Re-Architecting Interoperability
e-Health ePoster Library. Keshavjee K. Jun 6, 2017; 167119; EP05.02
Dr. Karim Keshavjee
Dr. Karim Keshavjee
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Abstract
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Purpose/Objectives: A web-based form could potentially solve several issues that currently plague electronic medical record forms: 1) Forms cannot be updated each time a new discovery is published in the literature; 2) Version control is almost impossible with current forms; 3) Every physician has to update their own forms each time an update is required; 4) Data is not easily captured for analysis and reporting; 5) Clinical decision support cannot be provided within the form, decreasing the impact of decision support; 6) A/B testing, the most powerful tool available to web designers, is not available to EMR vendors, researchers and clinicians. We sought to design an architecture that will allow web-based forms to integrate into multiple EMRs, be used seamlessly by health care providers and that will allow data captured on the web to be returned to the EMR for medico-legal purposes.

Methodology/Approach: We used a user-centered design process to identify user needs. We then engaged in joint design sessions where mockups of the form were modified iteratively and in real-time to address user feedback. Once the mock-up was finalized, we developed a prototype of the form for further evaluation. We used the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire, a well-accepted and validated questionnaire, to assess user acceptance of the form and behavioral intent to use the form.

Finding/Results: Users (N=12) responded to questions on a 5-point scale. We aggregated the scores by calculating the % of respondents who Strongly Agreed, Agreed or Somewhat Agreed. If the % was greater than 66%, it was colored green. If greater than 33% and less than 66%, it was colored orange. If the % was less than 33, it was colored red. See Table 1. Overall, the form was considered easy to use (Effort Expectancy) and useful for completing clinical work (Performance Expectancy). More marketing and supports could enhance Social Influence and Facilitating Conditions for use of the form.

Conclusion/Implication/Recommendations: Creating and integrating a web-based form into multiple EMRs is feasible and can be created in a way that clinicians find interesting and useful. This new tool could support capture of standardized data across multiple EMRs, allow for the return of clinical decision support to the point of care and be easily updated when new knowledge is published in the literature. The form could also be used for advanced A/B testing for forms improvement and for improving the quality of clinical decision support.

140 Character Summary: New web-based form revolutionizes application of evidence-based medicine to electronic medical records. Time to re-evaluate our current approach to EMRs.
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