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E‐Health Centre: a web‐based tool to empower patients to become proactive customers

2004; Wiley; Volume: 21; Issue: 2 Linguagem: Inglês

10.1111/j.1471-1842.2004.00484.x

1471-1842

Yousif Mustafa,

Software Engineering and Design Patterns

Much inspiration can be derived from the concept of e-commerce in domains such as car rentals (http://www.Avis.com) and book purchasing (http://www.Amazon.com). In both cases, customers have the ability to reserve a car or buy a book via the Internet any time around the clock. Moreover, customers can view the book (in the case of Amazon.com), read a synopsis about the book and a biography of its author(s), and view what other readers thought about the book before making any commitment to buy. This customer empowerment concept was the motivation to look at the health care industry and raise the following questions: How much is known about physicians prior to selecting them to provide individuals with the care needed? Is it possible to ask other patients about their experience with a physician before accepting him/her as our primary physician or specialist? Is there valid and reliable information about the physician's practice and credentials? Is it possible to at least establish what they look like? Is it possible to call after midnight and make an appointment for next week? Can the physician be posed a question without the 30 min hold over the phone? Can the prescription be forwarded to the pharmacy that is most convenient? These and other questions prompted the development of an empowerment tool similar to the two mentioned above (Amazon.com and Avis.com). This paper presents the web-based system that was developed to empower patients and to enable them to act as proactive customers rather than passive patients. This work was done in close co-operation with a medium-sized medical centre in the state of Missouri. The centre is a county owned hospital that services county residents and its surrounding communities. It offers state-of-the-art technology and services with its medical staff specialized in various areas of medicine. The centre employs 15 physicians, 6 pharmacists, and 375 nurses, technicians and administrators. It receives approximately 1700 patients per month and houses over 109 hospital beds for in-patients. The centre offers outpatient, surgical and diagnostic X-ray services and will be referred to as the 'e-Health Centre' for the rest of this paper. Just like any other medical facility, the centre currently schedules appointments to patients manually via lengthy phone calls or in person. After providing the required care to their patients, physicians provide them with hard copy prescriptions, which must then be taken to a pharmacy to be filled. Physicians may also refer their patients to specialists as needed. After conducting a combination of work observation, a series of intensive interviews and an overview of published texts1-4 with potential users of the centre the following list of requirements resulted: Patients should be empowered by providing them with the knowledge and ability to select the physicians of their liking. Patients should be allowed to access the system day or night and schedule their own appointments via the Internet without spending precious time holding for a nurse or having lengthy phone calls. Physicians should be provided with the capability to e-mail prescriptions directly to any pharmacy convenient to their patients. The system should be compatible with end-user operating systems such as any Microsoft Windows or Apple operating systems. At all times there should be a guarantee of the privacy and security of all users' information, especially when sending prescriptions to a pharmacy over the Internet. The system must be easy to use, reliable and cost-effective Patients at home, or any location, with access to the Internet can browse through the home page of the e-Health Centre shown in Fig. 1. They may choose to learn about the e-Health Centre, register if they are not already registered (Fig. 2), or contact the e-Health Centre for any inquiry or comment (Fig. 3). The Home Page of the e-Health Centre. Patients can register with the e-Health Centre on-line and, in order to register, they would have to provide some basic registration information then choose a username and password as shown in New Patient Information Form in Figure 2. New Patient Registration Screen. If the patient is already registered, his/her username and password will be verified and the patient will be allowed to explore the different capabilities of the system. Patients may choose, for example, to browse through a list of physicians alphabetically or by specialty and select a physician. Upon selecting a physician, patients will be able, as shown in Figure 3, to view the profile and photo of the selected physician, contact him/her for any question or remark, ask him/her to e-mail a prescription (or refill) to certain pharmacy, write an evaluation about him/her or view the physician's calendar to make an appointment. Physician Screen. When selecting 'View Calendar', the tool will show a calendar where patients can choose any day of any month to make an appointment. The tool has the logic to distinguish between a working and non-working days and would prompt the user to select another day if the chosen day is a non-working one. After choosing a valid working day, a scheduling page similar to the one shown in Figure 4 displays the available time slots for the selected date for the selected physician. The patient will then select any available time slot and would receive confirmation e-mail at a later time. Figure 4 shows some greyed areas, which indicate that those time slots were taken by other patients or blocked by the physician. Physician's Available Time Slots Screen. Physicians or their nurses would be responsible for providing their biographies, personal photos, maintaining their appointment files, responding to patients' inquiries and sending prescriptions to any pharmacy of the patient's choice. Physicians or their nurses may also send confirmation or cancellation emails to the respective patients. The physician's interface screens will not be shown due to space limitations. The system development process, starting from analysis down to construction, was driven by the following factors: Providing patients with vital information about physicians in order to make an educated choice. In addition to basic information of academic and career credentials, patients can view other patients' experience with certain physicians. They can view issues such as bedside manner, prescribing too many medications, caring about patients and responding to their needs. In fact, conveying a patient's experience in such a public fashion over the Internet, and looking at his photo, is an empowerment in itself. Empowering patients to become customers by providing them with all the choices and capabilities, such as selecting a physician, selecting the time to make an appointment, choosing the location where they pick up their medications and conveying their experience to other patients. Involving some patients, nurses and physicians in the development process to ensure user friendliness and ease-of-use. Various design guidelines1, 2, 4-7 were used for all the interfaces. The e-Health Centre system was developed on a Microsoft platform using Microsoft SQL Server, Active Server Pages and Cascading Style Sheets and took about 13 weeks to be completed. With a change of this significance the e-Health Centre system will introduce a number of challenges but this paper will focus on the three most important: Cultural The system will break a long-lived taboo where patients are always passive. This system will break this taboo, empower patients and enable them to become customers exactly like those who purchase books from Amazon.com. They can browse through physicians' credentials, view other patients' opinion of any physician before choosing him/her as their physician. Physicians and patients have to be ready to accept and deal with this challenge. Rating a surgeon by her patients, then publicizing that rating over the Internet for the whole world to read is out of the ordinary to say the least. The e-Health Centre will provide patients with the choice of having their prescriptions forwarded to any pharmacy of their choice. Physicians and pharmacists will have to accept this cultural change and deal with it accordingly. Risks The system will store every user's username and password and only users with a valid username and password will be allowed to gain access to the system. However, there will always be an element of security and privacy risk associated with using the Internet just as the risk associated with buying or selling from eBay.com for example. There is always the possibilty that someone may post untrue or libelous comments about a physician. However, this is not unique to this system. Most companies with websites ask their customers or visitors: 'How do you rate us or our service?' and the same legal approach and measure should be implemented to the e-Health Center. Managerial Physicians will have to modify some of their operating procedures. For example, a physician has to provide a 2–3 month calendar of his available time-slots in advance and make it accessible to patients. Physicians must access the system frequently to respond to their patients' enquiries, or view patients' review. Pharmacists have to be prepared to alter their operating procedures also to accept prescriptions by e-mail. An electronic prescription will be just a regular e-mail message. An e-mail message is accepted as a legal document. Verifying the originality of an electronic prescription should be no different from verifying a paper prescription. Technical All potential users of the system are required to acquire some basic computer skills and patients must have access to the Internet. It is likely that most pharmacies in the country already have access to the Internet. Therefore, there is no need for any investment in acquiring new technology. For the e-Health Center, however, one technical support person will be required to maintain the database, trouble shoot and provide technical customer support. Initially, patients, nurses and physicians of the e-Health Centre showed a great deal of enthusiasm throughout the whole development process. The few who were selected to test the system were very excited. Physicians did not seem to be bothered by the fact that their credentials, career history, or patients' comments are public. They were concerned that the system would bring additional work. Nurses thought that the system would relieve them from answering phone calls, but also had concerns about the extra work. Patients were excited and looked at the system as an empowerment tool, which would have not materialized without the 'magic' of the Internet.