1. 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

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

3. 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.

4. 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.

5. 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

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

8. 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

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

10. 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.

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

12. 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

13. We’re done
A/Prof Chris Pearce