Intended for healthcare professionals

Clinical Review ABC of health informatics

How computers help make efficient use of consultations

BMJ 2005; 331 doi: (Published 27 October 2005) Cite this as: BMJ 2005;331:1010
  1. Frank Sullivan, NHS Tayside professor of research and development in general practice and primary care,
  2. Jeremy C Wyatt, professor of health informatics
  1. University of Dundee.


    Efficient consultations deal with patients' problems promptly and effectively while taking into account other relevant circumstances. Sometimes the relevant circumstance is another health problem in the patient or their family, or it could be an issue affecting society at large, such as resource constraints. The immediate role of the team caring for Patrick Murphy (see box opposite) is to deal with his severe asthma.

    To do so the team needs information on the current problem, which is quickly obtained from Patrick's mother (who accompanied him in the ambulance) and background details from her or from his medical records. They also need to assess Patrick's physical status using clinical examination and other diagnostic methods. The information obtained enables the clinicians caring for Patrick to take the most effective management steps. In the longer term, data from the consultation may be used to redesign the service locally, or at the level of the health system. This article shows how informatics tools can make it easier to record important data, and that this processing can produce useful information for a low cost.

    Fig 1

    Acute asthma management flow chart for children >5 years in accident and emergency department. Adapted from Scottish Intercollegiate Guidelines Network, guideline 63 (

    Most doctors focus on assessing the patient and carrying out immediate management steps. Some clinicians see the recording of what happened and why as a necessary evil to be done in the minimum time, with the least effort. Legal responsibilities ensure that most encounters are recorded, but the quality of data is often constrained, partly because so much data are required.

    Fig 2

    Turning clinical data into improved patient outcomes

    Write once, read many

    Other tasks in the emergency consultation include gathering and recording information that may be useful to Patrick or other patients in the future. Paper or electronic records, or other …

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