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EHR Persona Development Project

Delivering eHealth Ireland | Office of the Chief Information Officer #EHRPersonas #HSEMasterclass 1

Office of the CIO

National Electronic Health Record

Persona Development Project

April 2017



Introduction This document provides preparatory materials for the Healthcare Leadership Masterclass Persona Development Project workshop.

It provides background and context materials as well as an overview of the Persona and Scenarios. This document also provides links to the detailed Personas and Scenarios

At the Healthcare Leadership Masterclass, participants will join a table focused on one particular care setting and so are encouraged to focus their pre-reading on the care setting they intend to contribute to.

Table of Contents What is the National Electronic Health Record (EHR)? 3 What is the EHR Persona Development Project? 5 What will we do at the Healthcare Leadership Masterclass? 6 Acute Care Focused Persona 7 Community Care Focused Persona 8 Integrated Care Focused Persona 9 Paediatric Care Focused Persona 10 Mental Health Services Focused Persona 11



What is the National Electronic Health Record (EHR)?

The National EHR for Ireland has four primary components:

National Shared Record: A National Shared Record delivered through a national portal will contain key patient data drawn from the various operational solutions within the health service, e.g. from systems in hospitals, community services and broader population health information. It will aim to provide a longitudinal view of the patient’s care and enable collaboration among clinicians and care givers. It will support them in making better informed clinical decisions through a more comprehensive understanding of the patient. The portal is the key means of providing access to specific records to user groups such as patients, carers and healthcare providers. Clinical need will largely determine which user groups have access to relevant and appropriate information in a secure manner and respecting privacy concerns. Community Care EHR Operational Systems: Across the care areas within the Community setting (Primary Care, Mental Health, Health and Social Care Professional Services, Older Persons Services and Disability Services), the EHR will enable the delivery of efficient and effective care through the provision of supporting technology. Core capabilities include: Patient Administration and Scheduling that contains key patient demographics and care

information, allows appointments to be managed with greater efficiency, and enables referral management,

Clinical Notes that provide facilities for care givers to record structured patient care information are required in order to be able to create a record of care across disparate services,

Test results that enable care givers to view the outcomes of investigations conducted in different locations,

Population Health Management that facilitates screening and surveillance of patient cohorts to provide more proactive management of care,

Referral Management to allow care givers to securely and quickly refer patients along the continuum of care,

Mobile Clinical Management that facilitates the connectivity for remote working recognising that care is often given in different locations in the community, including in the patient’s home.

The National EHR represents a move away from the current version of health records that are predominantly paper based and tied to specific organisations such as your hospital or primary care team, to digital records that are easily and securely shared.



Key information must also be made available from these solutions into the National Shared Record in order to facilitate collaboration along the continuum of care.

Acute Care EHR Operational Systems: Within the acute hospital setting, dedicated ICT solutions are required to manage the delivery of care. These operational systems include core components such as: Patient Administration that contains key patient demographics and care information that

facilitates scheduling and referral management, Order/Communications that enable materials/tests/diagnostics to be requested and results

received, Clinical Notes that provide facilities for care givers to record structured patient care

information, Medicines management that enables the tracking of all medications administered to the

patient. Key information must also be made available from these acute solutions into the National Shared Record in order to facilitate collaboration along the continuum of care. Integration Capability: The integration capability provides the glue that binds the system together and ensures the security of the information being transmitted. It also enables integrated care pathways to be realised across care settings through information sharing and communication.



What is the EHR Persona Development Project? As part of the National Electronic Health Record (EHR) Programme, eHealth Ireland has been working with stakeholders from across the health service to develop a set of Personas and Scenarios. These Personas and Scenarios help make the National EHR real by describing patient journeys in relation to interactions with the health service through outlining who they interact with, why and the role that the EHR plays during this journey. The Personas and Scenarios focus on the future state in a world where there is a National EHR including a National Shared Record, an acute EHR operational system, a community EHR operational system and the integration to successfully transfer information across the various systems. The Personas and Scenarios have three main purposes:

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.

Communications and Engagement

The Personas and Scenarios help make the National EHR real by outlining how interactions will look and feel in the future. They will be valuable as part of the engagement and communication with clinicians, health service professionals and the public.

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.

There are two types of Personas and Scenarios: Patient Focused: They describe a patient’s journey in relation to a particular interaction

with the health service. It outlines who they interact with, why and the role that the Electronic Health Record capabilities play during this journey,

Health Service Professional Focused: They describe their typical activities during the workday and how these activities will be performed using the capabilities in the Electronic Health Record.

Over the past few months approximately 170 personas and scenarios, describing anticipated use of the National EHR, have been created by health service professionals, members of the public and patient advocacy groups. They have been gathered from various submissions, engagements and large-scale workshops, including events attended by over 500 care providers and members of the public.



These have been published, unedited, on the eHealth Ireland website: http://www.ehealthireland.ie/Strategic-Programmes/Electronic-Health-Record-EHR-/List-of-Personas-Scenarios-.html

The project team are currently working to consolidate the inputs into a finalised set of Personas and Scenarios that identify how the EHR will support care. The Personas and Scenarios focus on different care settings, including: Acute Care, Community Services, Integrated Care, Paediatric Care, Mental Health Services.

What will we do at the Healthcare Leadership Masterclass? Consolidated personas and scenarios will be discussed at the Healthcare Leadership Masterclass, with the view to further elaboration and refinement. A synopsis of each has been provided below, along with suggested discussion / elaboration topics. The full scenarios are also provided in this document. To ensure maximum value from the workshop it is recommended that you read your chosen scenario, and consider the suggested topics / identify potential scenario extensions, in advance of the workshop. Further information including the detailed scenarios are is available at: http://www.ehealthireland.ie/Strategic-Programmes/Electronic-Health-Record-EHR-/DG-Masterclass-Documents/Personas-Scenarios-Workshop-at-HSE-Masterclass.html

http://www.ehealthireland.ie/Strategic-Programmes/Electronic-Health-Record-EHR-/List-of-Personas-Scenarios-.html

http://www.ehealthireland.ie/Strategic-Programmes/Electronic-Health-Record-EHR-/List-of-Personas-Scenarios-.html

http://www.ehealthireland.ie/Strategic-Programmes/Electronic-Health-Record-EHR-/DG-Masterclass-Documents/Personas-Scenarios-Workshop-at-HSE-Masterclass.html

http://www.ehealthireland.ie/Strategic-Programmes/Electronic-Health-Record-EHR-/DG-Masterclass-Documents/Personas-Scenarios-Workshop-at-HSE-Masterclass.html



Acute Care Focused Persona

Overview and Summary

Persona Overview Summary of Scenarios Suggested Discussion / Elaboration Topics

Andrew Hart 70 years old Hypertension, MRSA carrier, allergic to penicillin

1 GP referral to Rapid Access Prostate Clinic; includes subsequent MDT review and pre-admission assessment

2 Subsequent planned admission for surgery; includes admission lounge, intra-operative care, PACU, transfer back to ward and subsequent discharge, then ongoing follow up in OPD

3 A year later an emergency admission with pneumonia (at a different Hospital Group) requiring a brief period in intensive care

— Is the described EHR usage appropriate? If not what would you change?

— Are there any other key EHR interactions that should be included in this patient’s journey? Why are they important?

— Would you change any of the clinical elements of the described patient journey? Are there any major gaps you would like to include?

Discuss items in the General Topics section in the context of this patient journey.

— What information from the RAPC and the MDT review needs to be for sharing across other hospital groups and care settings?

— How is the IPCOR/Patient Buddy app used? Any thoughts on how it could it be integrated with / complement the patient’s use of the National EHR?

— Is sharing a transfer of care summary enough after the patient has left ICU or should the detailed ICU record be available to other care providers within the hospital? Is there a use case for both?

The detailed Acute Care focused persona and scenarios can be accessed by clicking here

http://www.ehealthireland.ie/!903KMD



Community Care Focused Persona



John Malone 60 years old COPD, hypertension, overweight, poor circulation, MND

1 Exacerbation of COPD - cared for in the community, includes self-management

2 Development of cellulitis following a fall, with referral to the Community Intervention Team for management at home

3 Diagnosis of MND, community-based care and end of life planning




— Discuss items in the General Topics section in the context of this patient journey.

Discuss clinical governance and legal aspects of using the EHR to convey John’s end of life wishes / advanced directive for no mechanical ventilation support.

— Should this be directly entered into the National Shared Record and available across the care settings to both view and update?

— How will a viewer be assured that this is current / up-to-date information?

The detailed Community Care focused persona and scenarios can be accessed by clicking here

http://www.ehealthireland.ie/!1JBYPT



Integrated Care Focused Persona



Alice Murphy 68 years old T2DM, hypertension, high cholesterol, osteoporosis, CKD

1 Community-based integrated care for management of diabetes

2 Referred to the Community Virtual Ward for enhanced care at home when increased risk of hospitalisation is identified; subsequent admission following a fall but CVW enables early discharge

3 Low eGFR identified on routine screening requiring a referral to nephrology





— Is the clinical trial scenario appropriate? Would the Community Pharmacist need more than usual access to the EHR in this instance?

— How do you expect the national Renal system and the acute operational EHR in use across the rest of the hospital to interact?

— Alice has Hep B vaccinations in the acute setting and flu in primary care –should there be a consolidated list of adult vaccinations given across all care settings available in the National Shared Record?

The detailed Integrated Care focused persona and scenarios can be accessed by clicking here

http://www.ehealthireland.ie/!70458N



Paediatric Care Focused Persona



Paedar Kelly From birth to 6 years. Premature at 26/40, RDS, BPD, NEC, IVH Ongoing-CP, developmental delays, asthma, epilepsy

1 Neonatal care, which includes transfer from regional NICU to tertiary NICU then to NCH for surgery then back to regional NICU and subsequently home with community and hospital followup

2 Community based management of ongoing health issues and transition from pre-school to mainstream school

3 Emergency admission to a paediatric unit (where Paedar is not known) following a severe asthma attack





— NCH staff will use the acute operational component of the National EHR and the regional units at CUMH will use MN-CMS. What are the use cases for sharing information as Paedar moves between these organisations during the neonatal period – full record access?; summarised transfer of care records?

— Immunisations will be given by Regional NICU staff, NCH staff, Practice Nurse, PHN, etc., each of which may use a different operational systems (MN-CMS, community operational EHR, acute operational EHR, GP practice management system). There is also a national childhood immunisations system (NICIS). What is the envisaged staff interaction / information flow between these systems?

— Paedar’s asthma management plan is created in the GP practice system but it will need to be available outside the practice e.g. if Paedar presents to an ED. Do others involved in Paedar’s care need to be able to update the plan or will a view-only mode suffice outside the GP practice?

The detailed Paediatric Care focused persona and scenarios can be accessed by clicking here

http://www.ehealthireland.ie/!E5YC8H



Mental Health Services Focused Persona

Overview and Scenario

Persona Overview Summary of Scenario(s) Suggested Discussion / Elaboration Topics

Tom Clancy 21 years old History of recreational drug use. Family history of hypertension.

1 Has been feeling a bit anxious recently, been more tired than usual and has been having difficulty concentrating. Behaving strangely - attends GP who refers him to an Early Intervention Programme for First Episode Psychosis

2 Presentation at ED following self-harm. No admission required but follow up conducted by Community Mental Health Nurse

3 Treatment in ED following overdose, assessment and admission to the psychiatric unit





— Does any member of the team delivering this service work across acute and community organisations? If so are there any specific considerations with respect to EHR usage if separate acute and community systems are procured?

— What concerns/challenges are there around privacy of mental health related information and consent around who can access what information?

The detailed Mental Health Services focused persona and scenarios can be accessed by clicking here

http://www.ehealthireland.ie/!DBJ9VM


Delivering eHealth Ireland | Office of the Chief Information Officer #EHRPersonas #HSEMasterclass