Reporting Observational Studies of the Use of Information Technology in the Clinical Consultation

Summary

Objectives

To develop a classification system to improve the reporting of observational studies of the use of information technology (IT) in clinical consultations.

Methods

Literature review, workshops, and development of a position statement. We grouped the important aspects for consistent reporting into a “faceted classification”; the components relevant to a particular study to be used independently.

Results

The eightfacetsof ourclassification are: (1) Theoretical and methodological approach: e.g. dramaturgical, cognitive; (2) Data collection: Type and method of observation; (3) Room layout and environment: How this affects interaction between clinician, patient and computer. (4) Initiation and Interaction: Who starts the consultation, and how the participants interact; (5) Information and knowledge utilisation: What sources of information or decision support are used or provided; (6) Timing and type of consultation variables: Standard descriptors that can be used to allow comparison of duration and description of continuous activities (e.g. speech, eye contact) and episodic ones, such as prescribing; (7) Post-consultation impact measures: Satisfaction surveys and health economic assessment based on the perceived quality of the clinician-patient interaction; and (8) Data capture, storage, and export formats: How to archive and curate data to facilitate further analysis.

Conclusions

Adoption of this classification should make it easier to interpret research findings and facilitate the synthesis of evidence across studies. Those engaged in IT-consultation research shouldconsider adopting this reporting guide.

Keywords

Healthcare research - observation - information science - medical informatics - medical records systems - computerized

 

Conflicts of Interest

The authors have no conflicts of interest to declare.

• References

• 1 Jha AK, Doolan D, Grandt D, Scott T, Bates DW. The use of health information technology in seven nations. Int J Med Inform 2008; 77 (12) 848-54.
• 2 Protti D, Bowden T, Johansen I. Adoption of information technology in primary care physician offices in New Zealand and Denmark, part 5: final comparisons. Inform Prim Care 2009; 17 (01) 17-22.
• 3 Protti D, Wright G, Treweek S, Johansen I. Primary care computing in England and Scotland: a comparison with Denmark. Inform Prim Care 2006; 14 (02) 93-9.
• 4 Robertson A, Cresswell K, Takian A, Petrakaki D, Crowe S, Cornford T. et al. Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation. BMJ 2010; Sep 1; 341: c4564 DOI: 10.1136/bmj.c4564.
• 5 Häyrinen K, Saranto K, Nykänen P. Definition, structure, content, use and impacts of electronic health records: a review of the research literature. Int J Med Inform 2008; 77 (05) 291-304.
• 6 Cruickshank PJ. Patient stress and the computer in the consulting room. Soc Sci Med 1982; 16 (14) 1371-6.
• 7 Silverman J, Kinnersley P. Doctors’ non-verbal behaviour in consultations: look at the patient before you look at the computer. Br J Gen Pract 2010; 60 (571) 76-8.
• 8 Hoerbst A, Kohl C, Knaup P, Ammenwerth E. Attitudes and behaviors related to the introduction of electronic health records amongAustrian and German citizens. Int J Med Inform 2010; 79 (02) 81-9.
• 9 Black A, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T. et al. The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview. PLoS Med 2011; 08 (01) e1000387 doi:10.1371/journal.pmed.1000387.
• 10 McLean S, Protti D, Sheikh A. Telehealthcare for long term conditions. BMJ 2011; Feb 3; 342: d120 doi: 10.1136/bmj.d120.
• 11 Taylor K. Paternalism, par ticipation and partnership - the evolution of patient centeredness in the consultation. Patient Educ Couns 2009; 74 (02) 150-5.
• 12 McKinstry B, Watson P, Pinnock H, Heaney D, Sheikh A. Telephone consulting in primary care: a triangulated qualitative study of patients and providers. Br J Gen Pract 2009; 59 (563) 209-18.
• 13 Patel V, Kushniruk A, Yang S, Yale J. Impact of a computer-based patient record system on data collection, knowledge organization and reasoning. J Am Med Inform Assoc 2000; 07 (06) 569-85.
• 14 Kushniruk AW, Myers K, Borycki EM, Kannry J. Exploring the relationship between training and usability: a study of the impact of usability testing on improving training and system deployment. Stud Health Technol Inform 2009; 143: 277-83.
• 15 EQUATOR network. Enhancing the QUAlity and Transparency Of health Research. URL: http://www.equator-network.org/
• 16 Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ. et al. Consolidated Standards of Reporting Trials Group. CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol 2010; 63 (08) e1-37.
• 17 Talmon J, Ammenwerth E, Brender J, de Keizer N, Nykänen P, Rigby M. STARE-HI -Statement on Reporting of Evaluation Studies in Health Informatics. Yearb Med Inform 2009; 23-31.
• 18 Coleman T. Using video-recorded consultations for research in primary care: advantages and limitations. Fam Pract 2000; 17 (05) 422-7.
• 19 de Lusignan S, Kumarapeli P, Debar S, Kushniruk AW, Pearce C. Using an open source observational tool to measure the influence of the doctor’s consulting style and the computer system on the outcomes of the clinical consultation. Stud Health Technol Inform 2009; 150: 1017-21.
• 20 de Lusignan S, Teasdale S. Achieving benefit for patients in primary care informatics: the report of a international consensus workshop at Medinfo 2007. Inform Prim Care 2007; 15 (04) 255-61.
• 21 de Lusignan S, Teasdale S, Little D, Zapp J, Zuckerman A, Bates DW. et al. Comprehensive computerised primary care records are an essential component of any national health information strategy: report from an international consensus conference. Inform Prim Care 2004; 12 (04) 255-64.
• 22 Vanopstal K, Vander Stichele R, Laureys G, Buysschaert J. Vocabularies and Retrieval Tools in Biomedicine: Disentangling the Terminological Knot. J Med Syst. 2009 Nov 12. DOI 10.1007/s10916-009-9389-z
• 23 Star S. Grounded classification: Grounded theory and faceted classif ication. Libr Trends 1998; 47 (02) 218-32.
• 24 Cockburn A. Writing Effective Use Cases. Boston, MA: Addison-Wesley Longman; 2001
• 25 Vaziri A, Connor E, Shepherd I, Jones RT, Chan T, de Lusignan S. Are we setting about improving the safety of computerised prescribing in the right way? A workshop report. Inform Prim Care 2009; 17 (03) 175-82.
• 26 Scambler G, Britten N. System, Lifeworld and doctor-patient interaction. In: Scambler G, editor. Habermas, critical theory and health. London, New York: Routledge; 2001
• 27 Greenhalgh T, Stones R. Theorising big IT programmes in healthcare: Strong structuration theory meets actor-network theory. Social Science & Medicine 2010; 70 (09) 1285-94.
• 28 Ventres W, Kooienga S, Vuckovic N, Marlin R, Nygren P, Stewart V. Physicians, patients, and the electronic health record: an ethnographic analysis. Ann Fam Med 2006; 04 (02) 124-31.
• 29 Greatbatch D, Heath C, Luff P, Campion P. Conversation Analysis: human-computer interaction and the general practice consultation. In: Monk A, Gilbert GN. editors. Perspectives on HCI : diverse approaches. London: Academic Press; 1995
• 30 Greatbatch D, Heath C, Campion P, Luff P. How do desk-top computers affect the doctor-patient interaction?. Family practice 1995; 12 (01) 32-6.
• 31 Pearce C, Arnold M, Phillips C, Dwan K. Methodological considerations of digital video observation: beyond conversation analysis. International Journal of Multiple Research Approaches. 2010 04. 02
• 32 Alvesson M, Sköldberg K. Reflexive methodology : new vistas for qualitative research. London: Sage; 2000
• 33 Goffman E. Frame analysis : an essay on the organization of experience. York, Penns: Northeastern University Press; 1974
• 34 Pearce C, Arnold M, Phillips C, Trumble S, Dwan K. The Patient and the Computer in the Primary Care Consultation. J Am Med Inform Assoc. 2011 10.1136/jamia.2010.006486
• 35 Robb N, Greenhalgh T. “You have to cover up the words of the doctor”: the mediation of trust in interpreted consultations in primary care. J Health Organ Manag 2006; 20 (05) 434-55.
• 36 Pringle M, Robins S, Brown G. Timer: a new objective measure of consultation content and its application to computer assisted consultations. Br Med J (Clin Res Ed) 1986; 293 6538 20-2.
• 37 Als A. The desk-top computer as a magic box: patterns of behaviour connected with the desk-top computer; GPs’ and patients’ perceptions. Family practice 1997; 14 (01) 17-23.
• 38 Booth N, Robinson P, Kohannejad J. Identification of high-quality consultation practice in primary care: the effects of computer use on doctor-patient rapport. Inform Prim Care 2004; 12 (02) 75-83.
• 39 Gibson M, Jenkings KN, Wilson R, Purves I. Multi-tasking in practice: coordinated activities in the computer supported doctor-patient consultation. Int J Med Inform 2005; 74 (06) 425-36.
• 40 Theadom A, de Lusignan S, Wilson E, Chan T. Using three-channel video to evaluate the impact of the use of the computer on the patient-centredness of the general practice consultation. J Inform Prim Care 2003; 11 (03) 149-56.
• 41 Miller G. The magic number seven plus or minus two: some limits on our capacity to process information. Psychol Rev 1956; 63 (02) 81-97.
• 42 Margalit RS, Roter D, Dunevant MA, Larson S, Reis S. Electronic medical record use and physician-patient communication: An observational study of Israeli primary care encounters. Patient Educ Couns 2006; 61 (01) 134-41.
• 43 Makoul G. The SEGUE Framework for teaching and assessing communication skills. Patient Educ Couns 2001; 45 (01) 23-34.
• 44 Elwyn G, Edwards A, Kinnersley P. Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Pract 1999; 49 (443) 477-82.
• 45 de Lusignan S, Wells S, Russell C. A model for patient-centred nurse consulting in primary care. Br J Nurs 2003; 12 (02) 85-90.
• 46 de Lusignan S, Kumarapeli P, Chan T, Pflug B, van Vlymen J, Jones B. et al. The ALFA (Activity Log Files Aggregation) toolkit: a method for precise observation of the consultation. J Med Internet Res 2008; 10 (04) e27.
• 47 Leong A, Koczan P, de Lusignan S, Sheeler I. A framework for comparing video methods used to assess the clinical consultation: a qualitative study. Med Inform Internet Med 2006; 31 (04) 255-65.
• 48 de Lusignan S, Kumarapeli P, Chan T, Pflug B, van Vlymen J, Jones B. et al. The ALFA (Activity Log Files Aggregation) toolkit: a method for precise observation of the consultation. J Med Internet Res 2008; 10 (04) e27.
• 49 de Lusignan S, Wilson E, Dyble A, Grant T, Theadom A, Chan T. The feasibility of using pattern recognition software to measure the influence of computer use on the consultation. BMC Med Inform Decis Mak 2003; 03 (01) 12 URL: http://www.biomedcentral.com/1472-6947/3/12/abstract
• 50 Pearce C, Walker H, O’Shea C. A visual study of computers on doctors’ desks. Inform Prim Care 2008; 16 (02) 111-7.
• 51 Shachak A, Hadas-Dayagi M, Ziv A, Reis S. Primary care physicians’ use of an electronic medical record system: a cognitive task analysis. J Gen Intern Med 2009; 24 (03) 341-8.
• 52 Schade C, Sullivan F, de Lusignan S, Madely J. e-Prescribing, efficiency, quality: lessons from the computerization of UK family practice. J Am Med Inform Assoc 2006; 13 (05) 470-5.
• 53 Scott N, Purves I. Triadic relationship between Doctor, Computer and Patient. Interacting with Computers 1996; 08 (04) 347-63.
• 54 Pearce C, Kumarpeli P, de Lusignan S. Getting seamless care right from the beginning - integrating computers into the human interaction. Stud Health Technol Inform 2010; 155: 196-202.
• 55 Fitter M, Cruickshank P. The computer in the consultation a psychological framework. Behaviour and Information Technology 1982; 01: 81-92.
• 56 Hersh WR. Ubiquitous but unfinished: online information retrieval systems. Med Decis Making 2005; 25 (02) 147-8.
• 57 Foy R, Hawthorne G, Gibb I, Eccles MP, Steen N, Hrisos S, White T, Croal B, Grimshaw J. A cluster randomised controlled trial of educational prompts in diabetes care: study protocol. Implement Sci 2007; 02: 22.
• 58 de Lusignan S, Lakhani M, Chan T. The role of informatics in continuing professional development and quality improvement in primary care. J Postgrad Med 2003; 49 (02) 163-5.
• 59 Yu D, Seger D, Lasser K, Karson A, Fiskio J, Seger A. et al. Impact of implementing alerts about medication black-box warnings in electronic health records. Pharmacoepidemiol Drug Saf. 2010 Dec 28. [Epub ahead of print]
• 60 Morris CJ, Savelyich BS, Avery AJ, Cantrill JA, Sheikh A. Patient safety features of clinical computer systems: questionnaire survey of GP views. Qual Saf Health Care 2005; 14 (03) 164-8.
• 61 Hug BL, Witkowski DJ, Sox CM, Keohane CA, Seger DL, Yoon C. et al. Adverse drug event rates in six community hospitals and the potential impact of computerized physician order entry for prevention. J Gen Intern Med 2010; 25 (01) 31-8.
• 62 Royal S, Smeaton L, Avery AJ, Hurwitz B, Sheikh A. Interventions in primary care to reduce medication related adverse events and hospital admissions: systematic review and meta-analysis. Qual Saf Health Care 2006; 15 (01) 23-31.
• 63 Robinson P, Purves I, Wilson R. Learning support for the consultation: information support and decision support should be placed in an educational framework. Med Educ 2003; 37 (05) 429-33.
• 64 de Lusignan S. An Educational Intervention, Involving Feedback of Routinely Collected Computer Data, to Improve Cardiovascular Disease Management in UK Primary Care. Methods Inf Med 2007; 46 (01) 57-62.
• 65 Kumarapeli P, de Lusignan S, Koczan P, Jones B, Sheeler I. The feasibility of using UML to compare the impact of different brands of computer system on the clinical consultation. Inform Prim Care 2007; 15 (04) 245-53.
• 66 Crow R, Gage H, Hampson S, Hart J, Kimber A, Storey L. et al. The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature. Health Technol Assess 2002; 06 (32) 1-244.
• 67 Stavropoulou C. Non-adherence to medication and doctor-patient relationship: Evidence from a European survey. Patient Educ Couns 2011; 83 (01) 7-13.
• 68 Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive Validity of A Medication Adherence Measure in an Outpatient Setting. J Clin Hypertens 2008; 10 (05) 348-54.
• 69 Shachak A, Reis S. The impact of electronic medical records on patient-doctor communication during consultation: a narrative literature review. J Eval Clin Pract 2009; 15 (04) 641-9.
• 70 Lewis C, Rieman J. Task-Centered User Interface Design: A Practical Introduction. URL: http://hcibib.org/tcuid/chap-5.html
• 71 Theadom A, de Lusignan S, Wilson E, Chan T. Using three-channel video to evaluate the impact of the use of the computer on the patient-centredness of the general practice consultation. Inform Prim Care 2003; 11 (03) 149-56.
• 72 Pearce C, Dwan K, Arnold M, Phillips C. Analysing the doctor-patient-computer relationship: the use of video data. Inform Prim Care 2006; 14 (04) 221-6.
• 73 Pflug B, Kumarapeli P, van Vlymen J, Ammenwerth E, de Lusignan S. Measuring the impact of the computer on the consultation: an open source application to combine multiple observational outputs. Inform Health Soc Care 2010; 35 (01) 10-24.
• 74 Pringle M, Stewart-Evans C. Does awareness of being video recorded affect doctors’ consultation behaviour?. Br J Gen Pract 1990; 40 (340) 455-8.