title: "How long does it take?" A mixed methods evaluation of computer-related work in GP consultations.
abstract: BACKGROUND
  Systematic reviews have suggested that time spent on computer-related tasks increases consultation length. However, these reviews pre-date the current ubiquitous use of computers in U.K. general practice.
  
  
  OBJECTIVE
  As part of a U.K. national study of the influence of information technology (IT) on the interaction between patients and healthcare professionals during consultations, we explored how IT functions affected time allocation and styles of computer use during general practitioner (GP) consultations.
  
  
  METHODS
  We drew on multichannel video recording of consultations and measured consultation phases and the duration of computer-related tasks. We related measures of actual time to GP's interpretation of computer use elicited in qualitative interviews.
  
  
  RESULTS
  Our sample included recordings of 112 consultations from 6 GPs in three practices. The computer was used for about one-third of the greater consultation. However, its use was concentrated pre- and post- the patient consultation. The workflow of consultation was exemplified through six computer use cases. Most functionality was accepted and accommodated within the consultation, though disruptive and time-consuming tasks were generally delegated to administrative staff. Recognised styles of computer use (minimal, block and conversational) were apparent, but applied very flexibly by GPs according to the nature of the consultation.
  
  
  CONCLUSIONS
  In contrast to earlier reports, contemporary computer use does not appear to have lengthened consultations. GPs adopted different styles of computer use in different consultations, challenging classifications that seek to stereotype GP computer use. Designing systems that support this versatility require an understanding of the fluid application of computer use within consultation structure.
authors: eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh. james.hayward@ed.ac.uk.
authors: James
authors: J
authors: Hayward
authors: Centre for Population Health Sciences, The University of Edinburgh. susan.buckingham@ed.ac.uk.
authors: Susan
authors: S
authors: Buckingham
authors: eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh. fionagh.thomson@st-andrews.ac.uk.
authors: Fionagh
authors: F
authors: Thomson
authors: eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh. H.Milne@student.liverpool.ac.uk.
authors: Heather
authors: H
authors: Milne
authors: Centre for Population Health Sciences, The University of Edinburgh. aziz.sheikh@ed.ac.uk.
authors: Aziz
authors: A
authors: Sheikh
authors: eHealth Research Group, Centre for Population Health Sciences, The University of Edinburgh. bernard.fernando@ed.ac.uk.
authors: Bernard
authors: B
authors: Fernando
authors: School of Health in Social Science, The University of Edinburgh. kathrin.beyer@ed.ac.uk.
authors: Kathrin
authors: K
authors: Cresswell
authors: Institute for the Study of Science, Technology and Innovation, School of Social and Political Science, The University of Edinburgh. robin.williams@ed.ac.uk.
authors: Robin
authors: R
authors: Williams
authors: Centre for Population Health Sciences, The University of Edinburgh. hilary.pinnock@ed.ac.uk.
authors: Hilary
authors: H
authors: Pinnock
mesh_terms: D003142:Communication; D057286:Electronic Health Records; D058005:General Practitioners; D006801:Humans; D009819:Office Visits; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D013997:Time Factors; D014584:User-Computer Interface; D014741:Video Recording / Q000379:methods