Understanding of health and biomedical principles by patients and physicians: relationship to the creation of EMR systems

Objective: The purpose of this paper is to analyze the organization of information and reasoning strategies involved in communication between doctor and patient and to consider how the use of digital resources, especially electronic medical record (EMR) systems, affects these.


Design: We summarize findings from a study in the first part of the paper in which patients were interviewed before their encounters with doctors and where doctor-patient interactions were documented and evaluated to determine the perception of the patient issue by patients and doctors. We present one of these experiences in depth, with characterizations of physician and patient models.
The contents of both paper and EMRs were contrasted in a second set of tests, and physician-patient interactions involving the use of EMR technology) were also video recorded and analyzed to determine the information collection and knowledge organization of physicians for medical decision-making.

Results: Physicians described patient issues in terms of the underlying disease’s causal pathophysiological information (disease model), while patients explained them in terms of disease narrative frameworks (illness model). The data-driven nature of the conventional relationship between doctors and patients enables doctors to capture the temporal flow of events and record key aspects of the narratives of the patients.

Conclusions: The doctor-patient interview helps doctors to capture key aspects of the disease model of the patient that are important from the viewpoint of the patient to understand the issue. A loss of this relevant information can result from the use of computer-based patient record technology. As a result, designers of such programs should take into account details related to the patient’s perception of medical concerns that will impact their compliance with them.