Lee et al.1 describe positive and negative patient perspectives of outpatient EMR use. From 108 telephone interviews, two major themes and six subthemes were identified. Overall, 85 % of patient perceptions of EMR use were positive. Of the negative perceptions, 66 % were related to lack of eye contact and attention from the provider and not sharing the screen with the patient. Only 7 % reported that EMR made it harder to talk with their doctors.

While EMR use in healthcare is important, there has been limited research exploring its impact on patient–provider communication.2 A systematic review revealed that EMR use often had a positive impact on information exchange, but diminished patient-centeredness and patient rapport.2 Both computer skills and behavioral style had the ability to overcome some of the negative influence that emerged.2 Physicians might employ three different methods of sharing information using the EMR. They can use active information sharing, in which they show the computer screen to the patient; passive information sharing, where the screen is not shown to the patient but they can lean in and look at the screen; or finally, technology withdrawal, where the screen is never shared with the patient.3 While there is no going back to paper records, it must be acknowledged that the EMR has dramatically changed the patient–provider encounter. One potential key for lessening the negative impact of a computer screen in the middle of a communication encounter is to actually introduce the EMR and explain what is being done at the beginning of the encounter.4

The sharing of information related to the EMR has the potential to enhance patient engagement and improve communication.4 However, the EMR also has the potential to compete with the patient for the provider’s attention.5 Screen-driven communication can limit patient narratives and hide clues about psychosocial and emotional concerns.5 Unfortunately, there seems to be little time spent training providers on how best to incorporate EMR into the clinical encounter.1 2 5 Increasing this communication training can result in enhanced rather than diminished communication and relationships.