AN Hedeen, MD, MPH, Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System; MK Chapko, PhD, Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System; Department of Health Services, University of Washington

Objectives: The number of clinicians using the VAs Computerized Patient Record System (CPRS) has dramatically increased. Many clinicians now have computer terminals available in outpatient examination rooms, but very little is known about patients' attitudes toward their provider using the computer during clinic appointments.

Methods: We developed a questionnaire to assess patient satisfaction with computer use during clinic appointments. The 10-item measure included three scales: ability-to-communicate, quality of care, and confidentiality. Psychometric assessment of the items involved factor analysis using orthogonal rotation and reliability assessment using internal consistency analysis. A random sample of General Internal Medicine Clinic (GIMC) patients at the VA Puget Sound Health Care System were surveyed at the completion of their clinic appointment. Patients responded to each item using a Likert-type scale. Both positively and negatively worded items were scored on a scale of 1 to 5 where 1 was the most positive response and 5 the most negative response. Analysis of variance and t-tests were used in the analysis.

Results: Questionnaires were completed by 510 (84%) of 619 GIMC patients asked to participate in the study. Ninety-two percent of respondents reported that their provider used a computer at some time during their appointment. Of these respondents, 53.3% reported that their provider used the computer at the beginning of the appointment, 59.0% during the middle, and 51.2% towards the end (many patients indicated more than one appointment segment). Seventy-eight percent felt that computer use by their provider had no adverse effect on provider-patient ability-to-communicate (mean score 2.1) and 92% felt that computer use could improve the quality of care (mean score =1.6). Only 54.9% of respondents reported no concern about patient record confidentiality, while the remaining respondents were concerned or unsure about record confidentiality (mean score 2.6). Older age, lower educational level, no self-reported computer use, and confidentiality concerns were associated with a significantly lower percent of positive responses on the ability-to-communicate scale and the quality of care scale.

Conclusions: Computer use by clinicians during outpatient clinic appointments was favorably perceived by most veterans surveyed. However almost half of the respondents reported concern or uncertainty about record confidentiality.

Impact: Since clinician use of electronic outpatient records is expected to increase as CPRS features are expanded and improved, assessing patient acceptance with this technology and identifying factors associated with patient dissatisfaction will benefit clinicians and CPRS strategic planners.