Dr. Jason Saleem
Dr. Jason Saleem

Today, medical records are mostly digital. And for physicians, that may mean they have to spend more time during patient exams looking at a computer screen — taking notes and charting.

“They’re kind of consumed with the computer instead of having eye contact on you,” said Dr. Jason Saleem, a researcher and assistant professor at the University of Louisville J.B. Speed School of Engineering.

But Saleem is trying to fix that through design. He worked with the Department of Veterans Affairs (VA) to test whether their new exam room design would positively impact patient care. The new design mounts the computer monitor to the wall with a moveable arm, rather than stationary in the corner.

“The VA has a new emphasis on veteran experience,” said Dr. Jennifer Herout, who was on the VA advisory board for the project. “And Dr. Saleem’s work is one important aspect of outpatient visit experience.”

Backed by a grant from the Agency for Healthcare Research and Quality, Saleem’s team tested the idea by setting up model exam rooms in UofL’s Center for Ergonomics, where Saleem is also the director. One room had the new design, and another had a “legacy” design where the computer was stationary in the corner of the room.

The team tested the rooms on 28 volunteer primary care physicians to see how the changes affected their efficiency, errors, mental workload, amount of screen sharing with the patient, eye gaze on the patient, situation awareness and workflow integration.

In the test, the rooms showed little difference in terms of physician efficiency, errors and time spent with the patient. But the new layout did show significant improvement in patient-centricity measures.

For example, doctors spent 75 percent more time sharing the computer screen with their patients in the room with the new layout than they did in the model legacy room, allowing patients to more actively participate in their own care.

“…previous research indicates that patients have better outcomes when they are more involved in the delivery of their own care,” said Dustin Weiler, who worked on the project while completing his master’s degree at UofL. He’s also the lead author on the resulting paper, published here in IISE Transactions on Occupational Ergonomics and Human Factors.

The UofL research also showed that physicians had a reduced cognitive load (down 31 percent) when using the new room design, because of the closer proximity of the computer screen in relation to the patient. They also gave higher ratings for situational awareness (up 14 percent) and workflow integration (up 17 percent).

The team repeated the lab tests in a follow-up field study at the Phoenix VA Medical Center, which has already implemented the new exam room design in one of its clinics. That test yielded very similar results and support for the new exam room design.

“While much of the focus in healthcare lately has been on technology, the physical configuration in which the technology is located is critical to its successful use,” Herout said.

Saleem is now working on a new grant application to extend this research into ways to optimize the exam room layout in the patient-centered medical home model of care. He’s hoping to work with several health care sites across the U.S., including some clinics at UofL.

Listen to Saleem’s full interview with Mark Hebert here