Tuesday, July 05, 2016

This Is An Interesting Review Of The Progress Made In My Health Record Usability. A Desperately Sad And Incompetent Saga.

I had missed this page when on the NEHTA site or maybe it is a new page from ADHA. Not sure.
Anyway it makes for interesting reading

Usability Improvements

PCEHR means the My Health Record, formerly the "Personally Controlled Electronic Health Record", within the meaning of the My Health Records Act 2012 (Cth), formerly called the Personally Controlled Electronic Health Records Act 2012 (Cth).
By operation of the Public Governance, Performance and Accountability (Establishing the Australian Digital Health Agency) Rule 2016, on 1 July 2016, all the assets and liabilities of NEHTA will vest in the Australian Digital Health Agency. In this website, on and from 1 July 2016, all references to "National E-Health Transition Authority" or "NEHTA" will be deemed to be references to the Australian Digital Health Agency.
When GPs began using the My Health Record system, they identified some usability issues within their vendor software that were impacting workflow, and some of the digital health features of their software were not as intuitive as originally hoped.

Clinical Usability Programme (CUP)

The Clinical Usability Programme (CUP) was established in 2013 to develop recommendations on how current and future general practice software vendors implementing the Agency specifications within their products might improve the usability of digital health functionality. CUP recommendations have been developed in close consultation with general practice users and clinical stakeholder groups. The recommendations are primarily aimed at GP software vendors, but can be used by software developers more broadly where they think their users will benefit.
Version 1.0 of the usability recommendations (Release 1) were issued in November 2013, with a subsequent updated version 1.1 (Release 2) issued in May 2014. These releases resolved the GP usability concerns that had been raised in relation to displaying My Health Record information on the screen, providing clear wording around clinician responsibilities for uploading Shared Health Summaries, and providing clear indication whether the patient has an active My Health Record.
In December 2015, version 1.2 of the usability recommendations (Release 3) were made available, giving vendors guidance on how to enhance their software through the use of prompts and reminders, as well as allowing GP users to customise and configure their My Health Record system interactions.
Version 1.3 is now available. This release gives vendors guidance on recording adverse reactions, specifically around the use of clinical terminology for recording a reaction type. Minor amendments and new recommendations were also included to make the recommendations clearer and easier to understand. An additional set of mock-ups have been developed to provide a visual representation of the CUP guidelines around the recording of adverse reactions.
Click on the following links for a visual representation of the CUP recommendations:
A number of software vendors are working on making usability enhancements to their software. Clinicians can check whether their software vendor has incorporated usability recommendations here. Alternatively, contact your software vendor to find out how and when they plan to incorporate usability recommendations into their product.
Please provide usability feedback by submitting the form as below:
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This is really an amazing saga where NEHTA has spent over two years trying to work out how to make the PCEHR / MyHealth record usable for clinicians.
In this process they have simply ignored the underlying conceptual flaw of building a system which was parallel to the present systems used by GPs, which adds work to their day and which distorts their workflows – while providing an unreliable source of information.
Usability should have been worked out before system implementation – not been an afterthought.
Another reason why it is vital that NEHTA’s errors be properly addressed in a planned and thorough and properly researched way! It is interesting to note just how few of the vendors have adopted the recent recommendations for improvement. Might it be they know they are simply putting lipstick on a pig?
Guess I am dreaming again.


Bernard Robertson-Dunn said...


"...they have simply ignored the underlying conceptual flaw of building a system which was parallel to the present systems used by GPs, which adds work to their day and which distorts their workflows – while providing an unreliable source of information."

That says it all. The pity is that they probably still don't understand the deep truths in that statement.

john scott said...

David, the basic tenets of the PCEHR, as you point out, are increasingly being called into question.

'Truth' happens to a 'New Idea' as it demonstrates its value. Further, the 'Truth' of a 'New Idea' is a bit like money; money is trusted until someone refuses to take it.

We poured in over $1 billion to demonstrate the 'truth' of the PCEHR idea.

The Opt-In model demonstrated very little support for the PCEHR.
The absence of vendor development activity is arguably an expression of declining confidence in the PCEHR as a basis for ROI.

We need a 'New Idea' to replace the PCEHR. This 'New Idea' must be able to demonstrate how it will deliver apparent value to all stakeholders.

A key component of that 'apparent value' would be that it enables and supports workflows--workflows that operate within and across clinical, organisational, jurisdictional as well as public/private boundaries. We can't support the management of patients with chronic conditions absent this capability.

The new Australian Digital Health Agency, in my opinion, would be well-advised to provide a channel for exploration of what might usefully take the place of the PCEHR. This would be with a view to salvaging as much as possible and providing both a new narrative and a transition pathway. Time is running out.