Year

2006

Degree Name

Masters of Information and Communication Technology (Research)

Department

School of Electrical, Computer and Telecommunications Engineering - Faculty of Informatics

Abstract

This thesis assessed the impact of the use of information technology (IT), specifically, electronic health records (EHRs), on general practitioners' (GPs') clinical work practices in NSW, Australia. The research framework and context was taken from EHR initiatives proposed by the Australian Commonwealth and State Governments for improving the Australian Healthcare system. A new system that provided increased access to electronic patient information was trialed in the Illawarra Region of NSW specifically utilizing a Smart ID Information System. The current research was administered under this larger project. The current research examined the Smart ID Information System (a pilot system designed to emulate EHRs) so the impact of EHRs on GPs' work practices could be considered. GPs work practices are hindered partially because Information and Communication Technology (ICT) infrastructure is not yet available to support them in their need to easily exchange patient information. Consequently patient clinical information is sometimes unavailable because it involves a labour intensive process to obtain that information. In solving the above problems with EHRs other problems are created such as positive identification of patients and their results and records. Also, issues of the threat to patients: privacy and confidentiality are enormous. The research question is therefore: how are GPs' clinical work practices impacted by the introduction of EHRs and associated unique patient identifiers (UPIs)? The research methodology was both a quantitative and qualitative inquiry which focused on two aspects of the Smart ID Information System project. It was broken into two parts plus supplementary results from a closely related study were used as secondary data. Firstly, a perception study investigated GPs' perceptions of current and future accessibility to patient clinical information and what their needs were, for acceptance of EHRs in general practice. This study was achieved through interviewing GPs. Secondly, an observation study investigated how the adoption of EHRs in the form of a pilot EHR system (Smart ID Information System) impacted on GP clinical work practices through observation of GP work practices. Results from secondary data were included here and discussed in the conclusion. Results of the perception study showed GPs agreed there was a problem with the exchange of patient information and the information flow between health service providers. The GPs were generally willing to use IT (via EHRs) to improve their work efficiency. They believed EHRs could help provide a solution, which overcame the existing problem of lack of patient information. The GPs were keen to increase the amount of information exchanged. Overall the idea of the Smart ID Information System as a pilot EHR system was well received by the GPs interviewed but the GPs highlighted the pilot EHR system implemented must be simple to use. Results of the observation study showed GPs successfully used the pilot EHR system within their consulting environment. The GPs proved they could successfully access the patient's record, integrate this access procedure and subsequent discussion of the information with the patient, into the consultation whilst maintaining their autonomy for their personal routine and work practices. The GPs found the access and consent procedure facilitated via the I-keys was quick and simple to use despite slow system performance. Both consultations in which the system was used were longer. Results of follow-up interviews from secondary data indicated GPs were willing to accept the technology knowing the benefits they would gain from its use. Of the GPs interviewed one GP thought consultations were longer, a second GP thought the length of consultations stayed the same. In conclusion the research found GPs agreed their work practices were hindered by inefficiencies due to non-availability of patient clinical information, and any system to improve this efficiency must be simple to use. EHRs (and UPIs) have minimal impact on GPs work practices and GPs studied were reasonably comfortable with the impact EHRs have on their work practices but this is only if EHRs do not significantly lengthen consultation times, such an EHR system runs efficiently, and excellent infrastructure is in place to support GPs. Results relating to consultation length with EHRs were inconclusive due to some consultations staying the same and some becoming longer. However, there is a possibility consultation length will increase with EHRs due to increased availability of patient information and dependency on prevailing technology. The current research involved a direct GP / patient relationship. Future research of EHRs in general practice could include an extension of the current research to incorporate an indirect GP / patient relationship. This is where significant benefits lie for GPs and patients from using EHRs. Another suggestion of future research could be the impact of EHRs and UPIs on the work practices of practice management staff, including receptionists and practice nurses working in GP's surgeries.

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