[0]活动日志文件聚合(ALFA)工具集一种精确观察会诊的方法%A de Lusignan,Simon %A Kumarapeli,Pushpa %A Chan,Tom %A Pflug,Bernhard %A van Vlymen,Jeremy %A Jones,Beryl %A Freeman,George K %+生物医学信息学，伦敦圣乔治大学社区卫生科学学院，伦敦sw170re，英国，+44 208 725 5661，slusigna@sgul.ac.uk %K视频记录%K过程评估%K观察%K对计算机的态度%K专业-患者关系%K全科医生%K家庭医生%K决策建模%K过程评估%K医疗信息学%K计算机%K病历系统，电脑化%K电子病历(EPR) %K电子病历(EMR) %K评价方法%K可用性%D 2008 %7 8.9.2008 %9原文%J J J Med Internet Res %G英文%X缺乏评估和比较电子病历系统的工具，无法为合理选择或发展议程提供信息。目的:开发一套工具来衡量不同EPR系统特征对会诊的影响。方法:我们首先制定了一个规范来克服现有方法的局限性。我们将其分为几个工作包:(1)开发一种显示咨询多通道视频的方法;(2)对活动进行编码和测量，包括计算机使用和语言互动;(3)自动捕捉非语言互动;(4)将多个观测结果汇总为单个可导航输出; and (5) produce an output interpretable by software developers. We piloted this method by filming live consultations (n = 22) by 4 general practitioners (GPs) using different EPR systems. We compared the time taken and variations during coded data entry, prescribing, and blood pressure (BP) recording. We used nonparametric tests to make statistical comparisons. We contrasted methods of BP recording using Unified Modeling Language (UML) sequence diagrams. Results: We found that 4 channels of video were optimal. We identified an existing application for manual coding of video output. We developed in-house tools for capturing use of keyboard and mouse and to time stamp speech. The transcript is then typed within this time stamp. Although we managed to capture body language using pattern recognition software, we were unable to use this data quantitatively. We loaded these observational outputs into our aggregation tool, which allows simultaneous navigation and viewing of multiple files. This also creates a single exportable file in XML format, which we used to develop UML sequence diagrams. In our pilot, the GP using the EMIS LV (Egton Medical Information Systems Limited, Leeds, UK) system took the longest time to code data (mean 11.5 s, 95% CI 8.7-14.2). Nonparametric comparison of EMIS LV with the other systems showed a significant difference, with EMIS PCS (Egton Medical Information Systems Limited, Leeds, UK) (P = .007), iSoft Synergy (iSOFT, Banbury, UK) (P = .014), and INPS Vision (INPS, London, UK) (P = .006) facilitating faster coding. In contrast, prescribing was fastest with EMIS LV (mean 23.7 s, 95% CI 20.5-26.8), but nonparametric comparison showed no statistically significant difference. UML sequence diagrams showed that the simplest BP recording interface was not the easiest to use, as users spent longer navigating or looking up previous blood pressures separately. Complex interfaces with free-text boxes left clinicians unsure of what to add. Conclusions: The ALFA method allows the precise observation of the clinical consultation. It enables rigorous comparison of core elements of EPR systems. Pilot data suggests its capacity to demonstrate differences between systems. Its outputs could provide the evidence base for making more objective choices between systems. %M 18812313 %R 10.2196/jmir.1080 %U //www.mybigtv.com/2008/4/e27/ %U https://doi.org/10.2196/jmir.1080 %U http://www.ncbi.nlm.nih.gov/pubmed/18812313