The ‘Face’ of the Electronic Health Record in the triadic consultation Associate Professor Christopher Pearce Professor Michael Bainbridge The computer is now an integral part of medicine and influences every action in our relationships with patients – indeed that is why we have this conference. We seek to not only preserve the human side of medicien, but make sure the digital assistants enhance it. Social Roles Usability Technical

Hospital: This is an example of a hospital system – one familiar to many of you

Ambulatory And this an example of an Australian general practice system – one of the popular ones. What they have in common is they are based on the formats of the old paper systems – whilst attempting to bridge to the computer age.

Triadic Consultation We now have a true triadic consultation. With three agents having different agendas and different roles. We have democratised data, shifted power, and enabled new forms of care. But to do so we need to better understand the ‘face’ of the computer – the presentation it makes in our interactions – and today we shall do so under four headings – the social constructs – the many new roles (beyond the paper ) that computers occupy, the all important useabiliuty and workflow aspects, and finally the technical.

Patient Clinician Computer Self Care Self Learning Communication TV Clinician Self Learning Co-ordination Communication Collaboration Quality Assurance Network Computer Knowledge Support (Decision & Education) Communication Facilitation Co-ordination / Monitoring of care interventions Quality Assurance Health record “History” taking

Social theory Goffmann and the dramaturgical Habermas and system vs personal Don’t spend too long on this – will bore them

Roles (a realist view) Context Mechanism Outcome In assessing the roles of software, over and above recording of patient information, and existing framework looked at these roles

Role Hierarchy Identify person Clinical Care Coordinate and Integrate Care (Clinical Governance) Population Care Research and Evaluation Policy and Strategy Administration and Billing.

Useability Data is created by workflow and also destroyed by workflow Those who create the data should be able to use the data ‘Big Data’ is nothing more than lots and lots of little data Data is created by workflow, and also destroyed by workflow. This is an example of bad data – unstructured, uncoded.

Technical Data Structures (free text, structured, coded etc). Coding – SNOMED terms and expressions. Enhanced decision support

Coding Wars Terminologies Classifications Standards OXIMS, RCGP, Read 123, SNOMED etc. Classifications IDC9, ICD9CM, ICD10, ICPC, LOINC,OPCS etc. Standards CEN TC251 ENV13606, HL7 V3 RIM Difference in purpose Not mutually exclusive

We’re done A/Prof Chris Pearce drchrispearce@mac.com Twitter @ChrisMP