5 EXPECTED OUTCOME
Upon completion of this doctoral research we hope
to have developed and tested a series of software
applications suitable, as defined by potential users,
for use within NHS paediatric ophthalmic care.
Although we hypothesise the chosen user-
centred methodology will produce both useful and
useable software, further work will be required upon
completion of this research to assess the suitability
of the outputs when integrated into the “real world”
NHS information system. Hence a secondary
outcome of this research will be the provision of an
evidence base to guide future software development
within the field. This evidence base will provide a
description of current clinical practices within
paediatric ophthalmology to which comparisons and
suitable evaluations may be drawn following health
information technology implementation in this
environment.
6 STAGE OF RESEARCH
Our national survey identified 7.8% of the paediatric
ophthalmic clinicians who responded (N=7 of 90)
used EMRs for the majority of their paediatric
patients. However, 64.4% reported prior experience
using an EMR. These individuals with previous
experience (N=58) were significantly more like to
identify ‘difficult-to-navigate system designs’
(69.0% vs 41.4%, P=0.013), ‘poor user interface’
(62.1% vs 34.5%, P=0.015) and ‘inability to
integrate EMR with other clinical IT systems’
(67.2% vs 31.0%, P=0.002) as barriers but
‘improved communications with patients’ (43.1% vs
18.8%, P=0.020) as a benefit of routine EMR use.
Overall, participants most frequently identified
‘software functionalities not meeting clinical needs’
as the biggest barrier (25.3%) with the biggest
benefit cited being ‘increased document legibility’
(23.2%), whilst 3.33% perceived no benefit at all.
Therefore, despite the movement to universal
EMR-adoption in the NHS, routine use within
paediatric ophthalmology is uncommon and more in
keeping with uptake in paediatrics (Leu 2012) than
general ophthalmology (Boland et al. 2013) in other
countries.
This initial research indicates there is a great
need for a user-centred approach, to identify and
align EMR software with clinical needs, overcoming
the largest perceived barrier of users. Accounting
for such user perceptions throughout the subsequent
design phase of this research is more likely to ensure
the product overcomes barriers challenging use and
delivers the benefits valued by paediatric ophthalmic
clinicians.
Additional, more in depth insights from
interview and clinical observational data will be
combined with these results to define EMR
requirements for paediatric ophthalmology,
considering both user-defined and user-observed
factors as is important in successful UCD
(International Organisation for Standardisation
2010). This will complete the first, exploratory
phase of the doctoral research. Next software will be
iteratively developed and tested against the user-
centric requirements, to assess the success of the
methodology for EMR development within
paediatric ophthalmology set in the NHS
information system.
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