Development and Usability Evaluation of GreyMatters: A Memory Clinic Information System
Objective This paper presents the development process of GreyMatters, a memory clinic system, outlining the conceptual, practical, technical, and ethical aspects, and focuses on the usability evaluation of the system. There was a need for a system to be developed for the memory clinics of Berkshire Healthcare National Health Service (NHS) Foundation Trust (BHFT) to aid the clinical and administrative processes of assessing, diagnosing, managing, and treating patients with cognitive disorders and mental health problems.
Methods The methodology for development of the information system involved phases of requirements gathering, modeling, and prototype creation, and “bench testing” the prototype with experts. The standard Institute of Electrical and Electronics Engineers (IEEE) recommended approach for the specifications of software requirements was adopted. An electronic health record (EHR) standard (EN13606) was used, and clinical modeling was done through archetypes and the project complied with data protection and privacy legislation. Usability evaluation of GreyMatters was done using the IBM questionnaires.
Results Though the initial development was complex, the requirements, methodology, and standards adopted made the construction, deployment, adoption, and population of a memory clinic and research database feasible. The electronic patient data including the assessment scales and scores provide a rich source of objective data for audits and research. In the usability evaluation of GreyMatters, overall responses to the Computer System Usability Questionnaire and After-Scenario Questionnaire demonstrated mild-to-moderate satisfaction with the overall system and with individual tasks. The results support that the system is an acceptable tool for clinical, administrative, business, and research use and forms a useful part of the wider information architecture. The implementation and sustainability issues and the lessons learnt were noted.
Discussion The development of a system needs to take into account the existing data collection methods and other information systems that will be used alongside. Use of graphical development tools to communicate requirements, build interfaces, and prototype may improve the quality and efficiency of system development. Standardized data collection assists in the provision of reports for clinical, audit, and service development use to meet the requirements of commissioners and to allow the easier identification of potential research participants. It is possible that in the usability evaluation, the satisfaction scores are overall lower due to the extra complication of using this system in addition to the Trust's main EHR. The small number of users is a limitation.
Conclusion The establishment of requirements and methodology, addressing issues of data security and confidentiality, future data compatibility, and interoperability and medicolegal aspects, such as access controls and audit trails, led to a robust and useful system. The system was modeled around health record standards that are based on long established research on EHR standards and archetypes which differentiates GreyMatters from simple web-based capture forms that were built in house by the Trust. Its strength is that it provides flexibility to record clinical information that the existing Trust systems can't. The evaluation supports that the system is an acceptable tool for clinical, administrative, and research use. Some aspects of the system like prescribing module do need further work.
Keywordsmemory clinic system - requirements - methodology - standards - usability evaluation - sustainability - EHR system
Received: 14 April 2020
Accepted: 18 September 2020
09 December 2020 (online)
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Improving services and support for people with dementia. Report by the Comptroller and Auditor General. HC 604 Session 2006-2007, 4 July 2007; National Audit Office. Available at: https://www.nao.org.uk/wp-content/uploads/2007/07/0607604.pdf. Accessed October 8, 2020
- 2 Memory Services National Accreditation Programme Standards for Memory Services, sixth Edition April 2018, Pub. No. CCQI273 Royal College of Psychiatrists. Available at: https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/quality-networks/memory-clinics-msnap/msnap-standards-6th-edition-2018.pdf?sfvrsn=d3a9bc94_2 Accessed October 17, 2020
- 3 G8 dementia summit agreements. Available at: https://www.gov.uk/government/publications/g8-dementia-summit-agreements. Accessed October 18, 2020
- 4 IEEE Standards. 830–1998 - IEEE Recommended Practice for Software Requirements Specifications. Available at: https://standards.ieee.org/standard/830-1998.html. Accessed October 8, 2020
- 5 Kalra D. ISO 13606-1:2019. Health informatics—Electronic health record communication—Part 1: Reference Model. Available at: https://www.iso.org/standard/67868.html. Accessed October 8, 2020
- 6 Open EHR. Available at: http://www.openehr.org Accessed October 20, 2020
- 7 Tapuria A, Kalra D, Kobayashi S. Contribution of clinical archetypes, and the challenges, towards achieving semantic interoperability for EHRs. Healthc Inform Res 2013; 19 (04) 286-292
- 8 Austin T. The development and comparative evaluation of middleware and database architectures for the implementation of an electronic healthcare record, PhD Thesis. University of London; 2004
- 9 Oracle Java. Available at: http://www.oracle.com/technetwork/java/index.html. Accessed October 20, 2020
- 10 Red hat. Available at: www.jboss.com. Accessed October 20, 2020
- 11 Hibernate. Available at: www.hibernate.org. Accessed October 20, 2020
- 12 Oracle Enterprise JavaBeans Technology. Available at: http://www.oracle.com/technetwork/java/javaee/ejb/index.html. Accessed October 20, 2020
- 13 Tapuria A, Evans M, Curcin V, Austin T, Lea N, Kalra D. Establishment of requirements and methodology for the development and implementation of GreyMatters, a memory clinic information system. Stud Health Technol Inform 2017; 235: 18-22
- 14 Servelec RiO EPR System. Available at: https://www.servelec.co.uk/product-range/rio/. Accessed October 20, 2020
- 15 Lewis JR. IBM computer usability satisfaction questionnaires: psychometric evaluation and instructions for use. Int J Hum Comput Interact 1995 2007; 7 (01) 57-78
- 16 Tapuria A, Evans M, Austin T, Lea N, Kalra D. Development and evaluation of a memory clinic information system. Stud Health Technol Inform 2014; 205: 106-110
- 17 Austin T, Sun S, Lea N, Tapuria A, Kalra D. Patterns: a simple but expressive data modelling formalism. Int. J. Knowledge Engineering and Data Mining 2016; 4 (01) 5-15
- 18 Aruchi Helicon. Available at: https://aruchi-helicon.rhcloud.com/pattern/describe?id=134. Accessed May 8, 2020
- 19 Berkshire NHS Trust deploys mental health app. Available at: https://www.ukauthority.com/articles/berkshire-nhs-trust-deploys-mental-health-app/. Accessed October 12, 2020