PT - JOURNAL ARTICLE AU - James Hayward AU - Susan Buckingham AU - Fionagh Thomson AU - Heather Milne AU - Aziz Sheikh AU - Bernard Fernando AU - Kathrin Cresswell AU - Robin Williams AU - Hilary Pinnock TI - ‘How long does it take?’ A mixed-method evaluation of computer-related work in GP consultations AID - 10.14236/jhi.v22i4.95 DP - 2015 Oct 01 TA - BMJ Health & Care Informatics PG - 409--425 VI - 22 IP - 4 4099 - http://informatics.bmj.com/content/22/4/409.short 4100 - http://informatics.bmj.com/content/22/4/409.full AB - Background Systematic reviews have suggested that time spent on computerrelated 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.What is already knownAlthough computers have been used in U.K. general practice consultations for four decades, there are on-going concerns about the amount of time new computer functions may take.General practitioners (GPs) adopt different styles of computer use during patient consultations.What this paper addsThis study found no evidence that computer use increases the length of consultation.The electronic health record is now the accepted norm in U.K. primary care, and in general, GPs do not express concerns about the time allocated to undertaking computer-related tasks within the consultation.Implications for clinical practiceDespite some preferences in how they used the computer within the consultation, all the GPs readily adapted their style to suit the individual consultation.Understanding of the skilful versatile strategies employed by GPs may be a useful design resource and inform clinical training.Computer designers need to address the tension between ordered computer function and the fluid demands of a clinical consultation.