title: The feasibility of using UML to compare the impact of different brands of computer system on the clinical consultation.
abstract: BACKGROUND
  UK general practice is universally computerised, with computers used in the consulting room at the point of care. Practices use a range of different brands of computer system, which have developed organically to meet the needs of general practitioners and health service managers. Unified Modelling Language (UML) is a standard modelling and specification notation widely used in software engineering.
  
  
  OBJECTIVE
  To examine the feasibility of UML notation to compare the impact of different brands of general practice computer system on the clinical consultation.
  
  
  METHODS
  Multi-channel video recordings of simulated consultation sessions were recorded on three different clinical computer systems in common use (EMIS, iSOFT Synergy and IPS Vision). User action recorder software recorded time logs of keyboard and mouse use, and pattern recognition software captured non-verbal communication. The outputs of these were used to create UML class and sequence diagrams for each consultation. We compared 'definition of the presenting problem' and 'prescribing', as these tasks were present in all the consultations analysed.
  
  
  RESULTS
  Class diagrams identified the entities involved in the clinical consultation. Sequence diagrams identified common elements of the consultation (such as prescribing) and enabled comparisons to be made between the different brands of computer system. The clinician and computer system interaction varied greatly between the different brands.
  
  
  CONCLUSIONS
  UML sequence diagrams are useful in identifying common tasks in the clinical consultation, and for contrasting the impact of the different brands of computer system on the clinical consultation. Further research is needed to see if patterns demonstrated in this pilot study are consistently displayed.
authors.affiliation: Primary Care Informatics, Division of Community Health Sciences, St George's University of London, UK.
authors.forename: Pushpa
authors.initials: P
authors.lastname: Kumarapeli
authors.forename: Simon
authors.initials: S
authors.lastname: de Lusignan
authors.forename: Phil
authors.initials: P
authors.lastname: Koczan
authors.forename: Beryl
authors.initials: B
authors.lastname: Jones
authors.forename: Ian
authors.initials: I
authors.lastname: Sheeler
mesh_terms: D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D003199:Computer Systems; D005194:Family Practice / Q000295:instrumentation*; D005240:Feasibility Studies; D006801:Humans; D012984:Software; D006113:United Kingdom; D014584:User-Computer Interface