The presentation of a model of an electronic patient record system for use in general practice in South Africa

English: Information drives the practice of medicine. Unfortunately physicians drown in the amount of information engulfing their day-to-day tasks. The invention of the patient record was the first step in trying to bring order to this situation. Numerous problems are, however, experienced worldwide with the manual paper patient records that have been in use in medical practices for the past few years. The obvious answer to overcome these problems is an electronic patient record (EPR). In South Africa (SA) the EPR is not generally used, despite its well-known potential advantages. Focusing on general practice, a research project therefore was undertaken to: • Ascertain whether a need for EPR systems exists • Identify problems associated with current paper medical records • Identify the requirements, expectations, and needs regarding EPR systems • Design and present prototype EPR systems for evaluation and testing by general practitioners (GPs) in SA according to their requirements, expectations, and needs as mentioned above • Present the GPs of SA with a model of a proposed EPR system, specifically designed for their requirements, expectations, and needs. The results of questionnaires that were sent out indicated that the GPs in SA realised the need for implementing computers in their practices. As in many parts of the world, they do experience frustrating problems with their current manual systems. These include misfiled and lost files, difficulty in recording external work, the identification of old, unused files, the durability and transferability of files, duplication, illegible/incomprehensible files that become too thick too fast, and the physical storage space for these files. The computer systems currently used in general practice focus mainly on administrative and financial duties, and there is a need to integrate these functions with clinical EPR's. The GPs also gave an indication of the type of system they would consider implementing. Abstract 529 Despite some problems that were foreseen, a clear impression was left that GPs believed in the concept of the EPR, that they definitely felt a need for it and that they would use it (personally), when available. Two prototype EPR systems were developed. The first prototype was demonstrated to a group of GPs to get a general idea of the system's compliance with their requirements. It was further put to the test by applying heuristic and usability evaluation methods. The latter was done in conjunction with the paper and pencil observation technique. The results of these evaluation methods were analysed and applied in the development of the second prototype. After the completion of the second prototype EPR system, a third alternative, namely the HUB Medical Computer System (based on the Foresighted Practice Guidelines principle) was acquired. It was deemed important to test this as an alternative to the template principle on which the first two prototypes were based. The second prototype and HUB were evaluated in a hands-on laboratory evaluation. Similar evaluations techniques to those applied to the first prototype were performed on the second prototype as well. Additionally the first and second prototypes were compared to each other with the aid of a task analysis. The users identified positive aspects in the HUB system. The second prototype was, however, received with enthusiasm. By taking the evaluation results to heart and using the second prototype as basis, an EPR model was thus presented. Broadly viewed, this model involves a graphical user interface (accessed via mouse/keyboard) based on the Tab-method, entering of consultations via the SOAP model, a query, report and printing facility, customization, and communication with the health care environment via e-mail and medical protocols. In future EPR systems for GPs in SA could be based on this model.