JMIR Publications

ABSTRACT

Background:

Longitudinal, patient-centered care represents a challenge for general practices. Decision support and reminder systems can offer targeted support.

Objective:

Following a user-oriented, step-wise approach, we developed an add-on for German electronic health record (EHR) systems which aims to support longitudinal care management of multi-morbid seniors using a visualization strategy. This study evaluated the prototype’s feasibility from both a technical and users’ perspective.

Methods:

The study was conducted with 18 general practitioners (GP) and practice assistants (PA) from nine general practices using a mixed-methods approach. In all practices, one GP and one PA tested the software each for four multi-morbid seniors. Technical feasibility was evaluated by documenting all technical problems. To evaluate the feasibility from the users’ perspective, participants’ responses during the software test were documented. Also, they completed a self-administered questionnaire including the validated system usability scale (SUS). Data were merged by transforming qualitative data into quantitative data. Analyses were performed using univariate statistics in IBM SPSS statistics.

Results:

From a technical perspective, the new software was easy to install and worked without problems. Difficulties during the installation occurred in practices lacking a 64-bit system and/or a current version of Microsoft.Net. Because EHRs used in German practices do not provide an interface to extract the data needed, additional software was required. Incomplete visualization of some laboratory data occurred although this function was implemented in our software as shown in previous tests. From the users’ perspective, the new add-on provided a better overview of relevant patient information, reminded more comprehensively about upcoming examinations, and better supported guideline-based care when compared to their practice-individual strategies. Fourteen participants (77.7%) were interested in using the software long-term. Eight of nine GPs were willing to pay 5 to 25 Euros monthly for its use (14.75±5.93). The usability was rated as 75.3% (42.5%-95.0%).

Conclusions:

The new EHR add-on was well accepted and achieved a high usability measured by the validated SUS. Perspectively, the legally consolidated, standardized interface to German EHRs will facilitate the technical integration. In view of the high feasibility, we plan to study the software’s effectiveness in everyday primary care. Clinical Trial: German Clinical Trials Register, unique identifying number: DRKS00008777 (date of registration: 06/19/2015)