. L., Wheeler, D. S., & Spooner, S. A. (2013) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2013.08.005 · Cited by 43
Ray, J. M., Ratwani, R. M., Sinsky, C. A., Frankel, R. M., Friedberg, M. W., Powsner, S. M., Rosenthal, D. I., Wachter, R. M., & Melnick, E. R. (2019) · Journal of the American Medical Informatics Association · doi:10.1093/jamia/ocz098 · Cited by 34
“The introduction of HIT, especially in the exam room, splits providers’ attention between a computer screen and the patient.(14) Empathic clinician communication is a key driver for better patient adherence, clinical outcomes, and reduced risk of malpractice lawsuits.”
BackgroundEl.Mahalli, A. A. (2015) · Europe PMC (PubMed Central) · Cited by 37
Computers in the Examination Room
Frankel, R. M. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.6559 · Cited by 35
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Impact of a problem-oriented view on clinical data retrieval
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An Ethnographic Study of Health Information Technology Use in Three Intensive Care Units
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Rattray, N. A., Sico, J. J., Cox, L. M., Russ, A. L., Matthias, M. S., & Frankel, R. M. (2016) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/j.jcjq.2016.11.007 · Cited by 28
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“Some raise concern this increased efficiency will be used to increase workload or reduce contact time with patients [10].”
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Electronic-clinical evaluation exercise (e-CEX): A new patient-centered EHR use tool
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“Optimally, the room should be organized to allow eye contact between the clinician and patient at all phases of the visit [24,32,33,37-39].”
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“Characteristic Searchesa (N = 4 328 330) Searches per user of search feature Median (IQR) 4 (1-28) Range 1-51 784 Time of day Morning (6:00-11:59 AM) 1 794 822 (41.”
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Frankel, R. M., & Saleem, J. J. (2013) · Patient Education and Counseling · doi:10.1016/j.pec.2013.08.011 · Cited by 17
“Imagine the difference in impact on the clinician’s 7-year old patient [27] comparing the alignment in Figs.”
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“However, in practice, these systems have the potential to increase documentation burden on clinicians, cause unexpected errors, and desensitize clinicians to alerts due to overflagging and alert fatigue [1,21,27-30].”
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BackgroundPractice and payment trends in neurology in 2012
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“A lthough changes in the health care practice landscape have been anticipated for over a decade,(1) practicing physicians experience these as chaotic due at least in part to the fact that health care reforms are difficult to implement(2) and programs designed to create change are perceived to be ineffective.(3,4) Fee…”
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“Studies show that EHR use can prevent providers from focusing on patients and can negatively impact the doctor-patient relationship (Frankel et al. 2005; Ventres et al. 2006; Toll 2012).”
BackgroundToll, E., Alkureishi, M. A., Lee, W. W., Babbott, S. F., Bain, P. A., Beasley, J. W., Frankel, R. M., Loveys, A. A., Wald, H. S., Woods, S. S., et al. (2019) · JAMIA Open · doi:10.1093/jamiaopen/ooz012 · Cited by 12
“Managing the volume of information and juggling the complexities of patient needs and EHR systems, while recording care that justifies reimbursement has overwhelmed US practitioners.(11,16,20,21) Longer workdays, work after work, more time spent documenting care and completing administrative tasks than face-to-face wi…”
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Educational approaches for improving physicians’ use of health information technology
Shachak, A., Randhawa, G. K., & Crampton, N. H. (2019) · Healthcare Management Forum · doi:10.1177/0840470419831717 · Cited by 10
Empathy in the age of the electronic medical record
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Have Electronic Health Records Improved the Quality of Patient Care?
Krenn, L., & Schlossman, D. (2017) · PM&R · doi:10.1016/j.pmrj.2017.04.001 · Cited by 8
It's time to bring human factors to primary care policy and practice
Beasley, J. W., Holden, R. J., Ötleş, E., Green, L. A., Steege, L. M. B., & Wetterneck, T. B. (2020) · Applied Ergonomics · doi:10.1016/j.apergo.2020.103077 · Cited by 9
“The current use of EHRs leads to disruption of “flow” and diminished patient engagement during the encounter (Csikszentmihalyi and LeFevre, 1989; Toll, 2012; Zheng, Haftel, Hirschl, O’Reilly and Hanauer, 2010) (Sinsky and Beasley, 2013).”
BackgroundMonroy, G. L., Shemonski, N. D., Shelton, R. L., et al. (2014) · Proceedings of SPIE, the International Society for Optical Engineering/Proceedings of SPIE · doi:10.1117/12.2040221 · Cited by 9
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“Unfortunately, there can also be negative consequences, such as deterred doctor-patient eye contact and reduced patient satisfaction (Alkureishi et al., 2016; Toll, 2012).”
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“reimbursement schemes that preferentially reward throughput over humanistic care (66); in-room electronic medical record systems that divert attention from direct care of the patient (67); and educational systems that prioritize narrowly biomedical models of diagnosis and treatment to”
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“Will these new dynamics further distract doctors from the patient sitting or lying before them (Toll 2012)?”
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“12,13 Considering these patterns, analyzing physician EHR utilization is key to optimal implementation and improvement strategies.”
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Strowd, R. E., III (2014) · Neurology · doi:10.1212/wnl.0000000000000819 · Cited by 4
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“Now, compounding the challenge of weaving threads into care and pulling administrative details from little drawers were the complexities of moving through the EHR and its endless clicks and windows, busy screens and small fonts, dropdown choices and templates, and new kinds of mistakes—click the wrong box and order th…”
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“Although EHR implementations were a prerequisite for digital care, they created their own problems: they have been associated with increasing clinicians’ workloads and physician burnout [15], were not easily interoperable with one another [16], contributed to increasing health care costs [17], became more complex over…”
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“…than a century later, an essay was published in the Journal of the American Medical Association that included an image that had been drawn by a young pediatric patient depicting her physician turned away from her and her family as he faced a computer screen and the electronic medical record [3].”
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“7 Unfortunately, even during the formative years of medical school, trainees are spending a disproportionate amount of their time with EHRs.”
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“Fourth, new and expanding technologies, such as electronic health records, online radiology and laboratory results, and up-to-the-minute communication strategies, may keep trainees in front of screens instead of at the bedside (Toll 2012).”
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Metadata
- Authors
- Toll, E.
- Affiliations
- Brown University (US)
- Corresponding author
- Toll, Elizabeth
- ORCID
- Toll, Elizabeth
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2012-06-20
- Volume
- 307
- Issue
- 23
- Pages
- 2497-8
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W3045969850
- Cited by
- 114
- References
- 0
- Citations by year
- 2025: 9 · 2023: 4 · 2022: 9 · 2021: 6 · 2020: 11 · 2019: 11 · 2018: 11 · 2017: 14 · 2016: 11 · 2015: 14 · 2014: 6 · 2013: 7 · 2012: 1
- FWCI
- 8.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Technology and Human Factors in Education and Health
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Health Professions › Medical Laboratory Technology › Quality and Safety in Healthcare
- Keywords
- health technology, technology costs, health care costs, medical technology
- MeSH terms
- Humans, Medical History Taking, Pediatrics, Physician-Patient Relations, User-Computer Interface, Electronic Health Records
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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