How long does it take? A mixed methods evaluation of computer-related work in GP consultations

James Hayward, Susan Buckingham, Fionagh Thomson, Heather Milne, Aziz Sheikh, Bernard Fernando, Kathrin Cresswell, Robin Williams, Hilary Pinnock

Research output: Contribution to journalArticlepeer-review


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 UK general practice.

As part of a UK 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.

We drew on multi-channel 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.

Our sample included recordings of 112 consultations from six 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

Compared 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 which seek to stereotype GP computer use. Designing systems which support this versatility requires an understanding of the fluid application of computer use within consultation structure.

What is already known
• Although computers have been used in UK general practice consultations for four decades, there are on-going concerns about the amount of time new computer functions may take.
• GPs adopt different styles of computer use during patient consultations.
What this paper adds
• This study found no evidence that computer use increases the length of consultation.
• The electronic health record is now the accepted norm in UK 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 practice
• Despite some preferences in how they used the computer within the consultation, all the GPs readily adapted their style to suit the individual consultation
• The skilful versatile strategies employed by GPs may be a useful design resource and aid knowledge-sharing through clinical training
• Computer designers need to address the tension between ordered computer function and the fluid demands of a clinical consultation.

Original languageEnglish
Pages (from-to)409-425
Number of pages16
JournalJournal of Innovation in Health Informatics
Issue number4
Publication statusPublished - 2015


  • primary care
  • consultation
  • information technology
  • computer use


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