Brownbridge G et al. 1984 "The doctor's use of a computer in the consulting room: an analysis."

Brownbridge G, Fitter M, Sime M. The doctor's use of a computer in the consulting room: an analysis. Int J Man Mach Stud 1984;21(1):65-90.
"With the general advance of information technology there has been considerable interest in the potential for interactive computer systems in medical consultations. If such computer applications are to be successful then the human, as well as the technological, factors involved in the ensuing change must first receive close attention. Here we report a human factors assessment of an interactive computer aid to history-taking and diagnosis, used during consultations in a hospital out-patient clinic, closely observing three different doctors during more than 50 consultations each. Systematic analyses of video-recorded consultations before and after the computer's installation enabled an assessment of the computer's effects on the routine of the clinic and the processes of the consultation. The computer's influence on the doctors' information gathering and processing is also investigated. Computer consultations followed a pattern which was very similar to that of pre-computer consultations. The disruption to the clinic's normal routine was minimal. Alternative strategies for incorporating computer use into the consultation were identified and the pros and cons of each are discussed. The system caused a slightly increased workload for doctors and nurses, reflected in a minor increase in the amount of time devoted to each patient, partly because doctors gathered more explicit information about patients' symptoms in computer consultations. The order in which the computer presented topics for discussion seemed to reflect the "natural" order in which the topics would be discussed, but there was some mismatch between the information doctors entered at the terminal and the information the system was designed to accept. Such evidence of the user incompatibilities of the system could help in the identification of criteria for the design of future consulting room systems and will lead to a better understanding of the issues involved in the interactions between patient, doctor and computer and result in more appropriate interfaces between the doctor and computer."

To "report a human factors assessment of an interactive computer aid to history-taking and diagnosis, used during consultations in a hospital out-patient clinic."

Tools Used
Type Clinic
Specialty care
Type Specific
Gastroenterology outpatient clinic
Small and/or medium
Other Information
"Over a period of 12 months [the] system has been used in the gastroenterology out-patient clinic of a local hospital during the patient's first visit."
Type of Health IT
Decision support system
Type of Health IT Functions
The computer system provides categories in which patient-specific information can be entered to aid in the diagnosis of dyspepsia symptoms. A small panel on the main screen constantly updates the statistical likelihood of the symptoms being caused by each of five diagnoses. "Minimal guidance [was provided to the physicians] on when, or in which sequence, to use [it]."
Workflow-Related Findings
The system required 8-10 seconds to "process" an entered symptom before allowing the doctor to enter more information. Patients often saw this delay as an invitation to continue talking, which required the physician to divide his attention or develop strategies to prevent the patient from giving more information at an inappropriate time.
Use of the computer during the consultation "formalized" the interaction because the physician aimed to extract the information needed for the computer program.
For one physician, the length of the consultation was significantly longer when using the computer. For the other two physicians, the consultation length did not significantly change.
"The evidence suggests that doctors do elicit more information from patients in ... computer consultations."
Physicians who did not enter the information when the patient was in the consulting room devoted more time per patient on average.
Physicians found the report printed by the system helped them in writing notes after the consultation. Some used the report as notes. One commented that the report made his job much easier.
All physicians discussed more topics in computer consultations than they did prior to implementation.
Physicians who entered patient information after the consultation were likely to indicate the occurrence of symptoms without receiving adequate information from the patient, but rarely omitted information. The physicians who entered patient information during the consultation rarely indicated the occurrence of symptoms without adequate information but were likely to omit information.
Topics requiring multiple entries were more likely to be incomplete because information provided on the screen could be misinterpreted as indicating all information had been entered.
The three doctors had two patterns of computer use, varying by how much they used the machine while the patient was in the consulting room. One type avoided using the computer while the patient was present, instead entering basic information before the patient entered the room and entering symptom data while the patient was changing for the physical exam. The second pattern involved using the computer "conversationally," asking the patient a question, turning to the computer to enter it, and then turning back to the patient to ask another question.
The physician who used the computer during the consultation would spend a lot of time facing the terminal during the consultation and needed to use eye contact and verbal cues to encourage the patient to speak.
Study Design
Pre-postintervention (no control group)
Study Participants
Researchers videotaped consultations of all dyspepsia patients seeing one of three doctors before and after the installation of the computer system.