The presentation of a model of an electronic patient record system for use in general practice in South Africa

[摘要] English: Information drives the practice of medicine. Unfortunately physicians drown in theamount of information engulfing their day-to-day tasks. The invention of the patientrecord was the first step in trying to bring order to this situation. Numerous problems are,however, experienced worldwide with the manual paper patient records that have been inuse in medical practices for the past few years. The obvious answer to overcome theseproblems is an electronic patient record (EPR).In South Africa (SA) the EPR is not generally used, despite its well-known potentialadvantages. Focusing on general practice, a research project therefore was undertakento:�?Ascertain whether a need for EPR systems exists�?Identify problems associated with current paper medical records�?Identify the requirements, expectations, and needs regarding EPR systems�?Design and present prototype EPR systems for evaluation and testing by generalpractitioners (GPs) in SA according to their requirements, expectations, and needsas mentioned above�?Present the GPs of SA with a model of a proposed EPR system, specificallydesigned for their requirements, expectations, and needs.The results of questionnaires that were sent out indicated that the GPs in SA realised theneed for implementing computers in their practices. As in many parts of the world, theydo experience frustrating problems with their current manual systems. These include misfiledand lost files, difficulty in recording external work, the identification of old, unusedfiles, the durability and transferability of files, duplication, illegible/incomprehensiblefiles that become too thick too fast, and the physical storage space for these files. Thecomputer systems currently used in general practice focus mainly on administrative andfinancial duties, and there is a need to integrate these functions with clinical EPR's. TheGPs also gave an indication of the type of system they would consider implementing.Abstract 529Despite some problems that were foreseen, a clear impression was left that GPs believedin the concept of the EPR, that they definitely felt a need for it and that they would use it(personally), when available.Two prototype EPR systems were developed. The first prototype was demonstrated to agroup of GPs to get a general idea of the system's compliance with their requirements. Itwas further put to the test by applying heuristic and usability evaluation methods. Thelatter was done in conjunction with the paper and pencil observation technique. Theresults of these evaluation methods were analysed and applied in the development of thesecond prototype.After the completion of the second prototype EPR system, a third alternative, namely theHUB Medical Computer System (based on the Foresighted Practice Guidelines principle)was acquired. It was deemed important to test this as an alternative to the templateprinciple on which the first two prototypes were based. The second prototype and HUBwere evaluated in a hands-on laboratory evaluation. Similar evaluations techniques tothose applied to the first prototype were performed on the second prototype as well.Additionally the first and second prototypes were compared to each other with the aid ofa task analysis.The users identified positive aspects in the HUB system. The second prototype was,however, received with enthusiasm. By taking the evaluation results to heart and usingthe second prototype as basis, an EPR model was thus presented. Broadly viewed, thismodel involves a graphical user interface (accessed via mouse/keyboard) based on theTab-method, entering of consultations via the SOAP model, a query, report and printingfacility, customization, and communication with the health care environment via e-mailand medical protocols. In future EPR systems for GPs in SA could be based on thismodel.

[发布机构] University of the Free State