D1.2.4_Appendix A_Simulated Consultation Healthcare
Contents
1. Version 1 0 4 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 service was administered to the patients The patient questionnaire consisted of 5 closed questions with a Likert scale and one open question Qualitative approach Semi structured interviews were carried out with physicians and pharmacists who had participated in some of the consultations in order to gain an insight into their opinion of the service In the interview information was requested on service aspects availability usability semantics legal issues and security potential impact barriers and facilitators Box 1 The interviews were conducted in English with the exception of Spain where the interview was performed in the native language of the interviewer and interviewee Thereafter the content was translated into English The interviewers requested permission to record the conversation and guaranteed confidentiality The interview was encoded with one identifier and was transcribed The in depth interview was not always performed in all the consultations Version 1 0 5 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 Box 1 Guideline for Health professional interviews Experience of the epSOS Service Description of the event see the process and difficulties Opinion in the service aspects availability usability semantics legal issues and Privacy confidentiality a2. s integrated that would absolutely be the best way EP1 The ideal here would be that it were a common history and that you wouldn t need to go to epnSOS and open the ideal is to have the history the allergies the most basic things they might have if any Then you wouldn t waste time because youd see it but whatever the case even so see it as a step forward HP3 the integration with the management program makes our work much easier as we don t have to go to the black box to see if I have it or not and so on we could include just as other programs include being able to substitute it with what I do have EP2 And then facilitators which we have talked about above all it is security think that it is the security that it gives me even think that feel greater security myself than the patient does EP2 32
3. Communication Safety Confidence Version 1 0 D 1 2 4 Evaluation Results Document Short Simulated Consultation 07 07 2014 Categories Missing information Technological Data security ethics legislations Reducing language barriers Patient s clinical safety Data reliability Weaknesses or Barriers Strengths or Facilitators Not specific diagnoses or more complex information eg blood pressure Physician s comments or specific clinical information eg specific surgery etc Different drug legislations in each country Time and burden or work Low use of the system Allows to reduce language barriers Provides information without relying on the patient s language Missing of some relevant information to Allows accessing to relevant information security like dosage that is helpful for clinical decision making Ensures confidence in relation to reliable data not dependent on the patient s memory 18 Aspects to improve Translate comments doctor field More detailed data on prescriptions as the name of medicine or dosage Include specific diagnosis and surgeries Include dosage Patient s prescription history as an element of support for decision making System of control to dispense the medicines confirm by a scanning that the medicine dispensed to the patient are the same ones as introduced in the patient history More rigorous process digital access and within the site T
4. Danish customers as well that is when it s not the patient that picks up the medicine it s their brother or sister their father their mother or whoever who doesn t know how they take it But it s just a feeling about professional confidence in what we do EP7 there is a kind of contrast between what it says here and what am really seeing EP2 If am a patient and I go to a foreign country to a country that don t know where they dont understand me and am told not to worry that the person am talking to knows what s wrong with me that gives me peace of mind this person already has information about me and knows how to help me HP 2 For the patient there is also security because first we are entering their data but in addition they are authorising us to enter their data EP2 So ld say when this starts to be routine when it s just the epSOS system I think it ll be less time consuming It ll take less time than a physical prescription It s an improvement compared with the paper prescription from Italy for instance That would be an improvement yes EP7 30 Version 1 0 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 Personal aspects Health professional computer skills Technology barrier Access to system Contextual aspects Low use Time and burden of work Legal aspects Different laws drugs by country B
5. on the patient s language 1 am delighted This is a step forward for me as am now old think it s an incredible step forward and am happy HP3 It s an improvement compared with the paper prescription from Italy for instance That would be an improvement EP1 for us to have a Clinical report in a language that one can understand is really good and useful HP1 It is a tool with great future In places like Mallorca or tourist sites where there is a large foreign population it is very useful to have the patient s medical history in their own language and not be dependent on insufficient language skills It is a tool that is now in the initial phase and that can be greatly improved upon HP2 Version 1 0 13 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 The other potential impact clinical safety of the patient is related with the assistance to clinical decision making It seems very interesting to me because it means having access to a patient s history who is away from home and in this way we have a lot of data of their clinical history which we can use As in this case where she was allergic to penicillin because if she had needed it it would have suited me very well HP3 AS a professional it gives me the security that this patient has this treatment prescribed and also you give me a name and that name is linked to a prescription and fu
6. patient safety EP1 Something that think is very important that is missing in this area is that the dose be indicated think that it s a very important detail first for checking that the patient is well informed and is taking the medication appropriately that he she has that information It is important first for patient safety and second to check treatment adherence EP2 b Social aspects Legal aspects process of data identification and informed consent were positively valued One of the interviewed discussed the importance of ethical aspects for confidentiality of data by the doctor and other emphasized the importance of rigorous process the need of digital access and within the site He also suggested translating the consent in both languages 0on the subject of data protection it should all be as rigorous as possible access to the system if possible here we demand that it cannot be digitally keyed in but should include a card reader because that guarantees or rather to put it another way with regard to the data protection law confidentiality would not be guaranteed EP2 c Potential impact In general the comments in this section highlight the utility of the tool The main two potential impacts identified were about communication and clinical safety of the patient The service is well appreciated in reducing language barriers having the information available without relying
7. s a heading called Pregnancy in Process which is very specific In fact contraceptives had to be included within Treatments think and that s not natural HP4 A student was allergic to a certain type of food don t remember what kind but couldn t find him in the listing so nothing could be done on the spot because it was mandatory don t remember what happened but I couldn t find him HP4 have also experienced certain difficulties particularly with respect to vaccines and allergies too because believe you need to indicate the start and end dates It s difficult to insert an end date and then the patient not necessarily remember the date of the allergy It s an important detail that ought to be included It s essential that all allergic reactions are recorded in a file the Patient Summary Sometimes you have to more or less invent the date if you want to include the day and month Otherwise there s no way you can do it the system s so rigid HP4 It would be lovely if there was just a PDF form could click on to get the consent out which is printed and then given to the patients so it s in their language The paperwork would need to do a written 24 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 consent that would be very nice if that was accessible in that picture even if you could give the consent form electronically as well t
8. the most important is for the health professional to be aware of what he or she is doing which is very confidential indeed HP1 28 D 1 2 4 Evaluation Results Appendix A SC_HE Simulated Consultation 07 07 2014 to have a clinical report in a language that can be understood is really a good thing very useful language barriers indeed HP1 Potential impact Communication Reducing Clinical Safety Version 1 0 That is right because now we have a certain communication problem with the patient difficulty to understand the language of each country HP2 Here with this overcoming this linguistic barrier is facilitated it is eliminated to a large extent and because afterwards we are handling the screen then even at a certain moment when you do not share mastery of a common language you can facilitate the patient s comprehension of what you are dispensing to him her can t you EP2 And when patients are foreigners at least for us there is inevitably a language barrier with respect to certain health problems could be translated That would be an asset HP4 For the health professional it is of great help as it helps him or her do the work in the sense that it saves time and facilitates clinical work HP2 It seems very interesting to me because it means having access to a patient s history who is away from home and in this way we have a lot of data of their clinical history whic
9. up in the patient s language contains Adequacy of information more specific diagnoses not all but some were very general You had to specify what type of disorder not all evidently but some HP2 And with respect to the blood pressure requirement feel this is a parameter that s not a stable factor you can have low blood pressure one day and average pressure another day When there is previous history of high blood pressure a patient s pressure needs to be recorded but not ona Version 1 0 23 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 Missing information about data prescription comments Version 1 0 specific day even though there is no mention of his her weight or height HP4 Well there was this picture where you say what type of medicine they have received With the Swedish patient could see what medicines but with the Italian there was some coding scripts so couldn t really see which lines were what What would be really nice and that s just drawing on my experience from our general system is that if there could be a lot of data perhaps when it was prescribed more data before you select it more data what the name of the medicine is what the active ingredient is what the strength of it is need to pick to ensure patient safety don t know either how long the prescriptions are in the epSOS system in the Danish sys
10. 07 2014 Security Technological measurements these are important parameters for obese patients HP4 The only part that is not translated is the doctor s comments and don t see why they were not Maybe if this part of the translation could be done even it was with one of these translation engines it would be good So again the only thing that is not translated are the doctor s comments and sometimes these comments may contain information that may be relevant for the clinician HP1 All the comments the free comments are not translated but the doctor who uses the system doesnt know that the comments will not be translated HP4 1 have perceived the information got as very secure think that the technological part complies with security measures both in our country as well as in other epSOS countries HP1 Here in Andalusia we have a checking system that we find works very well where we can confirm through scanning that what am saying digitally that am going to give the patient coincides with what physically give to the patient to avoid any errors errors in interpretation That would be a suggestion that would add for extra safety EP2 2 Core categories Social aspects Version 1 0 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 Subcategories Codes Legal issues Data security identification process and IC Professional
11. 2 1 0 Version 1 0 2 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 Table of Contents 1 Simulated Consultations healthcare encountels cccccecccseeeceeeeseeeeeeeeseeeeaes 4 1 1 BACKOFOUNQ esicssucseigsesdshndsandsnddacsdahiideandshidsasdshiGsand i iaa a Ep da iae a aap ie iini 4 1 2 6 0 lt 0 E sirin AE E E E E E ee AE 4 1 3 MoO ese ea E E 4 1 4 FRO SES PE E E E E E E E 7 1 4 1 Perception and acceptance of epSOS services according to the patient 8 1 4 2 Perception and acceptance of epSOS services according to the HPs 8 1 4 3 Health professional interviews c ccccsecesseceeeeeeeeeeeeeeeseeeseeeseeeeeeesaeees 9 1 5 CONG SION isre EEE ERE EESE EE EEEE ENEE ENRE 20 Annex 1 epSOS Experiences from eP pilot in Haparanda Sweden 21 Annex 2 Categories subcategories and some examples of health professionals COMMEN S pects ec EE 23 Version 1 0 3 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 1 Simulated Consultations healthcare encounters 1 1 Background The evaluation work package adjusted its activities and plan Deliverable 1 2 2 and Deliverable 1 2 1 EED Evaluation pilot plan epSOS phase on the basis of introducing virtual hypothesis scenarios through Simulated Consultations SC performed by volunteer patients offering their real Patient Summary PS and consulting the Health Profes
12. A U epsos EUROPEAN PATIENTS SMART OPEN SERVICES Smart Open Services for European Patients Open eHealth initiative for a European large scale pilot of Patient Summary and electronic Prescription D1 2 4 Appendix_A_Simulated Consultation Healthcare encounter WORK PACKAGE WP 1 2 DOCUMENT NAME D1 2 4 Appendix_A_ Simulated Consultation Health encounter SHORT NAME Simulated Consultation ok DATE 07 07 2014 Version 1 0 1 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 COVER AND CONTROL PAGE OF DOCUMENT Document name D1 2 4 Appendix_A_ Simulated consultation Healthcare encounter Document Short name Simulated Consultation Healthcare encounter i Author s Organization CAHIAQ CAHTA Dissemination level PU Public PP Restricted to other programme participants RE Restricted to a group specified by the consortium CO Confidential only for members of the consortium ABSTRACT This document deals with the results of the Simulated consultation SCs and healthcare encounters which took place in different epSOS participating pilot countries as a pilot test for evaluating the use end users acceptance and potential impact of Patient Summary PS and electronic prescription eP services In this document the methods results and conclusions will be presented Change History Version Status Changes 30 06 2013 Final after QR CAHIAQ ee er V0 1 V0
13. arrier on the part of the health professional for lacking computer skills that is if a professional uses a computer tool like us somehow he will not have that problem For some people computer skills are hard to acquire and will also run into difficulties but that won t be an added problem HP 2 Yes the technological in order to be able to access the patient summary HP2 the fundamental difficulty is having to move between too many screens EP2 The structure is already very rigid too rigid HP4 The first time the patient came it we didn t succeed to enter because we didnt know what number to choose to identify him We had trouble locating the identifiers on the cards it s very complicated HP4 Our experience is that everything s about routine so when it s routine it s easy for you If it s something you do very seldom you have to think about everything you do and you have to use your manual and you have to double check and so forth So when we re dealing with so few foreign customers a year every time we serve an EPSOS patient it will be the first time we do it EP7 It is compatible with daily practice but as we are often saturated we have difficulty with it perhaps HP3 think differences in legislation We are bound by legislation so that if you were prescribed Simvastatin which has 10 tablets in it we don t have that on the market and we cannot give you a pa
14. bility semantics as well as technological security issues The HPs reported that the service was accessible with an adequate response time but they also mentioned that it could be improved with more speed They valued the usability of the service positively considering it easy to use In relation with the format one of the participants said that the information was well structured and classified while others considered that the format could be better Version 1 0 10 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 think that it would be much more operational to have a visual with single screen view not to have so much information up front but instead have summarised information on the prescriptions that a patient has active at that moment in time and for each of them to offer more detail that would make it much faster because by refreshing the screen once we could do the dispensing It gives you an idea of the patient s global treatment that first of all but then it could almost be managed by blocks on a dialogue basis EP2 Another aspect considered mainly by the physicians is the rigidity in the use of the system For example in the limitations of some sections mandatory fields not required in the epSOS minimum data set or the fact that it is not possible to add new fields I have also experienced certain difficulties particularly with respect to vaccines and aller
15. ckage with 30 tablets in it because that would exceed the amount of tablets which were allowed It s very marginal or very little in that window That would be a frustration also for customers coming in Well m an epSOS patient My Italian physician has prescribed this medicine Simvastatin 20mg 10 tablets and we d say Well have large Simvastatin 20mg but I don t have any of 10 tablets cannot help you Then we re just back to the old system just out of frustration for the epSOS system Exactly Just as there may be medicines in other countries there may be medicines in Italy which are not on the market in Denmark EP1 31 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 Facilitators Ease of use Easy to access User manuals Integrated systems Safety Patient s clinical safety Version 1 0 Well think it is easy to Access because don t think you can ask for more HP3 But I d say it would be very nice to have that in a user manual just a picture of the card telling where to pick the numbers from just to make that slightly easier EP1 the best way would be to integrate it in the pharmacy system That would be absolutely the best way to do it So if it was possible for the eoSOS or the national health IT In Denmark to collaborate with those companies who makeup our pharmacy system and their exchange codes and update our pharmacy system where it
16. country included in the service This was the reason why one patient was unable to access the system so his card was not included in the service the tool runs faster or slower depending on the band width HP71 Version 1 0 14 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 The structure is already very rigid too rigid HP4 The first time the patient came it we didn t succeed to enter because we didn t know what number to choose to identify him We had trouble locating the identifiers on the cards it s very complicated HP4 The following aspects were stated by different professionals a Legal aspects because there are different drug legislations in each country l think differences in legislation We are bound by legislation so that if you were prescribed Simvastatin which has 10 tablets in it we dont have that on the market and we cannot give you a package with 30 tablets in it because that would exceed the amount of tablets which were allowed It s very marginal or very little in that window That would be a frustration also for customers coming in Well m an epSOS patient My Italian physician has prescribed this medicine Simvastatin 20mg 10 tablets and we d say Well have large Simvastatin 20mg but don t have any of 10 tablets cannot help you Then we re just back to the old system just out of frustration for the
17. e companies who make up our pharmacy system and their exchange codes and update our pharmacy system where it s integrated that would absolutely be the best way EP1 the integration with the management program makes our work much easier as we dont have to go to the black box to see if have it or not and so on we could include just as other programs include being able to substitute it with what I do have EP2 And then facilitators which we have talked about above all it is security think that it is the security that it gives me even think that feel greater security myself than the patient does EP2 e Other aspects The professionals agreed that it was feasible to implement epSOS services taking into account the tourist context or depending on the specific patients They also reported that the tool was compatible with daily practice as little time is needed and can even reduce the consultation time with foreign patients But one participant pointed out that this was also difficult because of the burden of work in daily practice Finally the training received was also positively assessed the tool is feasible for some patients for instance those that have more complex pathologies those who cannot communicate well with the physician and discuss their diseases those with comorbidities or chronic patients with many drugs prescribed HP2 Table 2 shows the different opinion of physicians and pha
18. ed by other participants for example the doctors comments had not been translated a section which may help the HP in the clinical decision making process some information about diagnosis surgery or detailed allergies was missing I would add that there was a student who was allergic to a specific kind of food but who was not on the list don t remember what happened but I couldn t find it on the list HP4 As far as surgical case history is concerned one student had had an operation on an abscess or something like that but couldnt find any record of his operation and there was no listing His operation was not listed so it couldnt be found there is no list to choose from HP4 An other suggested improvement is to have more detailed data on prescriptions as the name of medicine or dosage in the case of the pharmaceutical In this sense one of the pharmacists suggested to include a patient s prescription history as an element of support for decision making What would be really nice and that s just drawing on my experience from our general system is that if you there could have a lot of data perhaps when it was prescribed more data before you Version 1 0 12 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 select it more data what the name of the medicine is what the active ingredient is what the strength of it is need to pick to ensure
19. epSOS system Exactly Just as there may be medicines in other countries there may be medicines in Italy which are not on the market in Denmark EP1 b Personal aspects as the HPs computer skills that is the ability to use the tool even though the tool is considered easy to use Barrier on the part of the health professional for lacking computer skills that is if a professional uses a computer tool like us somehow he will not have that problem For some people computer skills are hard to acquire and will also run into difficulties but that won t be an added problem HP2 c Contextual aspects such as time and burden of work an aspect which might make the service difficult to use or the ow use of the system because the use can make it more easy to use Moreover some facilitators were identified for instance the ease of using the tool or the user manuals One aspect highlight was the integrated systems It was also discussed the safety as a facilitator to use the system Finally it would need more information to patients and professionals about the appropriate cards to access the system The best way would be to integrate it in the pharmacy system That would be absolutely the best way to do it So if it was possible for the eoSOS or the national health IT IN Denmark to collaborate Version 1 0 15 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 with thos
20. ethics Quotes think so because you need a number to be able to gain access or you need two numbers depending on the country and you need to fill out the informed consent also depending on the country consider the information that have received as very reliable Of course there might be an exception at the time of an emergency when you are unable to receive this documentation There is always a record of who and how the service was accessed and therefore it is important to have it under control HP1 The consent should appear in both languages I had some difficulty with the interpretation EP2 I believe that the consent should be in the web sphere and that there should be some kind of signature by the patient but that would be saved that the patient could use some kind of own personal identification code so that the patient has to be aware he she is giving consent even if just a short text I consent I authorise this person to access my data on this occasion something like that for the purpose of proceeding with the dispensing EP2 on the subject of data protection it should all be as rigorous as possible access to the system if possible here we demand that it cannot be digitally keyed in but should include a card reader because that guarantees or rather to put it another way with regard to the data protection law confidentiality would not be guaranteed EP 2 But
21. gies too because believe you need to indicate the start and end dates It s difficult to insert an end date and then the patient not necessarily remember the date of the allergy It s an important detail that ought to be included It s essential that all allergic reactions are recorded in a file the Patient Summary Sometimes you have to more or less invent the date if you want to include the day and month Otherwise there s no way you can do it the system s so rigid HP4 Additional usability aspect mentioned especially for pharmacists is in relation to IT architecture and some of examples given by respondents suggested the fact of integrating patient consent electronically in the epSOS system or integrating epSOS service in each local health information system But at the same time as operate the epSOS system operate my own pharmacy system Completely independent and that would be something for the future to merge those two systems Well the advantages would be you wouldn t have to flick between screens As it is now you have to flick between the screens in order to get the information and I translate take the information from the EPSOS system and I have to manually translate that into my system have to manually type it in EP1 I believe that in the future yes we should achieve integration of the management programs that would be ideal a file exchange system that pharmacy management
22. h we can use As in this case where she was allergic to penicillin because if she had needed it it would have suited me very well HP3 The problem is again as we talked about there s no indication and there s no dosage So the patient has to know exactly how to take the medicine and not all patients know that Which is for us a concern about patient safety EP1 29 Barriers Version 1 0 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 Confidence Saving time impact on duration of care Data reliability Patient s emotional safety AS a professional it gives me the security that this patient has this treatment prescribed and also you give me a name and that name is linked to a prescription and furthermore have a confirmation which gives me that security In other words it gives me the security that am attending the patient correctly attending to a prescription that is current No for the system that is authorised it is current and therefore the physician has the capacity to control its duration EP2 Then we have the medical histories of patients which contain objective data Relying on patients may lead to confusion as sometimes they may or may not remember or they may say one thing when in fact it might be something else The medical history contains validated data and is therefore highly reliable HP2 Sometimes we do experience this with
23. hat would be perfect that the consent form wouldn t be in this pharmacy it would just be in the epSOS system and you could pull out the data in your system EP71 But at the same time as operate the epSOS system operate my own pharmacy system Completely independent and that would be something for the future to merge those two systems Well the advantages would be you wouldnt have to flick between screens As it is now you have to flick between the screens in order to get the information and then translate it take the information from the eoSOS system and I have to manually translate that into my system have to manually type it in EP1 I believe that in the future yes we should achieve integration of the management programs that Semantics would be ideal a file exchange system that pharmacy management programs can interpret capturing the information which would make it much more flexible EP2 There are no inconsistencies and there are no half translations that is half of the text in one Understanding language and the other half in another Everything is displayed in Spanish or in the language of the country of origin HP1 While all items and headings were in French the pathologies were written in Spanish except for a clinical history of allergy which had been translated into French HP4 Some diagnoses are very generic the document that opens
24. impact on saving time In relation to security of the tool as mentioned above it would be necessary more complete clinical and pharmaceutical information As barriers technological aspects personal skills ability to handle computer applications and context variables different drug legislations among countries were identified among others Moreover the ease of use user manuals or integrated systems were some of the facilitators stated These results provide the first opinions on the tool after the use of epSOS services In addition some barriers facilitators and areas of improvement have been identified However a large number of SCs is needed to reach data saturation and the representativeness of the sample Version 1 0 20 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 Annex 1 epSOS Experiences from eP pilot in Haparanda Sweden Background The representatives of the ePrescription pilot sites in Sweden could not attend the focus group of ePrescription service that was held in Barcelona For this reason a phone interview was performed to both pharmacies on the 14th May This report includes the content of both interviews and the results will be integrated in the final D 1 2 4 Interview content description Two pharmacists working in a pharmacy in the north of Sweden were interviewed by telephone during one hour 2014 05 14 They have worked as pharmacists for 20 and 5 years re
25. ists have been able to dispense medicines to seven real customers during the pilot This can be compared to nearly 30 customers that they had to refuse because of no consent in advance The pharmacists do not know why some customers know and some do Version 1 0 21 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 not know about the need of consent Both the pharmacists are confident in the identification of the customers though they are used to look at Finnish identifications The eP service has been down during approximately two weeks during the pilot This time and when the pharmacists can t serve the Finnish customers due to lack of consent they refer the clients to a Finnish pharmacy nearby Improvements The pharmacists propose that the eP service has to be more integrated in their regular system Today they have to leave the counter and the customers to handle the eP service in another room print out the prescription and register it in the regular system Improvement of the eP service is also to allow the possibility to regret Today the pharmacists can t regret if they press wrong amount wrong dose etc Instead they have to start again The surveys for the patient and the pharmacists have been very time consuming and the pharmacists questioned the objectivity of the customers when the pharmacists ask customers to answer the survey and the customer has to return it answered to the
26. o use the understanding of data and the sense of titles and subheadings for the data Figure 2 Figure 2 Opinion of HPs after each health encounter N 32 The epSOS service reduces E 1 Strongly agree You delivered faster care when m2 Agree The response time was acceptable E 3 Uncertain E 4 Disagree In general titles subheadings for E 5 Strongly disagree The data were easy to understand 6 1 don t know The service was easy to use E 7 Not respond 1 4 3 Health professional interviews A total of 6 HPs participated in the semi structured interviews 4 physicians and 2 pharmacists The most outstanding aspect that HPs reported after using the service was the utility of the service It was also felt that it is a service for the future that reduces language barriers and it s an improvement but which needs to be gradually improved The results were grouped according to following dimensions availability service and social aspects potential impact barriers and facilitators according to the viewpoint of Health professionals Physicians or Pharmacist The quotes are written in italics between square brackets and with the code of the informant Figure 3 shows dimensions categories and subcategories Figure 3 Dimensions categories and subcategories of the main areas availability service and social aspects potential impact barriers and facilitators Version 1 0 9 D 1 2 4 Evaluation Results Ap
27. pendix _A_SC_HE Simulated Consultation 07 07 2014 SERVICE ASPECTS system Ease of use TOTAAL aspectes structured IT Architecture Understan Adequate 4 Missing Technological information rigidity system ding information information SOCIAL ASPECTS POTENTIAL IMPACT Legal i Ethic issues Issues Communication Confidence Impact a service Data Professional hi Reducing Patient s anent Impact on language linical saf Data reiability emotional P ane clinical safety erie time BARRIERS A i Personal ETE E Teelo ccess to aspects ontextua ega system aspects i aspects Accessibility IT Different Health Time and Different Architecture health professional Low use burden of System rigidity system card computer skills work drugs a Contextual aspects i Clinical Safety H 7 FACILITATORS Technology Integrated systems f Easy to User access manuals Patient s clinical safety g oy 7 There have been two cases where simulated patients could not access the epSOS service One for technical reasons and another because the patient did not present the appropriate id card number at the moment of the visit This last issue was highlighted as a weakness for the availability of the service a Service aspects The opinions of the professionals are described according to the following subcategories response time usa
28. pharmacist Version 1 0 22 Annex 2 Categories subcategories and some examples of health professionals comments Subcategories Codes Quotes think it is quite accessible We conducted a consultation in 4 minutes just under 5 minutes which is quite accessible have also shown the patient the summary in his own language which I could have spared of course but did just so so that the patient could see that all sections had been completed right But on many occasions this is not necessary and therefore think that the time spent is quite reasonable HP1 Relatively well considering it was a rather exceptional dispensation A dispensation with a foreign patient where there is a language barrier I think it might even be a step forward imagine myself in that same situation with a piece of paper in Swedish and things would be rather complicated would they not EP2 The speed of it is not the fastest It does take some time and I think it s just because so much data has to go back and forth and you have to find it But that speed could be improved EP1 It is very intuitive no problem Any user can learn how to use it it is very easy to learn how to use the tool HP2 It is relatively easy this is a system that is much more simple than autonomous systems more primary more basic and it is very heloful compared with what we have EP2 It s quite user friendl
29. programs can interpret capturing the information which would make it much more flexible EP2 Finally technological security aspects of the service were positively valued However one pharmacists suggested to improve the control to dispense system by double check of the Version 1 0 11 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 dispensation confirm by a scanning that the medicines dispensed to the patient are the same as ones introduced in the patient history Here in Andalusia we have a checking system that we find works very well where we can confirm through scanning that what I am saying digitally that am going to give the patient coincides with what physically give to the patient to avoid any errors errors in interpretation That would be a suggestion that would add for extra safety EP2 As for semantic aspects HPs reported that the information was presented in a comprehensible manner without half translated texts or inconsistencies The adequacy of information on the PS was evaluated by one of the physicians as correct and insufficient in some aspects by the other for example non specific diagnosis or more complete information about other aspects was needed the active principle is correctly translated HP1 there had been a surgical procedure but it did not specify which HP2 On the other hand missing information was identifi
30. ranslation of the consent In both languages DIO Impact on service Version 1 0 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 Categories Weaknesses or Barriers Strengths or Facilitators Aspects to improve Patient s emotional safety Provides confidence to the patient Saving time Reduces consultation time with foreign patients 19 1 5 Conclusions In general HPs as well as patients participating in the health encounters reported a positive opinion about the epSOS service after using it The utility in the exchange of medical information and communication was pointed out in both services PS and eP The opinions of interviewers about the service were analysed according the following dimensions availability service and social aspects potential impact barriers and facilitators The interviews showed some relevant aspects to be considered HPs showed a favourable opinion on the formal aspects of the service understandable information accessible time ease of use etc However they also reported that some of these aspects could be improved HPs felt that it was feasible to implement the service and compatible with every day clinical practice Regarding the potential impact on clinical and pharmaceutical practice there was a favourable view of the epSOS service as a communication tool useful in reducing language barriers confidence data reliability patient emotional safety and
31. rmacists about the epSOS service Version 1 0 16 Table 2 Dimensions categories and subcategories according type of opinion favourable aspects to improve or facilitators and weaknesses or barriers and professionals physicians and pharmaceuticals DAOA Categories Weaknesses or Barriers Strengths or Facilitators Aspects to improve Availability Access to system Service aspect Response time Usability Easy to use Format Structured information Format Rigidity system IT Architecture Semantics Understanding Adequacy of information Version 1 0 The service depends of the bandwidth failed service Different health system card in each country Adequate response time HPs computer skills Well structured and classified Limitations of some sections Mandatory fields not required i e date Not possible to add new fields Need to move between different screens Easy to use Help functions built in functions in the system User manuals Information presented in a comprehensive manner without half translated texts or inconsistencies 17 Information to users about the appropriate cards for service access Improve time response speed Better format Portal First screen with a summary prescriptions with details for eP system Integrated systems epSOS in the local system DIO Security Social aspect Legal aspects Contextual aspects Potential impact
32. rthermore have a confirmation which gives me that security EP2 However it s important to keep in mind the lack of some relevant information to security Finally another potential impact stated was that the epSOS service involves saving time compared to the traditional system The problem is again as we talked about there s no indication and there s no dosage So the patient has to know exactly how to take the medicine and not all patients know that Which is for us a concern about patient safety EP1 Other issues covered by the HPs were the utility of the tool to obtain confidence in relation to reliable data for instance data that is not dependent on the patient s memory or when it s not the patient who collects the medicine in a pharmacy In addition the tool can provide confidence in relation to the patient s emotional safety 1 have perceived the information got as very secure think that the technological part complies with security measures both in our country as well as in other epSOS countries HP1 d Barriers and facilitators The main barrier reported by professionals was on technological aspects related to usability The fact to move between many screens the rigidity of the system in some cases or as happened in one case when the access to the service failed It should be noted as an important barrier for the availability the different health system cards in each
33. sionals HP in a Point of Care PoC or pharmacy for a check up health advice or clinical doubt with no real need for healthcare This scenario implied also a qualitative approach through in depth interviews covering aspects about the opinion perception and potential impact of epSOS services Additionally aspects addressing barriers and facilitators of eoSOS are also addressed This document looks at the objectives methods results and conclusions of the SCs and Health encounters performed from November 2012 to June 2014 1 2 Objective To know and study the perception acceptance and potential impact of epSOS services according to the opinion of end users health professionals and patients after the health encounter 1 3 Methods Quantitative and qualitative approaches were used for simulated consultations SC and health encounters Patients HPs physicians for PS and pharmacists for Electronic Prescription eP services participated in the health encounters Each HP could participate in one or more SCs During the consultation patients were identified gave informed consent and their patient summary or electronic prescription was retrieved Quantitative approach After the consultation the HP filled in an online questionnaire on legal issues informed consent and on different aspects of the service legal aspects availability and service usability of the service A paper based questionnaire on legal and service aspects of the
34. spectively The pharmacy acting as a pilot in epSOS is situated very close to the Finnish border so besides the Swedish customers they have mostly Finnish customers Both pharmacists felt that the information and education prior to the pilot about the epSOS service ePrescription eP was easy and adequate but that the time between this and the start of the pilot i e a couple of months was too long Use of enSOS Both pharmacists felt excited to participate in the pilot and to test the eP service though this service already had a demand by their Finnish customers The pharmacists think that the eP service is easy to use and they had no problems to start using it in their daily work Before the pilot started they had a doubt about the status of the eP service but after a short time using the eP service one of the pharmacists said that the service felt like it was for real The pharmacists compared the eP service with paper prescriptions They get the same information and think the services are comparable but that it is easier and quicker to process the service for the customer with the paper prescription due to the language barriers With paper prescriptions they don t have to inform the customer about the need of for example the consent identification number etc as they have to do with the eP service They have a brochure in Finnish for the Finnish customers but this extra is also time consuming even if it is good The pharmac
35. spects to improve Opinion about the service advantages potential impacts of use barriers and facilitators Data analysis A descriptive analysis for the questionnaires was carried out with frequency distribution For the interviews content analysis was conducted to refine subthemes make comparisons between cases and identify contradictions and outliers Findings were triangulated reaching coding consensus with the research team and emerging themes discussed The results of transcription were contrasted by informants Version 1 0 6 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 1 4 Results The following sections describe the results of the questionnaires patient and HP and the HP interviews Table 1 shows the total number of simulated consultations and health encounters performed Table1 Total number of simulated consultations and health encounters performed from November 2012 to June 2014 France Paris Nanterre 1 University 4 SC X X X X Finland Italy and Sweden 2 1 Denmark Copenhagen 1 7 2 2 ee ee Lc Version 1 0 7 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 A total of 43 patients participated in the simulated consultations and health encounters and 31 patient questionnaires were obtained Six health professionals physicians and pharmacists participated in the in depth inter
36. tem it s two years max for emergency medicine it s seven days and then it s gone EP1 Something that think is very important that is missing in this area is that the dose be indicated think that it s a very important detail first for checking that the patient is well informed and is taking the medication appropriately that he she has that information It is important first for patient safety and second to check treatment adherence EP2 it is very handy for us to have what is called the patient s prescription history what we call the patient s pharmacotherapeutic history In the sense that if we have any doubts I have taken want to take need and so on and we see any inconsistency accessing their pharmacotherapeutic history can be very enlightening for us EP2 would add that there was a student who was allergic to some kind of food and I couldn tt find it the list don t remember what happened but couldnt find it on the list HP4 With regard to surgical case history a student had had an operation on an abscess or something like that but couldn t find in the relevant listing His operation was not listed and couldnt be found there is no list to choose from HP4 Indicate weight and height No weight and no height fields Impossible to indicate waist 26 Version 1 0 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07
37. view and a total of 32 HP questionnaires were filled in after the health encounter 1 4 1 Perception and acceptance of epSOS services according to the patient N 31 After the encounters patients answered the questionnaire about the epSOS service n 31 All patients gave their informed consent and considered legal aspects carefully Data privacy was appropriately maintained Regarding service dimensions all patients evaluated each aspect Most of the respondents N 24 reported that the PS and the eP services were useful for exchanging medical information and a good communication tool N 26 Figure 1 Figure 1 Patients opinion on service aspects after Health encounter n 31 Eyes BNo E Noanswer Do you thinkthat PS eP service is an improvement Would you recommend the epSO services to a Would you use the PS eP service again Do you thinkthat you received care faster than The PS eP service facilitate the communication gave or confirm consen 1 4 2 Perception and acceptance of epSOS services according to the HPs After the visit the HP online questionnaire was filled in but in some cases it was not possible because of technical problems Therefore 32 questionnaires were completed Regarding the service HPs answers showed strongly agreed and agree in most of the questions Version 1 0 8 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 especially in the ease t
38. y As said if there could be some more built in functions in the system if the Service aspects Response time Usability Ease to use Version 1 0 codes in the lock in process if it was written where could find those and if there was a little tag saying For this citizen you need this type of documentation and so forth just making it as user friendly as possible That would be very nice EP1 23 D 1 2 4 Evaluation Results Appendix_A_SC_HE Simulated Consultation 07 07 2014 Format aspect structured information Format aspect Rigidity System IT architecture electronic integration Version 1 0 The information is well structured and classified HP1 think that it would be much more operational to have a visual with single screen view not to have so much information up front but instead have summarised information on the prescriptions that a patient has active at that moment in time and for each of them to offer more detail that would make it much faster because by refreshing the screen once we could do the dispensing It gives you an idea of the patient s global treatment that first of all but then it could almost be managed by blocks on a dialogue basis EP2 The French were easier to understand think they are better the framework The French format is better than the Spanish one it s clearer you understand it immediately HP3 Contraception there
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