The use of electronic medical records in the studies reviewed. Of the selected journal articles, four examined issues related to electronic device use during the visit. The level of use was examined in two of the selected studies because one dealt with high computer use and the other with low use. In the high-use study, the physician was observed to use the computer for more than 40% of the visit. The timing of data entry varied between the two studies. Sometimes entry was in the presence of the patient, other times after the patient's visit had ended. In one case, the information collected by the doctor was transcribed by a staff member in the doctor's office. Studies have shown that physician data entry is considered a cost-saving measure for the physician's office (Booth, Robinson, Kohannejad, 2004)(Ventres, Kooienga, Marlin, Vuckovic, Stewart, 2005)(Margalit et al, 2006)(Ventres et al, 2006). One of the included studies found that computers were also used by the physician to manage the pace and direction of communication during the visit. This was done in several ways. The computer was used by the doctor in one of the included studies to break communication with the patient in order to collect their thoughts on a particular topic (Ventres et al, 2005). In some studies, when EMR use was extremely new, the computer system was used to reinforce important points and give credence to statements (Als, 1997). None of the articles selected for this review presented similar results. This could be because attitudes regarding computer use have changed since the time of this earlier study. The effects of EMR use on the physician and patient community...... middle of paper ......g used as a tool for the physician to communicate with their patient rather than as a means to create a distance between them (Ventres et al, 2006)(Frankel et al, 2005). A surprising finding is that physicians surveyed about EMR use did not believe patient-physician communication would be affected by using mobile computing options to view the EMR instead of desktop computers (Ventres et al, 2006)(Frankel et al, 2005)(Bullard, Meurer, Colman, Holroyd, Rowe, 2004). Doctors who used the electronic medical record as a checklist and verified information with the patient as they recorded it were more likely to be considered good communicators by their patients. One of the articles reviewed described the development of a transcription methodology that allows the physician to make the most effective use of time with the patient (Gibson, Jenkings, Wilson, Purves, 2005).