Project Information

Process impact: The statement of user needs documents and explains the actual desires of stakeholders in roughly their own words. What they desire is never exactly what the product provides. Documenting user needs here, independently from the SRS, helps to keep the SRS precise and makes the tasks of verification and validation more effective. This document is not an informal draft of the SRS, it is different document with a complementary purpose.

Agreed Goals

The North Shore Mobile Health Network (NSMobile) and members of the development team had a series of discussions around their project and the potential overlap between their project and the BC electronic medical summary (e-MS) project.

An initial proposal was submitted to e-MS after further discussions. This was revised to align with the developing Primary Care IT strategy of Vancouver Coastal Health. The finalized proposal was submitted to the e-MS group and was approved for funding.

The goals are to:

• Design a modular framework for a technology assisted practice application suite that will support the stepwise migration of physician groups through quality improvement and IT adoption in primary care consistent with the Vancouver Coastal Health's Primary Care IT Strategy (Version 1.0).
• Implement the core electronic medical summary modules of this model as an open source platform with a local (vs an enterprise wide) solution
• Implement a server / conduit / PDA based medical summary viewer to support the documented needs and desires of the NSMobile to support full service family practice care with a focus on after hours shared care of high acuity patients.
• Provide additional tools to support the work flows of maintaining this information electronically as part of routine care. This would include:
  • Medication Management
  • Referral Management
• To provide additional communitcation tools that support delivery of shared care.
• Test these tools with members of the North Shore Mobile Health Network

 

Environment

What is the system's business environment?

Family Physicians provide the majority of patient care within their offices. They are supported by one or more staff, who may be Medical Office Assistants (MOAs), Clinic Managers, or Nurses.

Family physician's work together in a call group to provide after hours care. This care is provided either at another clinic or outside the bounds of a clinic setting. Care can be delivered at home, on the phone, in the hospital, or in a nursing home.

Care is shared between members of the call group such that a single physician typically covers all patients of each doctor in that group. To provide better care, each physician should have access to summary data for the patients that they are responsible for and have an integrated mechanism to communicate between physicians about the delivery of care.

What is the system's physical environment?

This system is a web server that will run on a machine in a co-located academic data center at the University of British Columbia's Department of Family Practice. There is 24x7 monitoring, air-conditioning, etc. Users of this system are typically at their offices.

Users will access the server either through an online desktop interface (multiplatform) or through synchronization with their Palm PDA.

Summary data and messaging will be available on the physician's PDA that will often be used while the user is on call.

What is the system's technology environment (hardware and software)?

 

 

 

 

Server Hardware: For this deployment the server will be a IBM dual XEON processor server with a SCSI RAID 1 array. It will be housed, securely, at UBC and connected to the UBC network.

 

Server Software: OS: Debian based linux distribution.

 

Client Machines:

 

Majority of physician offices use Windows PCs, although ~10% use Macintosh computers and very few run Linux on the desktop. These are, typically, older machines. In discussions with the North Shore Mobile Health Network core team, all run at least 800x600 screen resolution, and a high speed internet connection. OS: Windows 98 or above, Mac OSX, current linux distro. J2SE 1.4 installed.

 

PDA: Tungsten C has been standardized on for this release.

 

 

 

Wireless networks have been installed in each office to allow syncing of PDAs.

 

Home computers may also be used. These, typically, are newer Windows machines than what are found in the office. They will have the same limitations as the office machines.

Stakeholders / Actors

All

All stakeholders share the following key needs:

1. Secure and appropriate access to the web server
2. Convenient access to the site any time over the Internet

Physicians

Physicians need to have quick access to components of the system. The main job of a physician is to deliver care to the patient that is seeking care. That is, they deliver care to the patient in front of them. Anything that aids that delivery of care will be seen as a benefit. Anything that detracts from that care will not be used. This is particularly true of full service family physicians today as the time demands are increasing and the complexity of patients is increasing.

Many physicians are not technophiles. They may use technology at home (email, web, word processing) and for administrative functions (spreadsheets for the office) but technology has had little impact on the delivery of care.

Most physicians in our group will be comfortable with the use of a PDA.

Key needs:

1. Easily find information about patients
2. Use tools that save time
3. Not be burdened by excessive input of information that does not immediately improve the delivery of care
4. Have access to information when they need it

Medical Office Assistant (MOA)

Medical Office Assistants typically run the office and arrange most of the administrative flow of care. That is they schedule appointments, manage phone calls, faxes, lab reports, prescription requests. They also track consultations, pull charts, greet patients, bill for services rendered and manage call schedules.

Key needs:

1. Access to administrative workflows for the clinic and activities of the clinic.
   1. Follow through consultation letters
   2. Review Call Schedules
2. Ability to easily communicate to the physician around issues as they come up.
   1. Alert doctor of expired prescription
   2. Alert doctor of pending emergency / admission / house call
3. Some MOAs may be granted the ability to update core data in the charts, such as problem lists, etc.

Nurses

Currently there are few nurses or nurse practitioners in primary care, although this is changing. They will have similar needs, at a high level, to physicians. They cannot, however, prescribe medication.

Clinic Administrator / Manager

Some larger clinics have a designated clinic manager who will be more in charge of the running of the office, in smaller clinics this person may be the MOA. The Manager should be able to manage user accounts (add / deactivate users, reset passwords, etc).

Server Administrator

There will need to be a designated technology administrator who can manage the system. This person will need remote access, ability to back up, update, manage users, etc.

Notes from Interviews and Brainstorming

 

User Stories

Managing Patient Data

Dr. Bob sees a new patient in the office. Instead of managing a paper summary on the left hand side of the chart, Dr. Bob opens up TAPAS and adds a new patient. Once he documents the patient summary, he prints out a copy for the chart as well as prints out a prescription for the patient.

Reviewing Data on Call

Dr. Smith is called while on call on a Friday night. An elderly patient is calling and she is having an increased shortness of breath and cough. This patient is not managed by Dr. Smith, but rather she is managed by her colleague. While on the phone, Dr. Smith searches for the patient in her PDA and sees that she has a history of CHF and is 60mg of lasix and has puffers for her COPD. When asked, the patient states that she has run out of lasix two days ago.

Managing a Prescription

Mr. Buck Rogers, an 78 yo who is stable, but has had a previous heart attack, high blood pressure, and high cholesterol, attends the clinic. He is well, but needs refills for his medications before attending holidays back east with his family. Dr. Bob sees him and refills all of his medications. Using TAPAS, he taps "refill" for each medication and selects 60 days for each of the 8 medications and prints out the prescription. The patient's summary is automatically updated within the the system. Dr. Bob then prints out a summary for the patient to take with him on the airplane.

Making a Referral

Buck Rogers is experiencing some chest pain. It is likely cardiac, however, appears stable. A referral to a cardiologist is warranted: a quick note into TAPAS/Referral generates a comprehensive note, providing the cardiologist with meidcal history, medications, allergies, etc.

Performance and Capacity Needs

By the end of the first year of service, we should to reach the following system capacity:

• There will be about 50 users of the system: 17 physicians and 30 support staff
• There are approximately 1000 patients per physician, not all of which will be input into the system.
• Complete Medical Summaries are expected on approximately 5% of patients
• Limited summaries (Demographics, medications, allergies) may be available for the remainder of patients, depending on the IT group's abilty to automatically input patient lists from existing sources.
• Messages and patient flags will also be stored on the server. It is expected that no more than 2% of patients will have active flags and that users will have no more than 20 active messages each.
• PDAs will need to be synced (one for each MD) to the server.
  • It is expected that PDAs will be synced several times a day (typically, this will be 1/day, more when on call)
  • PDAs will store patient summaries, call schedule, messages, as well as local content in the form of Plucked web pages.