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 2,298,105 2500000 2000000 1500000 893,530 1000000 500000 144,605 23000 66505 3091 0 Shared Health Summaries uploaded in MyHR (2013-2018) 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 na na na na 9.9 9.8 8.5 9.3 9.3 care Saw an after-hours general na na na na 8.1 8.7 8 8.4 8.5 practitioner Received a prescription for na 68.9 68 67.9 68.9 70.6 68.5 68.3 69.7 medication(a) 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 13.2 13.6 13.7 13.6 14.3 14.6 13.5 13.8 14.3 department Saw three or more health na na na 16.3 16.1 17.7 16.3 16.7 17 professionals for the same condition 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 Average number of Change over 10 years (million) services per person 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 organizations 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) • MyHR Integration approaches No Use Low Use • GP CS3 CS2 Administration GP • Administration nurses • Towards Administration GP nurses • ‘Regular’ Limited Use Use CS4, 6, 7, 9 CS1, 5, 8, 10
Findings • Patient workflow review (Interviews) Reception involvement Idea of MyHR triggers GP role in MyHR uploads Idea of GP/Nurse shared responsibility 9 8 7 6 4 2 1 1 1 1 0 0 WORKABLE NOT WORKABLE NOT SURE
Findings • Training, Policies, Procedures, Roles and Manuals Updates (Interviews) Updated role descriptions Policies defined Procedures reviewed Training delivered User manual / handouts 8 8 7 7 4 3 2 2 2 2 1 1 1 1 0 YES NO UNKNOWN
Findings • Users Engagement Improvement (Interviews) MyHR System Operator Incentives and Education Practice Management GP & Nurses Patients Requests to upload
Findings • GPs/Patients experience with MyHR Interaction (Observations) 16 14 14 12 10 10 Observations 9 8 8 8 6 6 6 5 4 4 3 2 2 2 2 1 0 0 0 0 0 0 0 Excellent Good Neutral Poor Worst Usability Rating Easy to use Easy to remember System response time Screen switching time
Findings • MyHR Upload process and time consumed (Observations) Observations 8 3 2 1 1 1 1 1 1 1 2 3 4 5 6 7 8 1 2 3 CS1 CS2 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 organisational change management and users engagement approach for this and any DH solution implementation in these organisations ….
Limitations • 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 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%
drurkhan@outlook.com
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