The following abstract appeared a little while ago.
Ensuring Clinical Utility and Function in a Large Scale National Project in Australia by Embedding Clinical Informatics into Design
Authors: Christopher Pearce, Cecily Macdougall, Michael Bainbridge, Jane Davidson
Pages : 28 - 32
DOI 10.3233/978-1-61499-289-9-28
Abstract
Across the globe, healthcare delivery is being transformed by electronic sharing of health information. Such large scale health projects with a national focus are a challenge to design and implement. Delivering clinical outcomes in the context of policy, technical, and design environments represents a particular challenge. On July 1, 2012, Australia delivered the first stage of a personally controlled electronic health record – a national program for sharing a variety of health information between health professionals and between health professionals and consumers. As build of the system commenced, deficiencies of the traditional stakeholder consultation model were identified and replaced by a more structured approach, called clinical functional assurance. Utilising clinical scenarios linked to detailed design requirements, a team of clinicians certified clinical utility at implementation and release points.
Here is the link:
The full paper is downloadable from the same page.
The discussion I found particularly interesting.
Discussion
CFA and clinical safety
As outlined in the introduction, the difference between CFA and clinical safety needs to be emphasised, especially as clinical safety is often assumed to encompass function. Clinical safety within NEHTA has a wide ranging brief that encompasses all aspects of the program, from health identifiers, to technical document reviews. Members of the clinical safety team were part of the CFA team, which allowed discussions on the tradeoff between safety and utility to be resolved and presented in a unified way. It also allowed safety to be involved in the user interface design issues, an area often overlooked.
Outcomes
The decision to conduct CFA testing was determined during the design closure period. A worldwide search was conducted as to how other programs were conducting clinical functional assurance at the level we were. Significantly, there appeared to be little literature around the concept, and contact by the team with other large programs confirmed the absence of similar programs. The most significant input was sourced from the UK and its Business Impact Matrix. The use of functional assurance was limited in many of the other programs investigated. Most areas focused on Clinical Safety.
CFA embedded clinicians, particularly those with informatics experience, in all aspects; detailed design work, assessing specifications, and monitoring build. Without CFA and its
functional assurance, the experience of the PCEHR naïve clinicians during User Acceptance Testing (UAT) would not have been as worthwhile. Conducting CFA prior to UAT minimised the risk to Go-Live. Testing the delivered system also identified potential problems for software providers who will be designing systems to deliver into the PCEHR.
The development of the CFA by the Australian program takes large-scale program development to a new level of assurance. The preparation for CFA works in collaboration with clinical leads, the business analysts, and the technical testers. The process itself is led and conducted by clinical leads, and at the end of the day, clinical leadership can assure that the system delivers as intended, and patients can be reassured.
Acknowledgments
All of the authors worked on the PCEHR program during the development and implementation, and would like to thank all of the team involved in the PCEHR program.
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As I read this the authors seem to be suggesting that they have and have applied a process called ‘Clinical Functional Assurance’ (CFA) that has resulted in a PCEHR that is working as intended.
They also point out that the came rather late to the design, build and delivery process.
My problem is that while the system may be working as intended it is not working - as far as I can tell - to meet the needs of either clinicians or patients at present so one is left wondering just what this process has delivered.
To suggest ‘clinical utility’ and function has been delivered is rather a stretch I believe.
This is rather confirmed by the recent poll of GPs conducted by Australian Doctor.
Most doctors reject e-health record system as 'white elephant'
- by: Fran Foo
- From: The Australian
- July 16, 2013
A VAST majority of doctors continues to shun the government's $467 million e-health record system, with about 58 per cent saying they would never participate in the scheme.
Some have warned that the opt-in, personally controlled e-health system, designed as an online summary of people's health information, risks becoming a white elephant.
Patients decide who can gain access to their e-health record and it allows them to view and control information added to their record by doctors or other healthcare professionals.
Patients rely on their GPs to create shared health summaries - which include diagnoses, allergies and medications - in the system.
More than a year after its launch, doctors are still resisting using the PCEHR because of several factors such as security and privacy concerns.
Their views were reflected in survey when the members-only Australian Doctor magazine canvassed the views of its subscribers for PCEHR participation rates.
About 58 per cent of respondents said they would never take part in the scheme and will not be promoting its use to patients.
Around 29 per cent said they would be taking part but have yet to write a health summary.
Only 6 per cent have written health summaries for the PCEHR.
Seven per cent said they would not be personally taking part, but colleagues in their practice were.
Australian Doctor's online poll comprised 514 participants.
Lots more here:
The view that things have not actually worked out seems to be supported by the recent departure from NEHTA by the lead author of the paper.
What do others make of the paper?
David.
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