1. Drop Box Drop Box Drop Box Drop Box Drop Box
Drop Box
Drop Box
Drop Box Drop Box
Drop Box
Free text for clinical note taking
Free text for clinical note taking
Free text for clinical note taking
Free text for clinical note taking
Free text for clinical note taking
SRQ response displayed
SRQ response displayed
SRQ response displayed
SRQ response displayed
SRQ response displayed
SRQ response displayed
Free text for clinical note taking
1 month 13 months 16 months0 month Estimated 24 months
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Background
Electronic patient data capture is becoming increasingly common
within clinical settings.
Integrated electronic health record (IEHR) is computer software that
combines practice management software with electronic health
records to harness patient self report data and enhance clinical note
taking.
Benefits include better quality patient care through improved progress
tracking and the ability to review treatment outcomes.
Objective
The case study addresses the process to implement IEHR in a
university exercise physiology teaching clinic with the aim to embed
research in practice and thereby improve student learning and patient
outcomes.
Methods
1. Procured new practice management software that includes IEHR.
2. In collaboration with university academics and a medical specialist,
a team of exercise physiologists wrote condition-specific protocols to
identify health information and outcome measures that met clinical and
research needs.
3. A local designer created images of multiple clinical interfaces using
graphic design software. The designer was guided by clinician
feedback around usability of layout.
4. A database expert was consulted throughout the building phase to
enhance existing software features and create new functions.
Discussion
An accompanying study involved three staff and fifteen students who
were interviewed on the benefits and disadvantages of adopting IEHR.
Descriptive words used by participants allowed feedback to be
categorised as ‘positive’, ‘negative’ or a ‘potential issue’.
Figure 3. Example clinical interface for Post Cancer Fatigue that is predominantly
clinician input with patient self-report responses displayed next to corresponding
questionnaire items.
Patients
complete self
report
questionnaires
prior to
consultation
and responses
are displayed
on the interface
6. The new IEHR system has been configured for data to be entered
by clinicians during consultations with patients
Results
5. The new IEHR system has been configured for data to be entered
via web-based questionnaires, accessed via a patient portal
Patients can
select from the
questionnaires
the clinician
has allocated to
them.
Figure 2. Example questionnaire completed via a secure web portal.
Figure 1. A) Flow chart demonstrating the iterative process behind designing and
building IEHR. B) A timeline of the process that exceeded expected durations.
A)
Graph 1. The proportion of staff and student feedback that were ‘positive’, ‘negative’
and ‘potential issues’ of implementing IEHR in a university exercise physiology
teaching clinic.
Table 1. Anticipated advantages most frequently reported by staff and students.
Table 2. Anticipated disadvantages or potential issues reported by staff and students.
Adoption of IEHR was supported by staff and students who perceive
more advantages than disadvantages and potential issues.
Implementing these systems in practice is resource intensive, but has
considerable potential to communicate and enhance clinical practice.
B)
1. Zandieh, S. et al., (2008). J Gen Intern Med23: 755-761.
2. Westbrook, J. et al., (2009). BMC Health Services Research 9: 201.
1 month 4 months 6 months0 month 9 months
Expected timeframe
Actual timeframe
It is anticipated the new IEHR system will allow:
• students to readily access patient health
information via tablets that will inform and
develop their clinical decision making in
practice.
• patient access to targeted health education
resources and their own progress data
accessible via their individual online patient
portal, which may enhance treatment
compliance and outcomes.
• clinicians to better track progress of patient
groups to evaluate and improve practice, and
to engage in clinical research.