title: Getting seamless care right from the beginning - integrating computers into the human interaction.
abstract: BACKGROUND
  The digital age is coming to the health space, behind many other fields of society. In part this is because health remains heavily reliant on human interaction. The doctor-patient relationship remains a significant factor in determining patient outcomes. Whilst there are many benefits to E-Health, there are also significant risks if computers are not adequately integrated into this interaction and accurate data are consequently not available on the patient's journey through the health system.
  
  
  METHODS
  Video analysis of routine clinical consultations in Australian and UK primary care. We analyzed 308 consultations (141+167 respectively) from these systems, with an emphasis on how the consultation starts.
  
  
  RESULTS
  Australian consultations have a mean duration of 12.7 mins, UK 11.8 mins. In both countries around 7% of consultations are computer initiated. Where doctors engaged with computer use the patient observed the computer screen much more and better records were produced. However, there was suboptimal engagement and poor records and no coding in around 20% of consultations.
  
  
  CONCLUSIONS
  How the computer is used at the start of the consultation can set the scene for an effective interaction or reflect disengagement from technology and creation of poor records.
authors.affiliation: Melbourne East General Practice Network, Melbourne, Australia. drchrispearce@mac.com
authors.forename: Christopher
authors.initials: C
authors.lastname: Pearce
authors.forename: Pushpa
authors.initials: P
authors.lastname: Kumarpeli
authors.forename: Simon
authors.initials: S
authors.lastname: de Lusignan
mesh_terms: D003201:Computers; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D019114:Remote Consultation / Q000379:methods*