REQUIREMENT GATHERING

FOR CUSTOMIZATION OF HP

EMR

INTRODUCTION

• Requirement Gathering is collection of a set of statements which

define what needs to be provided by a solution to meet the

expectations of the sponsor, stakeholders and users.

• The collection of requirements is obtained by interviews, RAP

sessions and/or workshops.

Requirements gathering is used in:

• Producing the business requirements.

• Producing the functional requirements.

OBJECTIVE

• To obtain suggestions regarding the customization of

EMR(developed by HP),for making it more user

friendly.

METHODOLOGY

• DATA COLLECTION:-

• Review of existing features of HP EMR and OPENEMR

• Feedback from doctors through questionnaire containing open

ended questions.

• Discussion with the doctors regarding the features of HP EMR.

• SAMPLE SIZE

• A target of 100 doctors was predicted, out of which 65 doctors

were approached.

CONTD…

• TOOLS AND TECHNIQUE

• SAMPLING TECHNIQUE:- Convenient and random

• TOOLS:- Questions were included from six concepts which were found

important for any successful EMR implementation

FOFOCUS AREAS

• Work flow management

• Specialist Screen variability

• Diagnosis

• Link with labs

• Connectivity to the IPD

• Offline availability

PRIORITIZATION OF REQUIREMENTS

Demand of

desired feature

HIGH

PRIORITY

MEDIUM

PRIORITY

LOW PRIORITY

WORK FLOW

MANAGEMENT

70%

SPECIALIST

SCREEN

AVAILABILITY

83%

DIAGNOSIS 63%

LINK WITH

DIAGNOSTICS

75%

CONNECTIVITY

WITH THE IPD

30%

OFFLINE

AVAILABILITY

77%

WORK FLOW MANAGEMENT

WORK FLOW VARIABILITY

BILLINGCOMPOSE NOTE

ORDER LAB MEDICATIONS AND CONSULTATION

INTERACT WITH PATIENT

REVIEW PATIENTS CHART

TASK FLOW FOR PHYSICIAN 1

TASK FLOW FOR PHYSICIAN 2

BILLINGCOMPOSE

NOTE

ORDER MEDICATIONS

REVIEW PATIENT CHARTS

ORDER LABSINTERACT

WITH PATIENTS

REQUIREMENTS

• Configured and customized implementation as per the task flow of

the physician.

• Automated to show which subtasks have been started and

completed.

• Minimum navigation of screens.

DATA ENTRY VARIATIONS

• Different physicians prefer different methods for entering notes

because of productivity issues.

• Dictations

• Use of tablet interface to enter data if the physician is not

comfortable with typing.

• The EMR system should be so designed so that it contains more of

selection by mouse click and minimal typing.

REQUIREMENTS

ACCESSING MULTIPLE PATIENTS

• Physicians examining several

patients in different examining

rooms loose ample amount of

time in logging out from one dept.

and logging into another.

• portable tablet EMR to minimize

the hassle to logging.

• Multi-patient navigation should

be implemented to reduce time

loss in High priority patient calls.

PRIORITIZATION OF REQUIREMENTS

Demand of

desired feature

HIGH

PRIORITY

MEDIUM

PRIORITY

LOW

PRIORITY

Configured

Implementation

52%

Data Entry

variation

78%

Accessing Multiple

Patients

32%

SPECIALIST SCREEN

• Physicians with different specialities need different functionality

and different information.

• Thus there should be speciality based customization.

Ophthalmologist

Obstetrician

Radiologist

Etc.

Patient visual information

Foetus record and

development

Image viewing screen

DIAGNOSIS

ENTERING SYMPTOMS

ISSUES AND REQUIREMENTS

• The symptom entry page shows only a single slot to enter the

symptom

• What if the patient comes with multiple complaints?

• The Doctor has to navigate to previous screen to enter other

complaints.

• Multiple or at least 3-5 symptoms entry slots should be there.

DECISION SUPPORT SYSTEM

Symptoms

1. Nausea

2. Tenderness in abdomen

3. Pain after meal

Suggested diagnosis

Cholecystitis

Its only a suggested feature, final decision is based on fine wisdom of the doctor

Suggested Diagnostic Tests

Ultrasound

Haematology with options.

These favours doctors adaptability and time saver

LINKS WITH DIAGNOSTICS

Uploading of laboratory tests and imaging data is

present.

laboratory tests and imaging data are carried in portable

devices.

CURRENT IMPLEMENTATION

Cloud linkage with diagnostics should be obtained.

Uploading should be done by the diagnostics section

based on patient ID number

REQUIREMENT

CONNECTIVITY WITH THE IPD

EMR IN IPD

• Tablet interface can be used for recording notes and vitals of the

in-patients. (data entered using patients ID number)

• Direct linkage between the physician screen and the ICU nursing

station should be there.

Doctor can monitor the vitals of his ICU patient while

sitting in his cabin.

Automated Alert generation, If the vitals range is

disturbed.

MEDICO-LEGAL REQUIREMENTS

MEDICO-LEGAL CUSTOMIZATION

• Separate link for medico-legal cases should be present which can

only be accessed by the physician.

• All entries must be done by the done from the physician log-in

only.

• Highly sensitive decision alert system should be implemented.

E.g. if medical problem entered by the doctor is “damaged spleen

and high blood loss”. And in vital registration b.p. entered id

120/80. system must generate a alert message to confirm the entry.

SECTORAL CUSTOMIZATION

Provision for adding parameters for menstrual

history, conceiving patterns.

Gynecological parameters are completely

avoided in the HP EMR and they should be a

part of it.

GYNAECOLOGIST

SECTORAL CUSTOMIZATION

Visual Analog Scale for pain management required

Separate format for orthopedic patients ORTHOPAEDICS

APGAR score tool required for evaluating

condition of new bornPAEDIATRICS

Neurological scale for higher function tests like

motor activity to be added

NEUROLOGIST

SECTORAL CUSTOMIZATION

Format for body composition analysis is needed

Disease classification must be as per ayurvedic guidelines

Terminology for examination and observation should be

as per ayurvedic system

Prognosis should be there to note down disease progress

AYURVEDA

OFFLINE AVAILABILITY

• While a purely online EMR sounds wonderful, intelligent offline

availability of these EMRs is critical ,where internet availability is

not reliable, and internet adoption (especially amongst senior

citizens) is not that high.

• Offline availability can be enabled through smarter software

designs, as well as storage devices such as CDs, USB drives, etc.

RECOMMENDATIONS

• Work Flow configurable EMR

• EMR should be linked to every stake holder of the

healthcare system

• Less typing, more clicking (generation of pool drop

boxes)

• Offline backup support

REFERENCES

• www.upassoc.org (JOURNAL OF USABILITY STUDIES)

• www.scoop.it/health-in-india

• www.infoway-inforoute.com

• Experience from the forefront of EMR use(case study)

• www.csu.edu/division/psc/pmguides/requirementgathering

“I keep six honest serving men

(They taught me all I knew);

Their names are What and Why and When

And How and Where and Who.”

...Rudyard Kipling.

THANK YOU