A UXD approach to patient information systems, e. g A UXD approach to patient information systems, e.g. Electronic Continuity of Care Record (eCCR) Robin Dyers (MBChB, MSc, FCPHM(SA) 03 October 2017

Objectives Illustrate the use of the unique identifier in the WC for retrieving patient details from the provincial PMI for a clinician-centric system Demonstrate a web-based interface for constructing discharge summaries which meet all current reporting requirements and aids the discharge workflow and sign off processes Demonstrate interoperability between Clinicom PAS and eCCR

Background - PMI | Patient information Names, Date of birth, Sex, National ID, Passport # Addresses (Geocoding in process thanks to Global Fund) Contacts Folder locations Meta data (e.g. # folders registered, last activity dates) Family relationships Births Mortality

Background: User Experience Design approach UX can be described as “all aspects of the end-user's interaction with the company, its services, and its products. The first requirement for an exemplary user experience is to meet the exact needs of the customer, without fuss or bother. Next comes simplicity and elegance that produce products that are a joy to own, a joy to use.…” - Nielson & Norman Group (UXD consultants for Apple)

Problem Statement (1) In 2011 local research showed that only 25%-40% of patients with chronic and infectious diseases such as TB arrived at PHC after discharge from hospital, I.e. Poor continuity of care Research also showed revealed > 150 different versions of discharge summary templates and fragmented discharge processes 2 key interventions: Leverage the PMI to track patients across the care continuum – Data harmonization project Digitize and standardize hospital discharge summaries - eCCR

Old “corporate consultative” model for development RESPONSE Finance Chief Directorate Pharmacists Primary Health Care Clinical Governance Junior Clinicians Senior Clinicians Districts Health Impact Assessment CEOs Clerks & Case Managers Hospitals Health Programmes Geographic Service Areas Information Management Pharmacy Directorate Operations Executive Committee GOVERNANCE COORDINATION IMPLEMENTATION NEED

User feedback from pilot phase Junior Clinicians: “easier discharge process, concise, integrated” Senior Clinicians: “quality of discharge letters has improved: clinical content, legible, coding coverage” Ward Clerks & Case Managers: “improved completeness of ICD coding”

Problem Statement (2) In 2015 WCGH deployed eCCR – a standard electronic discharge summary that caters for most clinical needs for general admissions However, there is high demand for ability to customize discharge summaries for specialised clinical areas, e.g.: Neonatology; Child Health; Maternity; Mental Health; Oncology eCCR uptake hindered at large hospital specialist departments due to the generic nature of summary the inability to customize dischargea summary fields the inability to do so flexibly in response to updates to clinical practice guidelines and needs Questions about legitimacy of user inputs

New user-centered approach New enhancement in response to the need for a tool to design/build your own summary builder templates. Designers should be able to create, name, edit, delete and save a new summary builder template. Interoperability with NHLS lab test results (Order Entry) Interoperability with appointment / booking systems Functionality within the eCCR that supports flexibility will be reused in the design of full EMR

Fields will be triggered by the logic in the Rules Engine

Templates fields will build on the familiar user experience of eCCR

Conclusion The PMI or HPRN can provide tangible direct benefits to patients by the harmonisation of clinical information and facilitation of continuity of care. However the success of designs around PMI / HPRN depend on: Responding to the complexity of clinical business processes Ensuring technical efficiency gains in business process re-engineering Providing end users with a voice and actively building its legitimacy Meaningful end-user engagement together with rigorous appraisal of their needs. The eCCR is an instantiation of an iterative action-reflection method for managing an evolving model for patient-centred care. eCCR’s method is the leverage point– not the software.

Discussion Acknowledgements Western Cape Public Health Data Centre Health Systems Technology Western Cape Global Fund team Centre for e-Innovation: Fiona Wilson Provincial Clinical Governance Committees Thank you Discussion