In New Zealand, your medical records are accessed like this. You go to your doctor, tell them your sick. They open a piece of software and add some information to your record.
However, almost all patients go to more than one healthcare institution. An average patient could visit a GP, the hospital, and a specialist. On top of that, there are records about you kept at institutions you might not think of - your pharmacy, and the labs which your GP refers you to. So the model actually looks more like this.
These records are considered medical records, and the software which manages them is an Electronic Medical Record System. These are not Health Records. The distinction is that these records only show a slice of your health - your GP doesn't know what your specialist knows, and they don't know what the hospital knows. All of the institutions only are seeing what information is relevant to their institution, not your actual health.
An Electronic Health Record, however, works like this:
All interested parties have access to a centralised record. This record takes the needs of all institutions into consideration, and you. This means it can be considered a health record, as it aims to assess your health from as many facets as possible (Amatayakul, 2009).
An EHR system is more than a storage system; it is a network. If you visit a hospital, they already have a list of medications you've been prescribed on hand. If you have to visit a different GP (say you're on holiday), they can just look up your record in the EHR system. Your records are accessible when and where you need them.
Practice Management Software
The software used in General Practices in New Zealand are categorised as practice management software (PMS). They deal with the day to day operation of the medical practice.
Their functionality includes an EMR system, but also appointment scheduling, invoicing, managing government claims, patient analysis, and more.
New Zealand has a few PMS products in usage, with MedTech32 holding the market majority:
MedTech32
MedTech Evolution
MyPractice
Profile (For Mac and Windows)
Indici (Web App)
Scope of research
The question I want to explore is, "What are the difficulties faced in developing healthcare software". However, the scope of this research is limited, due to time. So, I'm going to focus on a few specific areas:
EHR Systems. There are a lot of different categories of healthcare software, but I will be focusing my research on EHR systems.
Primary Care. New Zealand citizens mostly interact with Primary Care - General Practices, and Pharmacies. The alternative is Secondary Care - Hospitals, and Specialists. The majority of my focus is going to be on Primary Care, as that's where the majority of healthcare takes place.
New Zealand. It's much easier to design in a system I'm familiar with.
Finding research which fits all of these criteria is, well tricky. So this is not a strict scope. However, regarding my design output - it will be focused on these criteria.
Research Methods
To research this question I'm focusing on three methods - A cross-disciplinary literature review, qualitative, semi-structured interviews, and a survey (Martin & Hanington, 2012).
These research methods are most appropriate due to the scope of this project, and the scope of my output. Creating a practical EHR system would require years of time, lots of funding, and a team of programmers, designers, and medical professionals. Even if I could create a system, without backing and buy-in from institutions, it would get minimal real world usage.
So, what is the value of my thesis? The best use of my time is to: discover problems, and generate ideas. Unlike commercial vendors, I don't have the requirement to make a profit - so I can explore ideas and problems which may have been dismissed due to being financially unfeasible. Therefore, I picked my research methods with the aim of finding the unexpected and trying unique approaches.
Cross-Disciplinary Literature Review
Healthcare software exists at the intersection of many fields - software development, design, and healthcare. Beyond that, it bleeds into the fields of media theory, business, governance, and economics. So it only makes sense to approach my literature review from every discipline. There are many different ways to approach the problem of software for healthcare, so I wanted to review all approaches.
In a traditional thesis, at this point I'd summarise themes from my literature. However, as my medium is a website, I can approach this differently. My literature is spread throughout my entire design section, and I discuss specific works when appropriate.
All the literature reviewed is linked together on this index page, where they're organised by field.
Interviews & Survey
My primary user research method was semi-structured, face to face interviews. I used a semi-structured approach as I was specifically looking for topics I wouldn't have thought to ask about.
As additional user research, I performed an open-ended survey with 19 NZ GPs, which was a very effective way to discover major themes and complaints.
Both methods are discussed in further detail in the next section.
