Workflow in General Practices Dr. Urooj R. Khan Introduction 1. - - PowerPoint PPT Presentation

The MyHealthRecord Impacts On Patient Workflow in General Practices

• Dr. Urooj R. Khan

Introduction

• 1. PCEHR/MyHR been live for more than five years
• with over $1billion investment
• experienced slow progress in adoption
• now have 9 out of 10 Medicare patients registered

500000 1000000 1500000 2000000 2500000 Shared Health Summaries uploaded in MyHR (2013-2018) 3091 23000 66505 144,605 893,530 2,298,105 Jun-13 Dec-14 Dec-15 Jun-16 Jun-17 Dec-18

Introduction

• 2. GPs are the most consulted health services…

2009 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18 Proportion of Persons (%) Saw a general practitioner 80.8 81.6 80.9 81.1 82.2 82.9 81.9 82.5 84.3 Saw GP for urgent medical care na na na na 9.9 9.8 8.5 9.3 9.3 Saw an after-hours general practitioner na na na na 8.1 8.7 8 8.4 8.5 Received a prescription for medication(a) na 68.9 68 67.9 68.9 70.6 68.5 68.3 69.7 Saw a dental professional na 49.4 48.6 49.4 49.7 48.9 48.2 48.1 50.1 Saw a medical specialist na na na na 36.2 38 36.4 36 37.4 Had a pathology test(b) na na na na 53.4 55.6 55.5 55.3 57.3 Had an imaging test(c) na na na na 37.4 38.3 37.5 37.8 39 Admitted to hospital 13.2 12.8 12.8 12.9 12.8 13.5 12.7 12.6 12.5 Visited hospital emergency department 13.2 13.6 13.7 13.6 14.3 14.6 13.5 13.8 14.3 Saw three or more health professionals for the same condition na na na 16.3 16.1 17.7 16.3 16.7 17

Experience of health services in the last 12 months and comparison with past years, persons15 years and over (ABS, 2018)

Introduction

• 2. On average people are seeing their GPs more now as

compare to 10 years ago..

Primary care services Total number of services (million) Average number of services per person Change over 10 years GP 148 6 18% Allied Health 71 3 43% Dental 46 2 No trend data

Use of primary healthcare services in 2016–2017 (AIHW, 2018)

Introduction

• 3. Population trends….Our population is growing ….

Population Growth rate (ABS, 2018)

Introduction

• 3. Population trends…. we are living longer..

Life expectancy (years) at birth by gender, 1881–1890 to 2014–2016 (AIHW, 2016)

Does that mean ….more GP visits, more workload and need of better way to manage patient care?

Introduction

• 4. MyHealthRecord and General practices
• GPs are the main contributors of health summaries
• Digital disruption in their patient workflow
• Considered culturally complex for any change management (Willis

et al., 2014)

• Out of 85% of signed-up general practice, only 16% participating in

MyHR (DOH, 2015)

Introduction

• Why ?
• Systematic literature review (past five years papers published in

10 journal databases) conducted but no answer !

• May be MyHR tasks are too complex ?
• Or may be it takes too long?

Method

• Qualitative Case Study research design
• Survey, Interviews and Observations
• Surveys findings from wide range of general practice users (271)

were presented last year in the 7th International Conference on Health Information Science (HIS 2018).

• This presentation brings results of interviews and observations.
• 10 general practices based in Victoria involved, engaging

GPs, practice administration, nurses and patients.

• 20 observations of SHS uploads during GP/patient

consultation

Findings

• Some general findings about participant clinics

(2017)

• Small-to-medium size service-based, mixed

private/corporate ownership, busy and complex

• rganizations with limited resources
• Similar patient workflow with clinical information system,

MD / BP

• Implemented PCEHR using ePIP during 2013-15, but

commenced using MyHR after PIP 2016 policy change

• Causing digital disruption with effort expectancy

believed to be higher than performance

Findings

• MyHR adoption status in participant case studies (CS)

No Use CS3 Low Use CS2 Limited Use CS4, 6, 7, 9 Towards ‘Regular’ Use CS1, 5, 8, 10

• MyHR Integration approaches
• GP
• Administration  GP
• Administration  nurses
• Administration  GP  nurses

Findings

• Patient workflow review (Interviews)

7 1 2 9 1 1 8 1 6 4 WORKABLE NOT WORKABLE NOT SURE Reception involvement Idea of MyHR triggers GP role in MyHR uploads Idea of GP/Nurse shared responsibility

Findings

• Training, Policies, Procedures, Roles and Manuals Updates (Interviews)

2 7 1 3 4 2 7 1 2 8 2 8 1 1 YES NO UNKNOWN Updated role descriptions Policies defined Procedures reviewed Training delivered User manual / handouts

Findings

• Users Engagement Improvement (Interviews)

Practice Management GP & Nurses Patients MyHR System Operator Incentives and Education Requests to upload

Findings

• GPs/Patients experience with MyHR Interaction (Observations)

6 14 2 8 8 2 4 9 2 5 1 10 6 3 2 4 6 8 10 12 14 16 Excellent Good Neutral Poor Worst Observations Usability Rating Easy to use Easy to remember System response time Screen switching time

Findings

• MyHR Upload process and time consumed (Observations)

1 1 2 3 1 1 1 8 1 1 2 3 4 5 6 7 8 1 2 3 CS1 CS2 Observations TIme Consumed (minutes)

Conclusion

• It is the present vague / adhoc procedures, resulting in MyHR time-

consuming views and limited adoption just to satisfy funding criteria.

• But even in this situation of limited adoption, benefits of information

accessibility were noted …

• More attention is needed towards structured approaches of
• rganisational change management and users engagement approach

for this and any DH solution implementation in these organisations….

Limitations

ACT NSW NT QLD SA TAS VIC WA SHS uploaded 1.0% 24.4% 23.8% 16.1% 5.4% 0.9% 15.5% 12.8% GPOs 1.1% 35.2% 2.2% 20.7% 6.3% 1.8% 23.3% 9.3% Consumers 86.7% 90.2% 93.6% 91.2% 89.3% 90.3% 89.3% 90.4%

• Research limited to the state of Victoria
• Pragmatic consideration of time and resources
• Victoria is 1 of the 4 major contributors of health summaries
• 89.3% of consumers and 23% of general practices participation

May 2019 Statistics

drurkhan@outlook.com