Any interest in talking about improving the user experience of practice management software on this platform?
https://ehealthforum.nz/t/new-rescript-alert-risk-of-alert-fatigue-and-lack-of-collaboration/31083/3
If you looked at the different types of primary care practice medical systems, the biggest limitation of enhancing user interface is change and adoption considerations.
There’s been plenty of attempts made on design led approaches but often it is limited by the coding framework on what’s available, as well as underlying architecture. Cosmetic user interface changes is something that should be strive for, but you will need to work on who it’s serving and how easy is it to support when you are a generalist signing in the morning and having a combination of what does the patient want, what does the system want you to do with the patient (pop health dashboards) and then how to streamline prescriptions, access to referral + external connected sources and invoicing. And each area has a different application to connect!
I could probably write a short book on this topic (and might even do so one day ) 
. The short story is that probably the biggest constraint on improvement is that it’s a dysfunctional market with very low margins - plus I’d echo @SamuelWong’s point about change management barriers. It would be an easier problem to solve if the practice and patient management concerns were separated. Much of the former functionality (e.g. finances & scheduling) is available in numerous generic applications. The movement towards holding patient data in national repositories (NHI, immunisations, medications, etc.) will also reduce the need for monolithic PMS applications which become increasingly difficult to maintain and swap out.
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@pkjordan The biggest downside (and to a degree upside) of Practice Management Systems is the compliance aspect of operating Capitation Systems in New Zealand. If a Primary Care service needs to operate in New Zealand, they must conform to all the HISO standard specified applications and integrations, and as you pointed out, extremely low margins in New Zealand for software operations. You’ll be lucky for an average GP to consider spending more than $2200 per user per annum on PMS (and connected services) licensing, so that pretty much rules out sustainable development for ‘good UX’ while maintaining ‘high compliance’ to everything else required to run.
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I agree with you on this 
Yes I think you’re right here too.
@SamuelWong tell me more about the upsides, I’m intrigued
The upside is actually the lack of proliferation of international vendors coming into the NZ market that doesn’t standardise how New Zealand wants/needs to operation. We’ve had some other non-GP PMS sellers being purchased by one or two organisations (perhaps 3-5 sites/facilities) and refused to enable customisations to accommodate local contract requirements because ‘we as NZ are too small with high compliance’.
To be honest, if there’s an enforceable interoperability approach where both national and international players use standards to play together, we would be delighted to have a true ‘free market’ PMS ecosystem. But everyone else so far in the international market conforms to proprietary standards, with token ‘FHIR’ API implementation when it’s an interpretation of FHIR rather than following the actual standard.
Good UX/UI relies on local workflows to be enabled., which requires understanding the Practice concerns. PMS services three masters in NZ, - how the clinical user wants it, how the practice/organisation needs to manage their billing/Accounts/CRM system, and how does the software align with the local ecosystem requirements (e.g. when you need to send referrals, receive results and access national system connectors like NHI lookup, NES, Hira and other services).
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@SamuelWong thanks for this
Many basic practice management system requirements - particularly funding and regulatory - vary considerably from country to country. No international standard is going to cover them all - hence the FHIR Extensions Model. Even configuring a NZ PMS to work in Australia (which I did in the 90s) is a major task as their reimbursement system is based on Medicare. In many large federal countries, requirements vary from state to state. Another reason why NZ is an unattractive location for overseas PMS suppliers is that it is a very low profit margin business with high expectations (from nominally private businesses) that the Government should fund general practice IT (>85% in the last NZ Doctor Survey).
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Yes the finance side is definitely a challenge
What are the compliance & regulatory aspects?
In NZ, these relate mainly to the overarching legal requirements & funding rules (e.g. Health Privacy Code, ACC & Medicines Act) rather than the PMS themselves. Over the years, there have been several market surveys but, AFAIA, no direct compliance criteria for the systems.
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thanks so much for this @pkjordan and @SamuelWong
I really appreciate the time you’ve taken to explain the complexities
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