"Attention on the flight deck": What ambulatory care providers can learn from pilots about complex coordinated actions

Richard Frankel, Jason J. Saleem

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: Technical and interpersonal challenges of using electronic health records (EHRs) in ambulatory care persist. We use cockpit communication as an example of highly coordinated complex activity during flight and compare it with providers' communication when computers are used in the exam room. Methods: Maximum variation sampling was used to identify two videotapes from a parent study of primary care physicians' exam room computer demonstrating the greatest variation. We then produced and analyzed visualizations of the time providers spent looking at the computer and looking at the patient. Results: Unlike the cockpit which is engineered to optimize joint attention on complex coordinated activities, we found polar extremes in the use of joint focus of attention to manage the medical encounter. Conclusion: We conclude that there is a great deal of room for improving the balance of interpersonal and technical attention that occurs in routine ambulatory visits in which computers are present in the exam room. Practice implications: Using well-known aviation practices can help primary care providers become more aware of the opportunities and challenges for enhancing the physician patient relationship in an era of exam room computing.

Original languageEnglish
Pages (from-to)367-372
Number of pages6
JournalPatient Education and Counseling
Volume93
Issue number3
DOIs
StatePublished - Dec 2013

Fingerprint

Ambulatory Care
Communication
Physician-Patient Relations
Aviation
Videotape Recording
Electronic Health Records
Primary Care Physicians
Primary Health Care
Joints
Pilots

Keywords

  • Electronic health records
  • Person/machine interaction
  • Situation awareness
  • Social interaction

ASJC Scopus subject areas

  • Medicine(all)

Cite this

"Attention on the flight deck" : What ambulatory care providers can learn from pilots about complex coordinated actions. / Frankel, Richard; Saleem, Jason J.

In: Patient Education and Counseling, Vol. 93, No. 3, 12.2013, p. 367-372.

Research output: Contribution to journalArticle

@article{7531f56f42034a93a07bbcc8d93474ea,
title = "{"}Attention on the flight deck{"}: What ambulatory care providers can learn from pilots about complex coordinated actions",
abstract = "Objective: Technical and interpersonal challenges of using electronic health records (EHRs) in ambulatory care persist. We use cockpit communication as an example of highly coordinated complex activity during flight and compare it with providers' communication when computers are used in the exam room. Methods: Maximum variation sampling was used to identify two videotapes from a parent study of primary care physicians' exam room computer demonstrating the greatest variation. We then produced and analyzed visualizations of the time providers spent looking at the computer and looking at the patient. Results: Unlike the cockpit which is engineered to optimize joint attention on complex coordinated activities, we found polar extremes in the use of joint focus of attention to manage the medical encounter. Conclusion: We conclude that there is a great deal of room for improving the balance of interpersonal and technical attention that occurs in routine ambulatory visits in which computers are present in the exam room. Practice implications: Using well-known aviation practices can help primary care providers become more aware of the opportunities and challenges for enhancing the physician patient relationship in an era of exam room computing.",
keywords = "Electronic health records, Person/machine interaction, Situation awareness, Social interaction",
author = "Richard Frankel and Saleem, {Jason J.}",
year = "2013",
month = "12",
doi = "10.1016/j.pec.2013.08.011",
language = "English",
volume = "93",
pages = "367--372",
journal = "Patient Education and Counseling",
issn = "0738-3991",
publisher = "Elsevier Ireland Ltd",
number = "3",

}

TY - JOUR

T1 - "Attention on the flight deck"

T2 - What ambulatory care providers can learn from pilots about complex coordinated actions

AU - Frankel, Richard

AU - Saleem, Jason J.

PY - 2013/12

Y1 - 2013/12

N2 - Objective: Technical and interpersonal challenges of using electronic health records (EHRs) in ambulatory care persist. We use cockpit communication as an example of highly coordinated complex activity during flight and compare it with providers' communication when computers are used in the exam room. Methods: Maximum variation sampling was used to identify two videotapes from a parent study of primary care physicians' exam room computer demonstrating the greatest variation. We then produced and analyzed visualizations of the time providers spent looking at the computer and looking at the patient. Results: Unlike the cockpit which is engineered to optimize joint attention on complex coordinated activities, we found polar extremes in the use of joint focus of attention to manage the medical encounter. Conclusion: We conclude that there is a great deal of room for improving the balance of interpersonal and technical attention that occurs in routine ambulatory visits in which computers are present in the exam room. Practice implications: Using well-known aviation practices can help primary care providers become more aware of the opportunities and challenges for enhancing the physician patient relationship in an era of exam room computing.

AB - Objective: Technical and interpersonal challenges of using electronic health records (EHRs) in ambulatory care persist. We use cockpit communication as an example of highly coordinated complex activity during flight and compare it with providers' communication when computers are used in the exam room. Methods: Maximum variation sampling was used to identify two videotapes from a parent study of primary care physicians' exam room computer demonstrating the greatest variation. We then produced and analyzed visualizations of the time providers spent looking at the computer and looking at the patient. Results: Unlike the cockpit which is engineered to optimize joint attention on complex coordinated activities, we found polar extremes in the use of joint focus of attention to manage the medical encounter. Conclusion: We conclude that there is a great deal of room for improving the balance of interpersonal and technical attention that occurs in routine ambulatory visits in which computers are present in the exam room. Practice implications: Using well-known aviation practices can help primary care providers become more aware of the opportunities and challenges for enhancing the physician patient relationship in an era of exam room computing.

KW - Electronic health records

KW - Person/machine interaction

KW - Situation awareness

KW - Social interaction

UR - http://www.scopus.com/inward/record.url?scp=84888364734&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84888364734&partnerID=8YFLogxK

U2 - 10.1016/j.pec.2013.08.011

DO - 10.1016/j.pec.2013.08.011

M3 - Article

C2 - 24001659

AN - SCOPUS:84888364734

VL - 93

SP - 367

EP - 372

JO - Patient Education and Counseling

JF - Patient Education and Counseling

SN - 0738-3991

IS - 3

ER -