Modelling the computerised clinical consultations : a multi-channel video study

Kumarapeli, Pushpa (2011) Modelling the computerised clinical consultations : a multi-channel video study. (PhD thesis), Kingston University, .


This study aims to understand the use of a computer during GP consultations and to enable the development of EPR systems which are easier to review, enter data into, use to take action, and is more sensitive to the clinical context. This thesis reports the development of a multi-channel video and data capture toolkit, the ALFA (Activity Log File Aggregation) because existing observation techniques have limitations. None of the existing tools are designed to assess human-computer interaction in the context of the clinical consultation, where the social interaction is the prime focus. The ALFA tool-kit has been used to observe and study 163 live primary care consultations supported by computer systems with four different designs. A detailed analysis of consultation interactions was then performed focusing on doctor-patient communication and the integration of the computer into the consultation workflow. The data collection elements of the ALFA supported recording of consultation activities by providing rating techniques attuned with the characteristics of those interactions. The Log File Aggregation (LFA) component of the ALFA toolkit aggregated those multitudes of data files into a single navigable output that can be studied both quantitatively and qualitatively. A set of Unified Modelling Language (UML) sequence diagrams were then created as they could be used by software engineers to develop better systems. This research proposes a framework with three elements to analyse the computerised clinical consultation; (1) the overview of the context within which the consultation was carried out, (2) time taken to perform key consultation tasks and (3) the process used. Traditional analysis with its emphasis on the technology often misses crucial features of the complex work environments in which the technology is implemented. Direct observation could inform software designers in developing systems that are more readily integrated into clinical workflow. Direct observation of the consultation, using the ALFA toolkit is acceptable to patients; captures the context of the consultation the precise timing and duration of key tasks; and produces an output a software engineer can understand. ALFA offers a range of possibilities for research in the consulting room. The computer should be considered as an active element of the consultation; room layout and consultation models should let the computer in, while software engineers take in the capacity to sustain patient centred social interactions as a core facet of their design agenda.

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