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Using the computer in the clinical consultation; setting the stage, reviewing, recording, and taking actions: multi-channel video study.

Kumarapeli, P and de Lusignan, S (2012) Using the computer in the clinical consultation; setting the stage, reviewing, recording, and taking actions: multi-channel video study. J Am Med Inform Assoc.

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Abstract

BACKGROUND AND OBJECTIVE: Electronic patient record (EPR) systems are widely used. This study explores the context and use of systems to provide insights into improving their use in clinical practice. METHODS: We used video to observe 163 consultations by 16 clinicians using four EPR brands. We made a visual study of the consultation room and coded interactions between clinician, patient, and computer. Few patients (6.9%, n=12) declined to participate. RESULTS: Patients looked at the computer twice as much (47.6 s vs 20.6 s, p<0.001) when it was within their gaze. A quarter of consultations were interrupted (27.6%, n=45); and in half the clinician left the room (12.3%, n=20). The core consultation takes about 87% of the total session time; 5% of time is spent pre-consultation, reading the record and calling the patient in; and 8% of time is spent post-consultation, largely entering notes. Consultations with more than one person and where prescribing took place were longer (R(2) adj=22.5%, p<0.001). The core consultation can be divided into 61% of direct clinician-patient interaction, of which 15% is examination, 25% computer use with no patient involvement, and 14% simultaneous clinician-computer-patient interplay. The proportions of computer use are similar between consultations (mean=40.6%, SD=13.7%). There was more data coding in problem-orientated EPR systems, though clinicians often used vague codes. CONCLUSIONS: The EPR system is used for a consistent proportion of the consultation and should be designed to facilitate multi-tasking. Clinicians who want to promote screen sharing should change their consulting room layout.

Item Type: Article
Authors :
AuthorsEmailORCID
Kumarapeli, PUNSPECIFIEDUNSPECIFIED
de Lusignan, SUNSPECIFIEDUNSPECIFIED
Date : 15 December 2012
Identification Number : https://doi.org/10.1136/amiajnl-2012-001081
Related URLs :
Depositing User : Symplectic Elements
Date Deposited : 28 Mar 2017 13:48
Last Modified : 28 Mar 2017 13:48
URI: http://epubs.surrey.ac.uk/id/eprint/773422

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