Using electronic patient records in practice: a focused review of the evidence of risks to the clinical interaction.

Electronic patient records (EPRs) are increasingly being viewed as key to high quality chronic disease management, and have been advocated for epilepsy care. Whether EPRs can really deliver on their promise, however, remains a matter of debate. In this focused review, I highlight one set of risks associated with EPR use: risks to the interaction between health professional and patient. This review summarises a small body of evidence derived from studies that examined - in fine-grained detail - recordings of real consultations. These show that EPRs are often used in ways that prioritise the demands of the system over the needs of the patient. However, they also demonstrate that health professionals sometimes integrate EPRs in ways that enhance the clinical encounter. I argue that we not only need more of this kind of interaction-based research - as opposed to focusing on the single EPR user - but that the findings from these previous studies need to be acted upon. They indicate a need both for the design of EPRs and the training of EPR users to be sensitive to the impact of EPR use on the interaction between health professional and patient.