Roadmap for 2016 Q1 and Q2

2016 begins with the release of our Q1 and Q2 roadmap! The highlights are:

We encourage you to bookmark our roadmap page because it will have the most up to date information regarding changes to this roadmap including timelines. Remember, the delivery date of these timelines will depend on the feedback from our early adopter customers and developers.

Performance

We are continuing our focus on speed of page loading times. The more quickly PKB can show information to the user, the more often users choose to access the information which makes the patient’s care more accurate and safe. You can monitor current page load speed on pkbstatus.com. We want every page to load within a second. We are a long way away from this but we have also come a long way. Over the past year we set up parallel decryption infrastructure so that multiple virtual machines are able to decrypt in parallel the data points for a particular page, e.g. all the measurements or all the discussion messages.

This year we are making a number of optimisations:

Shifting the database server to Solid State Drive (SSD). Reading and writing from SSD hardware provides lower latency.
Shifting to a Advanced Encryption Standard (AES) algorithm from the current DESede (Triple DES). This is orders of magnitude faster, more secure and allows us to encrypt more data with a single key.
Each page will be optimised to make fewer database queries. We will start with the most commonly used pages i.e. the dashboard, the discussions page, the patient summary page and the lab results page.

Stability

Last year we had focused on major architectural changes that support population-scale deployments with patient-controlled health information exchange. With these architectural changes complete, we are focusing on stability of the platform to allow a lot more automated testing every night for new code, which in turn allows upgrades to be more frequent and smaller.

Paediatric patient management

PKB handles records about children differently from those about adults. This is to help professionals looking after the safety of children and to comply with local laws enforcing that protection.

Change of ownership at age 16

At age 15 and 9 months, PKB software sends an email to the child, their carers and the coordinators of all teams looking after the child. The message reminds all parties of the upcoming 16th birthday and the age at which most children have the capacity to control access to their record and all children should have their capacity assessed. Any coordinator can log in and formally assess to remove access of parents and if necessary switch the registration email address to that of the child (e.g. if the parent’s email address had been used to register on behalf of the child). Read more about change of ownership at age 16.

Enforcing access to a child’s record

Certain parties should always have access to the child’s record regardless of the wishes of the child or the parents. A coordinator looking at the team page of the child can enforce access for these parties so that neither patient nor carers can stop sharing. Examples include the local family physician and pediatricians; both parents after a divorce; third parties directed by court order such as social workers. Read more about enforcing access to a child’s record.

Freezing accounts to prevent access by non-professionals

A professional can temporarily remove access to the child’s record by the child and their carers. This is useful during investigations into the safety of the child where a party with access to the record may be harming the child. While frozen the child cannot log into their record and the carers cannot access the child’s record. Read more about freezing access.

Discharge a patient

A professional can discharge a patient when the team’s episode of care has ended. For example this might be the end of a hospital in-patient stay or the end of a therapeutic referral. Formally discharging the patient is important to provide a summary to the next team to take over looking after the patient and to maintain the privacy of patients after they have left the care of a clinical team.

When you discharge a patient in PKB your team will no longer have access to the patient’s record and the patient will no longer be able to send messages to members of your team. Your team will still be able to search and find the patient’s records to regain access. To formally access a patient’s record after discharge you have to enter the reason for the access, including explicit consent (e.g. the patient is with you in clinic), implicit consent (e.g. after a new referral) and break-the-glass emergency (e.g. the patient is unconscious in your emergency department). Read more about how to discharge a patient.

Professional views

Professionals need to look at a lot of information on one screen in a patient’s record. They are used to seeing lots of information tightly packed but they also typically have smaller screens than home users do. We are redesigning the professional view within PKB to make it more dense and with less white space.

The patient summary page will list the latest panels as well as the vitals signs from measurements.

Clicking on a panel will show the results.

The discussions page shows information about professional users in as few lines as possible to minimise vertical scrolling. Where a message is formal communication (e.g. a discharge letter or a clinic letter) rather than an online consultation the bottom of the page allows the user to enter their notes rather than send a reply.

The professional’s schedule screen is also getting a makeover into a monthly view.

Test results

We changed the test results screens a lot in 2015 to support the safety requests of pathology departments and the accreditation requirements of ISO 15189. You can read more about what we currently have on the pathology department documentation page. However, the usability of these pages was poor and patients were confused by the changes we had put in place. We did a major redesign over the New Year.

Test results view

The default lab results page maintains the safety requirements of aligning tests on the x-axis when they are from the same date, while still showing on the y-axis the actual values. Results in range are a green and those out of range are red. The former are a solid circle while the latter are a border only for colour blind users. A plus in the circle indicates a comment from the laboratory e.g. a warning about a faulty sample.

Every test result will have the reference range on that date from that laboratory. This cannot be changed except by the laboratory which had sent the result in the first place. A reference range shows which results are abnormal in the general population.

But every test can have a patient goal set by any user looking at the patient’s record. For example a patient with leukaemia may always have anemia but their physician may set up a goal for the patient. A patient goal shows which results are unacceptable for a particular patient.

At the top of the page the user sees their favourite results e.g. a patient with HIV and diabetes may track their CD4 count and HbA1c levels most closely out of all the results in all the panels their doctors may be ordering for them. There is also a search box for quickly finding a result.

By default all test panels are collapsed and they can be manually expanded according to the user’s interest.

Clicking on an individual test result shows full details of that test result, and the rest of the panel below it. Any user can add an annotation to the graph e.g. a diabetic can add the time of their meal and the time of their insulin injection below the actual glucose result from their glucose monitor. Moving the mouse across the graph shows the annotations.

As well as the comments which had come from the laboratory.

Back on the main test results page the user can tick the box next to each of multiple test results and then click the Compare button to compare these tests.

Adding test results

At scale the most important way to add test results it through direct HL7 integration with laboratories. But for a few patients the ability to manually add test results is critical. These are often the sickest patients, receiving care from multiple hospitals across a country or even multiple countries. Not all of laboratories are (yet) integrated with PKB so manually uploading data from local laboratories is helpful for the specialist teams monitoring the patient. Our focus in the redesign was to make the process of adding test results as fast and easy to understand as possible.

The first change is for tests to be added by the name of the individual test rather than the name of the panel. For example rather than adding “Liver function test (LFT)” you can just type in “Ala” to get “Alanine transaminase (ALT)” which is part of the LFT. The next page automatically shows all the test results of the LFT panel alongside the originally chosen ALT.

We optimised the panel page for speed of data entry. The attachment of a scan of the original piece of paper is at the top of the page so that the upload process can start while the user manually fills out the numbers in the rest of the page. The user can move between fields by pressing the tab key. The targets for each test result are pre-filled with the most recent target entered for that result but the user can overwrite any with a new target.

Two-factor authentication

Professionals will have this first for added security. Eventually we will provide the option for patients who can choose to switch on the added security without affecting usability for most patients.