E-collaboration for healthcare (Telemedicine / E-prescribing)

1. Fellowship Week # 11 E-collaboration for healthcare(Telemedicine / E-prescribing) 15th of August, 2010 ITI Smart Village Sunday Week 4 Information Technology Institute

2. Agenda E-prescribing Guidelines, Forms & Tools Inpatient vs. Outpatient Roadmap Healthcare professionals Training and Community Final Project Groups HCI Google Virtual Clinical Practices Conclusion – Assignment + Groups + Course Overview 2 hours 2 hours 2 hours Information Technology Institute

3. Prescription • Medication errors • Inpatient and outpatient • Prescription forms • Tools overview • Challenges and Issues • Requirements Information Technology Institute

4. Preventing Medication errors • www.youtube.com/watch?v=pCjn_aiy8sI • www.youtube.com/watch?v=1HYnK0pgESk&feature=related • www.youtube.com/watch?v=yUDqm6Vsq48&feature=related Information Technology Institute

5. Comparison • Inpatient • Outpatient Information Technology Institute

6. Prescription forms • Ain Shams Hospital • Drug sheet • Doctors order Information Technology Institute

7. Tools • Open EMR: http://www.oemr.org/modules/cjaycontent/index.php?id=19 • Blue Claw: http://www.blueclaw-db.com/prescription_drug_programs.htm • Ezscriptwriter, Doctors Desktop, infoRxMed • National ERX, RCOPIA, epocratesrx • Practice FusionBlue Fish and (PF)4MedicaMedic AidOEMRQuicdoc pocketRx1sequelmed Clinic gate… etc. Information Technology Institute

8. Tools (cont.) DrFirst: • Patient eligibility, formulary, medication and pharmacy fill history • Drug-drug interaction, allergy and duplicate alerts • Integrated with more than 20 EHR vendors • Ability to integrate with practice management (PM) program or EHR • Ability to renew multiple medications at same time • Availability for PDAs, Smart phones, BlackBerrys and iPhones • Optional service to create an interface for EHRs, practice management programs or demographic upload of information Information Technology Institute

9. How are they certified? Vendors are certified based on • several services • e-prescribing, • e-refills, • Rx history, • eligibility and • formulary. Many Vendors are certified only for e-prescribing and e-refills at this point. (pharmacy connected) Information Technology Institute

10. Summary RxHub • created in 2001 by three of the leading pharmacy benefit manager (PBM) organizations: AdvancePCS (acquired by Caremark), Express Scripts, and Medco Health Solutions. • These organizations are responsible for funding and administering drugs on behalf of insurance companies and employers in order to control costs. • RxHub creates another network between physicians and pharmacies to route patient medication histories (based on claims data) and pharmacy benefit information to physicians. SureScripts • founded in 2001 by the National Association of Chain Drug Stores • (NACDS) and the National Community Pharmacists Association (NCPA) to improve the quality, safety and efficiency of the overall prescribing process. • Strongest motivating forces behind this collaboration was the need to reduce the number of call backs by pharmacists. • Largest network to link electronic communications between pharmacies and physicians, allowing the electronic exchange of prescription information. Information Technology Institute

11. July 2008 Surescripts & RxHub Information Technology Institute

12. E-prescribing Obstacles and Issues (killer?) • Adoption rate is low. • Physicians are reluctant to pay because they believe pharmacists and PBMs benefit more from eRx. Physicians don’t want to lose time learning to use a new system. • Test electronic prescribing standards prior to final adoption • Many EHR e-prescribing programs lack decision support, they still only generate a paper script or one that can be faxed to a pharmacy. Information Technology Institute

13. E-prescribing Obstacles and Issues (killer?) • E-prescribing or eRx will eventually be part of all EHRs. In 2007 the Certification Commission for Healthcare Information Technology (CCHIT) • E-prescribing is slower than paper scripts, but not when you factor in time spent calling back pharmacists or playing “phone tag” • Still no federal laws require e-prescribing. • e-prescribing or add incentives to improve adoption? • Most authorities at this time have an attitude of cautious optimism. Information Technology Institute

14. E-prescribing Accuracy (requirements) • Activity reports: patient specific information • Allergy data: drugs and other agents • Available drug listing: formularies specific for patients • Drug reactions and interactions • Drug /allergy /drug interactions • Drug/food / herbal interactions • Drug reference • Drug reports: patient medication history • Eligibility check: Insurance eligibility • Favorite prescription list Information Technology Institute

15. E-prescribing Accuracy (requirements) C. • Generic medication listing • Global pharmacy list, last office visit • Practice Pharmacy (favorite) list • Patient schedule • Patient Sharing: other physicians seeing patient • Patient demographics: age, gender, others. • Pharmacy search • Prescription report: all drugs physician (s) prescribed • Rapid medication entry (character recognition system • Renewals / Refills: available for each patient • Referrals: from and to physician entering data Information Technology Institute

16. Guidelines • NHS Guides: http://www.warringtonandhaltonhospitals.nhs.uk/page.asp?fldArea=7&fldMenu=4&fldSubMenu=1&fldKey=982 • Guidelines: http://www.scotland.gov.uk/Publications/2006/08/23133351/18 • Repeat Prescription Form: https://secure10.yourwebservers.com/zetlandmedicalpractice-co-uk/prescriptions.asp Information Technology Institute

17. Electronic prescribing and HIPAA privacy regulation • Safe medication management, personal health information, information privacy and security. • Health Insurance Portability and Accountability Act of 1996 (HIPAA) limit the sharing of health information over distributed computer networks. • HIPAA, future electronic prescribing systems will be designed to encourage clinically appropriate, networked sharing of patient health information. Information Technology Institute

18. What are we doing? Let’s check our roadmap Information Technology Institute

19. Roadmap Collaboration Communication skills, Problem solving Teamwork Ergonomics HCI Web 2.0 tools E-research Information Technology Institute

20. Human Computer Interaction • What is Interaction Design? • Examples of bad HCI • What is usability, any challenges? • How to design content considering HCI factors? • Open up your blogs (as a sample) • Online Free Course Information Technology Institute

21. Agenda: HCI Why? 02: How to design? 03: What? 01:

22. 01: What is Interaction Design? • What is ID? Designing interactive products to support people in their everyday and working lives • Sharp, Rogers and Preece The design of spaces for human communication and interaction • Winograd • Why ID? Develop usable products • Usability means easy to learn, effective to use and provide an enjoyable experience Involve users in the design process

23. 01: What is HCI? • The Association for Computing Machinery (ACM) defines HCI as…. ‘a discipline concerned with the design, evaluation and implementation of interactive computing systems for human use and with the study of the major phenomena surrounding them’ • The British HCI group defines HCI as…. ‘a multidisciplinary field concerned with the application of computer science, psychology, ergonomics and many other disciplines in industry and commerce. Its goal is to facilitate the design, implementation and evaluation of information and communications systems that satisfy the needs of those who own and use them’

24. 01: Multi disciplinary HCI? Cognitive psychology Social & organisational psychology Human Factors/ Ergonomics Computer Science Engineering Artificial Intelligence HCI Design Linguistics Anthropology Philosophy Sociology

25. 01: HCI Overview? ENVIRONMENT Processing Responding Sensing HUMAN/S Displays Controls COMPUTER/S Operation

26. 02: Why do we need HCI? • Because bad design is easy…….. Examples • Because many advantages can arise from the study/application of HCI…….. • Because industry wants people with good HCI knowledge/skills • Because good design leads to usability • Learnability: is it easy to learn? • Efficiency: once learned, is it fast to use? • Memorability: is it easy to remember what you learned? • Errors: are errors few and recoverable? • Satisfaction: is it enjoyable to use?

27. Examples of poor design “Misleading” "Photograph courtesy of www.baddesigns.com"

28. Examples of poor design Conflicting icons "Photograph courtesy of www.baddesigns.com"

29. Examples of poor design Misuse of colour Image courtesy of Interface Hall of Shame http://www.iarchitect.com/mshame.htm

30. Examples of poor designPoor message design Image courtesy of Interface Hall of Shame http://www.iarchitect.com/mshame.htm

31. Examples of poor designPoor consideration of cultural factors Image courtesy of Jakob Nielson, Designing Web usability (2000)

32. Examples of poor design Touchscreensin cars!

33. Examples of poor design Poorly designed

34. 01: What’s wrong with the toy?

35. 02: How do you open the toothpaste?

36. 03: What’s wrong with the toy?

37. 04: Why doesn’t the cap fit?

38. 05: Course – What’s next? Click Here Read More Click Here Click here… Click Here

39. Benefits of HCI • Increased product sales • Increased user satisfaction • Decreased customer support costs • Decreased development costs

40. Benefits of HCI (in relation to IT systems in the workplace) • Increased user productivity • Increased user satisfaction • Decreased employee turnover/sick leave • Decreased training costs • Decreased maintenance costs

41. Some common fallacies with HCI/Human Factors (Pheasant, 1986) • The design is satisfactory for me - therefore, it will be satisfactory for everybody else • This design is satisfactory for the average person - it will, therefore, be satisfactory for everybody else • The variability of human beings is so great that it cannot possibly be catered for in any design - but since people are wonderfully adaptable it doesn’t matter anyway

42. Some common fallacies with HCI/Human Factors (cont…) • Human Factors (HCI) is expensive.. • …and since products are actually purchased on appearance and styling, Human Factors considerations may conveniently be ignored • Human Factors (HCI) is an excellent idea; I always design things with this in mind - but I do it intuitively and rely on common sense

43. HCI in the 21st century • How can we understand user-system interaction when the technology is used… • .. by an increasingly diverse user population • .. with increasing functionality • .. in more diverse environments

44. What is usability? • Usability: The extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use ISO 9241 - Ergonomics requirements for office work with visual display terminals (part 11 - guidance on Usability) -1998

45. What is usability? • Usability depends on who the users are: • Need to know users and characteristics • Usability depends on what the users’ goals are: • Need to know what users need/want to do (tasks) • Usability depends on where users carry out their tasks: • Need to know the environmental context (social/ organisational and physical)

46. What is usability? • Usability can be measured: • Effectiveness = achievement of goals (e.g. success/failure rates) • Efficiency = resources utilised in achieving goals (e.g. errors, time) • Satisfaction = comfort, acceptability (e.g. ratings)

47. Usability measures Effectiveness • The extent to which a user’s goal, or task is achieved • Assessed by examining users’ successes/ failures with product, e.g. • % of tasks/sub-tasks completed • Ratio of successes to failures

48. Usability measures Efficiency • The amount of effort required (resources expended) to accomplish a goal • Assessed by examining: • Time on task • Workload (physical and mental) • Deviations from critical path • Error rates

49. Usability measures Satisfaction • The comfort and acceptability of use • Assessed by measuring: • subjective ratings of ‘ease of use’ (absolute and/or relative) • ratings of utility of functionality • likes and dislikes, etc.

50. User-centred design Testing Design Requirements Environment Equipment - early focus on users and tasks - empirical measurement - iterative design - participatory design Task User