Measuring the impact of different brands of computer systems on the clinical consultation: a pilot study

Charlotte Refsum, Pushpa Kumarapeli, Aruni Gunaratne, Richard Dodds, Ali Hasan, Simon de Lusignan

Abstract


Background UK general practitioners largely conduct computer-mediated consultations. Although historically there were many small general practice (GP) computer suppliers there are now around five widely used electronic patient record (EPR) systems. A new method has been developed for assessing the impact of the computer on doctor_patient interaction through detailed observation of the consultation and computer use.
Objective To pilot the latest version of a method to measure the difference in coding and prescribing times on two different brands of general practice EPR system.
Method We compared two GP EPR systems by observing use in real life consultations. Three video cameras recorded the consultation and screen capture software recorded computer activity.We piloted semi-automated user action recording (UAR) software to record mouse and keyboard use, to overcome limitations in manual measurement. Six trained raters analysed the videos using data capture software to measure the doctor_patient_computer interactions; we used interclass correlation coefficients (ICC) to measure reliability.
Results Raters demonstrated high inter-rater reliability for verbal interactions and prescribing (ICC 0.74 to 0.99), but for measures of computer use they were not reliable. We used UAR to capture computer use and found it more reliable.Coded data entry time varied between the systems: 6.8 compared with 11.5 seconds (P = 0.006). However, the EPR with the shortest coding time had a longer prescribing time: 27.5 compared with 23.7 seconds (P = 0.64).
Conclusion This methodological development improves the reliability of our method for measuring the impact of different computer systems on the GP consultation. UAR added more objectivity to the observationof doctor_computer interactions. If larger studies were to reproduce the differences between computer systems demonstrated in this pilot it might be possible to make objective comparisons between systems.

Keywords


clinical consultation; computer system; user action recording

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DOI: http://dx.doi.org/10.14236/jhi.v16i2.683

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