Developing a Framework for Comparing Different Video-techniques Used to Assess the Clinical Consultation: A Qualitative Study

Aaron Leong
McGill University

Phil Koczan
St. George's University of London

Simon De Lusignan
St. George's University of London

Ian Sheeler
St. George's University of London

Adrienne Shaw
St. George's University of London

Topic: Evaluation and methodological issues in ehealth
Track: Research
Type: Poster presentation

     Full text: Not available
     Slides: Not Available
     Last modified: March 29, 2006

Abstract
Background: Single-channel video is an established method for assessing the clinical consultation, however, it is hard to infer the body language of the clinician [1] or how information in the consultation is being integrated into the medical record [2]. A three-channel video was developed combining the conventional view of the whole consultation; with a second camera looking at the doctor's facial expression; and a third copying the video output from the computer monitor [3]. However, this was expensive requiring professional grade video to ensure synchronisation of the time sequence. More recently improvements in the quality of budget priced technology have
enabled acceptable three-channel video to be set up using domestic grade equipment [4]. However, the choice of three video channels was arbitrary and the camera angles selected has not been critically appraised.

Objective: To develop criteria for comparing different multi-channel video methods of recording the clinical consultation.

Methods: We adopted a qualitative, hypothesis generating approach. Single channel and three-channel recordings of simulated consultations were shown to twelve health professionals with experience of communications skills training and experience of the assessment of the consultation using (single channel) video. Semi-structured interviews were conducted, and recorded verbatim. The recordings were typed and transferred into NVIVO software for coding and analysis. The transcripts were analysed thematically to identify what factors were important in assessing the quality of the consultation and what views of the consultation were required to inform an assessor whether it were completed satisfactorily.

Results: The major elements needed in any tool used to assess the consultation are the ability of the video to pick up quantifiable non-verbal communication of the doctor and the patient, and the ability to qualitatively and quantitatively reflect the use and impact of the computer on the consultation. The information provided by the current three-channel video used could be further classified to essential, desirable and redundant to guide the future development of the multi-channel video. Essential criteria for multi-channel video assessment were: camera angles which were as close as possible to the view of the other person in the consultation, so that eye-contact could be accurately assessed; detailed view of the patient's body language; what information on the computer was "distracting" the clinician and how the clinician interpreted the consultation in the computerised medical record. Desirable information included: compromises in patient confidentiality; using information on the computer screen to educate the patient; time wasted 'fiddling' with the computer. Many areas of the clinical computer system screen were redundant, especially when the clinician was not looking at or entering data into the computer. Observers would have liked to be able to enlarge the different channels to enable more detail to be seen at different times in the consultation.

Conclusions: A multi-channel video tool used to appraise the consultation could be developed to monitor: Body language and facial expression of clinician and patient; as well as how the doctor's knowledge and information collected into the consultation are synthesised into the medical record; and the impact of the computer on the clinical consultation. This study will provide the basis of a rating scale to compare and optimise multi-channel methods of assessment of the consultation.

References:

1. Coleman T. Using video-recorded consultations for research in primary care: Advantages and limitations. Family Practice. 2000; 17(5):422-7.
2. de Lusignan S, Wells SE, Russell C, Bevington WP, Arrowsmith P. Development of an assessment tool to measure the influence of clinical software on the delivery of high quality consultations. A study comparing two computerized medical record systems in a nurse run heart clinic in a general practice setting. Med Inform Internet Med. 2002; 27(4):267-80.
3. 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(3):149-56.
4. Sheeler I, Koczan P, Wallage W, de Lusignan S. Low cost three-channel video for assessment of the clinical consultation. Submitted for publication Informatics in Primary Care.