PCEHR interface not the sticking point for clinicians

Anecdotal evidence from users of general practice and medical specialist clinical software about the programs' interfaces to the PCEHR shows that whatever clinical usability issues the system has, the actual interface is the least of its problems.

Several clinical software vendors contacted by Pulse+IT say they have received very little feedback on the interfaces they have designed within their systems, and the issue is not high on the list of requests for new features or improvements.

Most agree that this is probably because few clinicians seem to be actually using the system, even though more than 50 per cent of general practices in Australia have applied for the eHealth Practice Incentives Program (ePIP), for which using the PCEHR is a requirement.

While there are some issues that need to be fixed – including some products that list older medications at the top rather than the bottom of the screen, and problems with incorrectly defaulting dates – the main problem from a vendor point of view has been their clients' difficulties in signing up for system in the first place and a lack of actual use.

Several software companies have been taking part in NEHTA's clinical usability program (CUP), which is currently looking at fixing some of the perceived issues.

Craig Hodges, chief operations officer for Best Practice, said his company did plan on making some enhancements to the PCEHR interface, but in its experience, very few of the current list of feature requests from users relate to the PCEHR.

Indigenous healthcare software specialist Communicare is currently collecting feedback on changes to the interface its users would like to see as part of the CUP, which will be released early next year.

However, Communicare operations manager Heidi Tudehope said her team hadn't received much feedback from users about the PCEHR interface.

“Communicare sites were jointly the first to connect to and upload documents to the PCEHR, so have had some longevity with the feature,” she said.

“Many of our services have enabled the PCEHR, though to my knowledge the uptake was driven largely by services wanting to maintain their eHealth compliance and to be eligible for electronic Practice Incentive Payments (ePIPs), rather than a desire to use the facility.

“While we have a few champion users out there engaging with the facility, I believe general use is not yet widespread. Consequently our user suggestions for changes have been minimal and less than one per cent of our feature requests have anything to do with PCEHR functionality.”

Paul Carr, CEO of Genie, said his company hadn't had any feedback on the interface.

“Most support calls relate to registration, getting certificates and general set-up,” Dr Carr said. “We’ve made a couple of small changes suggested by CUPS, but are waiting on this to be finalised before we implement anything else.”

Asked what percentage of his current list of feature requests relate to the PCEHR, Dr Carr said “zero”.

Stat Health has also had no requests for changes to the PCEHR interface from its users, CEO Carla Doolan said.

“We have received no feedback from our clients using PCEHR regarding changes they would like,” Ms Doolan said. “It seems very few practices have many patients registered for PCEHR.”

Former head of the PCEHR, Andrew Howard, and former NEHTA clinical lead Kean-Seng Lim both told Pulse+IT that the view of documents within clinical software is not as as good as in the provider portal.

Mr Howard said there were several poorly designed screens and interfaces in the GP environment.

“As part of the certification process for practice software, software doesn't actually need to go through a clinical usability test as part of the certification,” he said.

When GPs see the provider portal, they “love the interface”, he said. “The portal is a much better user experience than their GP software ...”

Dr Lim said different software vendors have implemented the system in different ways and some had made it easier to create a document than others.

“Providers have been finding it frustrating at some levels because of those software implementation issues, and again this is something that hasn't been uniformly implemented,” he said. “There has been quite a lot of variation in the way vendors have implemented it.”

Dr Lim said the main barrier to use in a practical sense had more to do with the quality of data within the clinical systems, rather than their look.

In October, NEHTA began recruiting general practices to participate in a questionnaire and face-to-face interviews as part of an assessment of the usability of the system.

“There have been anecdotal reports of usability issues relating to the integration of eHealth products in primary and community healthcare settings,” NEHTA wrote in a letter to practices.

“Currently, it is not clear what specific usability issues exist, what is causing them, how they are affecting clinical and administrative workflows, and how severe and widespread they are.”

However, it is understood that many of these issues were identified by clinicians during a review forwarded to NEHTA in May. Documents seen by Pulse+IT show that clinicians had raised concerns about the usability of the interfaces in that month, with a recommendation that clinical leads be consulted when new views to the different parts of the PCEHR were being built.

Posted in Australian eHealth

Comments   

# Peter MacIsaac 2013-12-18 06:04
A couple of comments:
1. My initial experience of the user interface in my GP vendor system (who shall remain nameless in the hope they might improve) has be awful. In the absence of a test facility for PCEHR (can you believe that!) I created my own live summary of my own health record (using what I believe to be best practice in the implementation of my product's ambiguous/optio nality laden approach to recording significant health care events such as problems, past history, procedures). The result was an event summary that was missing Current Medical Problems, contained a significant amount of non-summary information contained in problem notes, contained several paragraphs of meaningless technology related metadata, and finally managed to put the doctors home address and email on the document instead of the practices. Unusable, dangerous clinically and an assault on the doctors privacy.

On the viewing side I couldn't view the medicare or PBS data via the vendor interface (but could via the portal - go figure!).

These comments have been strongly fed back to the vendor (who informs me that these are addressed in the current update- so lets hope to see an improvement on this abysmal start). As a clinical informatician I can only weep at the lack of clinical IT expertise employed by some vendors and the failure of the PCEHR conformance and testing process to pick up such major shortcomings.

A nice touch was the SMS notification feature from PCEHR that a document had been uploaded to my PCEHR - with such genuine sophistication to enable concerned consumers personally monitor PCEHR use , do we really need the raft of personal controls that will inevitably delay uptake and contribute to failure of clinicians to engage.


The elephant in this room, in my opinion, is the likely failure of the dual opt in system (consumers and providers) coupled with highly manual data upload processes to allow a sufficient critical mass of data about any consumer to be created to make the system reliable as a healthcare delivery tool. The problem is not about missing information due to consumer hiding behaviour, it is that information will be missing due to patchy uptake driven by our national top down approach, and consumer engagement model.

As stated in the article, providers are not commenting on the system as there is no point in accessing it - official figures suggest a small percentage of the population registered and even fewer documents, and almost no clinical use or retrieval.

International experience, should we have sought lessons from really comparable countries,, is that Health Information Exchange occurs locally and is effectively implemented regionally. With regions federated to create a whole system.

Key socio technical requirements and international lessons on how to do healthcare information exchange have been generally ignored in the PCEHR design and implementation If you build it they will come, but it has to work and be meaningfully useful in some realistic timeframe.

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