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transcript
EHR Personas Workshop
Fran Thompson
Programme Director
Workshops – Dublin Castle
Tuesday 31st January and Wednesday 1st February 2017
#EHRPersonas #ehealth4all
Delivering eHealth Ireland | Office of the Chief Information Officer #EHRPersonas #eh2030
EHR Personas Development Workshop
Welcome to the workshop!
Sincere thanks to our partners for facilitating us here today
Delivering eHealth Ireland | Office of the Chief Information Officer #EHRPersonas #eh2030
What is the National Electronic Health Record?
The National EHR
comprises:
What does the National EHR do?
• Transforms patient experience
• Delivers greater patient safety and more
effective care
• Drives efficient delivery of health services
• Makes the wider reform programme
possible:
- Underpins integrated care
- Provides the information for
proactive health and wellbeing
initiatives
- Provides the operational systems to
realise CHO’s and Hospital Groups
- Captures accurate information on
activities that show the true cost of
treating a patient
!The National EHR is a fundamental cornerstone for the delivery of high quality,
comprehensive and accurate information in a timely manner for the provision of
patient centred, effective and efficient care
Pharmacy
GP Systems Private Hospitals
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The EHR Programme
Moving from paper records
locked in organisations to a
digital patient record shared
across care settings
4 Components
Examples:
• Order Communications /
Results Reporting
• Medicines Management
• Clinical Notesstems
Examples:
• Single MPI
• Scheduling
• Clinical Notes / Records
• Screening & Surveillance
National
Shared
Record
Community
Operational
Systems
Acute
Operational
Systems
Individual Health Identifier
The “glue” that binds all this together
and maintains integrity and security
across the system
eHealth Blueprint
National EHR Registries and Domains
Stakeholders
Clinical Management / Point of Care Environment
National EHR Integration and Access Layer
Communication Layer
Core Capabilities
I.A.A.A.Layer
Pro
vid
er H
ealt
h P
ort
al
National EHR RegistriesClient Registry Provider Registry Location Registry
National EHR DomainsMedical Imaging Laboratory Results Pharmaceutical
HistoryClinical Document
RepositoryEncounter History
Message Queuing
Message Data & Transformation
Message Encoding
Service Management
Identity Management
Authentication Access Secure Audit
Single Sign On Exception Handling Context Management Terminology ServicesRecord Locator Services
Orchestration ETL PrivacyCertification and Integration Toolkit
Secure Messaging
Logging
Immunization History
Infectious Disease History
National AnalyticsPerformance Management
Population Based Analytics
Business Intelligence
Registration
National eHealth Blueprint
Healthcare Providers Patients Corporate Administrators and Managers
Legitimate Relationship Services (LRS)
Corporate Setting
Fin
an
ce M
an
age
me
nt
Pro
cure
me
nt
Hu
ma
n R
eso
urc
es
and
P
ayro
ll M
anag
eme
nt
Ass
et M
an
age
me
nt
Hea
lth
& S
afe
ty
Co
ntr
act
Man
age
men
t
Faci
litie
s M
ana
gem
ent
Ro
ste
rin
g Ti
me
Re
cord
ing
Pro
gram
Man
age
me
nt
Cu
sto
mer
Re
lati
on
ship
M
ana
gem
ent
Consumer Health & Wellbeing
Pat
ien
t to
Pro
vid
er
Secu
re M
ess
agin
g
Self
-Hea
lth
M
ana
gem
ent
Sch
edu
ling
and
A
dm
inis
tra
tio
n
Nat
ion
al P
atie
nt
Po
rtal
Vir
tual
Car
e
Edu
cati
on
&
Aw
are
ne
ss
Community Healthcare Organisations
Pat
ien
t A
dm
inis
trat
ion
Ca
se M
anag
em
en
t
Elec
tro
nic
Do
cum
ent
Man
age
men
t
Clin
ical
No
tes
and
Re
cord
s
Pat
ien
t T
est
Re
sult
s
Ca
re P
ath
way
s an
d D
eci
sio
n
Sup
po
rt
Ref
err
al M
ana
gem
ent
Mo
bile
Clin
ical
Ma
nag
em
en
t
Po
pu
lati
on
He
alth
M
ana
gem
ent
Co
mp
ute
rize
d P
hys
icia
n O
rde
r En
try
eP
resc
rib
ing
Hospital Groups
Ho
spit
al P
atie
nt
Ad
min
istr
ati
on
Ho
spit
al M
ed
ical
Imag
ing
Ho
spit
al L
abo
rato
ry
Ho
spit
al P
har
ma
ceu
tica
ls
Ca
se M
anag
em
en
t
Dis
ease
Man
age
me
nt
Ca
re P
ath
way
s an
d D
eci
sio
n
Sup
po
rt
Co
mp
ute
rize
d P
hys
icia
n O
rde
r En
try
Ref
err
al M
ana
gem
ent
Po
pu
lati
on
He
alth
M
ana
gem
ent
Elec
tro
nic
Do
cum
ent
Man
age
men
t
eP
resc
rib
ing
Elec
tro
nic
Clin
ical
No
tes
and
R
eco
rds
The Individual Health Identifier
Programme is a key enabler that
allows information to be shared about
a patient
PharmacyGP Systems
Private
Hospitals
Other healthcare providers will
access and contribute to the National
Shared Record through the
Integration Capability
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Transformation – Not an IT Project!
The National EHR implementation is not considered an IT
programme but is being approached as a broader change
and transformation journey
It is a clinically led programme because the National EHR
is a crucial element that will help deliver new models of
care and greater standardisation of care processes and
pathways
The National Electronic Health Record is
not a large IT project!
Delivering eHealth Ireland | Office of the Chief Information Officer #EHRPersonas #eh2030
The EHR Persona Development Project
Why develop Personas?
Communications and
Engagement
The Personas and Scenarios help make the National
EHR real by outlining how interactions will look and feel in
the future. This will be important as part of clinician, health
service worker and citizen engagement and
communication.
Requirements
Development
The process of engaging with stakeholders to create the
Personas and Scenarios helps to develop and deepen the
set of National EHR requirements in a way that is
meaningful for all stakeholders. The approach also takes
a more holistic view of overall outcomes required.
Managing
Supplier
Engagement
The Personas and Scenarios can be used as part of
managing the engagement with potential suppliers. They
provide a consistent set of cases through which suppliers
can illustrate functionality and showcase how they can
achieve the outcomes that will address some of our
existing challenges
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Personality
Primary Care Persona Example
7
John O’Brien
John at a Glance
• Age: 60
• Location: Sligo
• Family Status: Married
with 4 Children
• Education: Leaving Cert
• Employment Status:
Self Employed
BioJohn is a 60 year old self-employed carpenter. He likes to spend time with his family which
includes using technology to keep up with his children and grandchildren. John doesn’t pay too
much attention to his own health and wellbeing.
Extrovert Introvert
Organised Disorganised
Emotional Rational
Health StatusJohn smokes about 1 pack of cigarettes a week. He describes himself as being reasonably
healthy but he rarely goes to see a doctor for check-ups. Sometimes he has shortness of breath.
Whenever he is sick, he’s not good at following treatment regimes.
GoalsHe wants to stay healthy without having to make major adjustments to his lifestyle.
Frustrations/FearsHe doesn’t like interacting with the health service and is very protective of his personal healthcare
information.
Technology Broadband Access Smartphone/
Tablet
Low High
Tech ComfortLow High
Internet Usage
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Primary Care Scenario Example
8
Actors:Citizen (John O’Brien), GPs (Dr. Mooney & Dr. Wilson), Pharmacist, Radiologist, Consultant
Scenario: Patient Diagnosed with COPD
John O’Brien, 60, sees his family GP, Dr. Mooney, for the first time in over four years. To this point in his life, John has rarely gone to the
doctor but over the last two years he has been suffering from a persistent cough with intermittent episodes of shortness of breath.
Dr. Mooney accesses his practice system and carefully reviews the history of his present illness, as well as John’s past medical, family and
social history. He discovers John has a 45 to 50 pack per year history of smoking. Upon completion of the examination, Dr. Mooney’s
presumptive diagnosis is COPD (chronic obstructive pulmonary disease). Using his practice system, (which is integrated with the EHR), Dr. Mooney
creates and sends an electronic referral request for a chest x-ray and an electronic referral request for pulmonary function tests at the local hospital.
Finally he prescribes a short-acting B2 agonist inhaler and counsels John to stop smoking. Dr. Mooney records all of the findings from this visit in the
practice system.
Later in the day, John goes to the pharmacy and purchases his inhaler.
John also goes to the Diagnostic Imaging department of the local hospital and gets his chest x-ray done. The radiologist views the image later that day
and creates a report indicating findings consistent with COPD.
Three weeks later, John attends his appointment for pulmonary function tests at the hospital outpatient department. The test is interpreted the next day
by a consultant who finds evidence of obstructive airway disease and creates a report.
Unfortunately, John really enjoys smoking and is not convinced it is related to his breathing problems. As a result, he continues to smoke. He finds the
inhaler difficult to manage so he rarely uses it. A few months later, John develops an upper respiratory tract infection (URTI). His cough and breathing
worsen significantly so he returns to see Dr. Mooney accesses John’s results for the tests he had ordered and prescribes an antibiotic and two types of
inhalers. John goes to a different pharmacy than he used previously but only gets the antibiotic prescription filled.
Ten days later John is in a small town in a neighbouring county visiting family. His breathing and cough have not improved so he goes to a local GP, Dr.
Wilson. The assistant in the clinic uses information provided by John to create a new profile linked to his Individual Health Identifier (IHI). Dr. Wilson tries
to access John’s summary health record from the national health portal but is denied access saying the patient has restricted access to his health data.
John has a choice to whether to allow Dr. Wilson access to his Electronic Health Record. John grants access to Dr. Wilson via a consent tracking
service. Dr. Wilson is now able to access John’s Electronic Health Record and obtains a list of his five most recent encounters with the health system.
Using this information along with her own examination, Dr. Wilson feels there is bacterial resistance to the antibiotic prescribed, along with non-
compliance using the inhalers. She prescribes a different antibiotic and counsels John on using his inhaled medications.
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Primary Care Scenario Example
9
Actors:Citizen (John O’Brien), GPs (Dr. Mooney & Dr. Wilson), Pharmacist, Radiologist, Consultant
Scenario: Patient Diagnosed with COPD
John O’Brien, 60, sees his family GP, Dr. Mooney, for the first time in over four years. To this point in his life, John has rarely gone to the
doctor but over the last two years he has been suffering from a persistent cough with intermittent episodes of shortness of breath.
Dr. Mooney accesses his practice system and carefully reviews the history of his present illness, as well as John’s past medical, family and
social history. He discovers John has a 45 to 50 pack per year history of smoking. Upon completion of the examination, Dr. Mooney’s
presumptive diagnosis is COPD (chronic obstructive pulmonary disease). Using his practice system, (which is integrated with the EHR), Dr. Mooney
creates and sends an electronic referral request for a chest x-ray and an electronic referral request for pulmonary function tests at the local hospital.
Finally he prescribes a short-acting B2 agonist inhaler and counsels John to stop smoking. Dr. Mooney records all of the findings from this visit in the
practice system.
Later in the day, John goes to the pharmacy and purchases his inhaler.
John also goes to the Diagnostic Imaging department of the local hospital and gets his chest x-ray done. The radiologist views the image later that day
and creates a report indicating findings consistent with COPD.
Three weeks later, John attends his appointment for pulmonary function tests at the hospital outpatient department. The test is interpreted the next day
by a consultant who finds evidence of obstructive airway disease and creates a report.
Unfortunately, John really enjoys smoking and is not convinced it is related to his breathing problems. As a result, he continues to smoke. He finds the
inhaler difficult to manage so he rarely uses it. A few months later, John develops an upper respiratory tract infection (URTI). His cough and breathing
worsen significantly so he returns to see Dr. Mooney accesses John’s results for the tests he had ordered and prescribes an antibiotic and two types of
inhalers. John goes to a different pharmacy than he used previously but only gets the antibiotic prescription filled.
Ten days later John is in a small town in a neighbouring county visiting family. His breathing and cough have not improved so he goes to a local GP, Dr.
Wilson. The assistant in the clinic uses information provided by John to create a new profile linked to his Individual Health Identifier (IHI). Dr. Wilson tries
to access John’s summary health record from the national health portal but is denied access saying the patient has restricted access to his health data.
John has a choice to whether to allow Dr. Wilson access to his Electronic Health Record. John grants access to Dr. Wilson via a consent tracking
service. Dr. Wilson is now able to access John’s Electronic Health Record and obtains a list of his five most recent encounters with the health system.
Using this information along with her own examination, Dr. Wilson feels there is bacterial resistance to the antibiotic prescribed, along with non-
compliance using the inhalers. She prescribes a different antibiotic and counsels John on using his inhaled medications.
+
Background
Typical interactions or activities
How the EHR will be used
Outcomes
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Workshop Overview
Instructions and examples are provided
Within your table:
Self-select a person to act as the scribe for the table and a person to act as
the table coordinator
First develop the view of the Persona
The Persona should be representative of a typical person in terms of demographics and
attitudes
Create two Scenarios that are set in a future where the National EHR
capabilities that are proposed have been introduced
focus on conditions that impact on large numbers of health service users
focus on a typical set of activities that the person would do during their working day
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Conclusions
Feedback and queries
Email to follow with short feedback survey
Next steps
Outputs from today will be written up and contribute to the final
Personas and Scenarios
Personas and Scenarios will be published online by May 2017
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Conclusions
Follow progress of EHR Personas
Website: www.ehealthireland.ie/personas
Templates are online if you wish to contribute to further Personas and
Scenarios
Facebook: eHealth Ireland
Twitter: #EHRPersonas, @eHealthIreland
Email: Fergal.Marrinan@hse.ie
Council of Clinical Information Officers
Email: ccio@ehealthireland.ie
Website: www.ccio.ie
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Conclusions
Many thanks for your
participation today
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