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Functionality and Usability Assessment of SEHA’s E-Referral System

Functionality and Usability Assessment of SEHA’s E-Referral System

The functionality assessment of SEHA’s e-referral system developed by Cerner is measured against the success or failure of such systems from the same developer in other parts of the world (Kachrilas et al., 2011). Speculations about the future of British urological practices earlier noted that there would be an increase in workload. The speculative insinuations were made due to the rising trend among the patients seeking counseling, screening, and investigations (Kachrilas et al., 2011). All these processes are grouped under the activities of an outpatient clinic. The government’s influence on improvements in health care added some pressure and induced the reduction of waiting time and effective exploitation of outpatient resources. Investigations showed that only twenty percent of urologists were able to adhere to the recommendations of the British Association of Urological Surgeons (BAUS) regarding the outpatient workload (Kachrilas et al., 2011). It was also noted that medical consultants worked more than they used to in the past, spending more time with their patients.

On the other hand, the dramatic increase in surgical treatments and the list of medical investigations showed that patients were more informed and demanding. Doctors were also willing to share their knowledge and offered more time for consultation to patients (Kachrilas et al., 2011). The uncontrollable upsurge entailed the responsibility of data storage and processing. Therefore, it was deemed fit to use electronic methods of data storage for the new and revisiting patients in order to manage and reduce the workload pressure on medical professionals (Kachrilas et al., 2011).

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In April 2008, the National Health Service (NHS) trust observed an implementation of the Care Record Service (CRS) designed by Cerner. This initiative was part of a national program for the integration of information technology with the National Healthcare Service, which involved the investment of £12.7 billion. Although some complications were expected during the implementation process, the actual difficulties were much more serious than had been earlier anticipated. According to Kachrilas et al. (2011), almost all the clerks’ duties were now to be performed by doctors on a computer while attending to a patient. The results of such an overwhelming change included the uncompleted information fields of CRS information. The inability to properly use the data storage and processing facility extended until 2009 when it was suspended (Kachrilas et al., 2011).

Information exchange, storage, and distribution are very vital aspects of healthcare practices. The need to collect, store, and share information accurately, effectively, and timely resulted in the development of different sorts of information technology (IT) tools. Accessing information through any form of IT tools like websites, database interface, and other IT sources is an innovative method of information dissemination. Although the intentions behind the implementation and integration of IT resources with medical practices are meant to improve the workflow, cut costs, and optimize services, the process itself can also be very frustrating for the end users.

Further discussions will elaborate on the usability and accessibility of a Cerner-developed e-referral system for SEHA medical facilities in the United Arab Emirates. Usability and accessibility assessments of the e-referral system in this case are based on the feedback from the end users of the system at the facilities where it is being exploited. Discussions will also include the description of the system, its basic functional evaluation, information architecture, strategic alignment, and future state.

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Description of the System and Its Basic Functional Evaluation

System Developer

The system was developed by Cerner, a renowned information technology company, which has been involved in the development and provision of strategic information processing systems and IT resources for medical facilities and practices.

Description and Basic System Functionality Evaluation

According to Charlyn Acosta, a dietitian and an end user of the Cerner’s system at Sheik Khalifa Medical City (SKMC), “Cerner designed the system based on the needs and recommendations of the facility.” Considering the constant and spontaneous change in medical practices, the system is regularly upgraded to suit the newly arising needs. Cerner is currently working on simplifying the usability complications experienced by the end users of the system at SEHA Medical facilities. The functionality of the system is relative to the purpose why it has been developed in the first place. In this case, SEHA medical facility operators wanted an e-referral system that would save time and money as well as replace manpower with technology in comparison to the previously exploited manual referral method. The e-referral system is meant to obtain patient’s information through SEHA’s website and other affiliated e-portals; thereafter, it directs the information gathered to the database interface where the information is being sorted and used for contacting respective patients for booking doctor visits and consultant appointments.

Description of Information Architecture and Usability

Naseem Begum, an IT specialist who works with SKMC, states that the system has gradually improved business and service performances accordingly. Regarding the information architecture, it is a thin client which enables a multi-user system. As for its usability, the e-referral system is currently being used throughout all SEHA medical facilities. Medical consultants at these facilities are quite satisfied with the level of progress achieved so far.

Since SEHA has an on-going ten-year contract with Cerner, all arising issues noticed during the system usage are noted and compiled for an annual upgrade of the system, which is a part of Cerner’s service provision agreement. Jill Rigg, a manager of the clinical dietetic department in SKMC, stated that “the electronic referral is easy, compared to the old manual method because the referral is inclined towards the appropriate receiver or end user, if the end user has the accurate knowledge.” Moreover, she further elaborated that, after Cerner integrated the e-referral system at SEHA medical facilities, there were a couple of issues with usability, but they were fixed through recent upgrades. Some of these upgrades were also influenced by the state’s PDCA plan. According to Khaleej Times (2012), an online journal based in the United Arab Emirates, CEO of the Health Authority – Abu -Dhabi (HAAD) Zaid Al Siksek stated during the speech that he gave at the opening of the Abu Dhabi Medical Congress (ADMC) in 2012 that the government had invested an estimated 10 billion AED on improving the country’s health sector. One of the changes/improvements that he mentioned was the implementation of referral systems in medical practices. Basic insurance card holders were also part of those for whom the system was intended (Khaleej Times, 2012).

Since the beginning of 2013, more than 1.3 million basic insurance plan holders were directed to SEHA’s primary healthcare centers and Ambulatory Healthcare Services (AHS) to receive treatment, diagnostics, and medical consultations (Khaleej Times, 2012).

Strategic Alignment

One of the caregivers interviewed about the level of satisfaction experience stated that appointments used to take longer time and patients had to wait for a very long time, but the e-referral system allowed them to make an orderly booking of appointments. Coupled with that was the implementation of “Walk in” appointments in the hospital which was faster and more pleasant to patients. A “yes or no” survey conducted among dietitians showed that eighty-three percent of them were dissatisfied. The majority of these dietitians were not satisfied with the inability of the administration to bridge the gap by maintaining the continuity of care through the implementation process. The rest of them were convincingly satisfied with its current level of accessibility and ability to save costs and enhance the quality of care and services.

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Strengths and Weaknesses of the System


Since its implementation, the system has saved much costs. Moreover, it is easy to access and fast to use. Apart from that, it guarantees confidentiality and exhibits a high level of record visibility in and from all SEHA medical facilities (Abu Dhabi, Al Ain and Gharbia hospitals).


The system seems complicated and not user-friendly to ordinary people (non-medical professionals). The lack of end user knowledge on a proper and simple access approach exists among some medical practitioners too. Other weaknesses include the inability to access the referrals properly, prioritize them as well as review the referral before booking an appointment. Australian primary healthcare researchers and medical practitioners in a peer report journal (Reed et al., 2014) make the following recommendations:

  • The designing of a cross-sectoral program requires a clear definition of specific improvements that are expected;
  • Sufficient training and technical support is needed for the successful implementation of innovative technologies;
  • The most likely acceptable programs/systems are those which have been developed based on the existing systems and clinical procedures.

The e-referral system can be improved by creating accessibility awareness information channels for both workers at SEHA facilities and patients. Hardcopy pamphlets with descriptive information that explains how to access and use the e-referral system should be made available to patients at all SEHA medical facilities when they visit. A pop-up window suggesting the referral system usage and its effective exploitation to SEHA’s corporate website visitors should be installed on the website. Trainings on accessibility and usability of the system should be held after every upgrade for staff, especially for employees who have issues with adapting to using the system. Aiden Malone from Cerner confirms that the proper governance of exploitation procedures and relevant processes must also be aligned in order to ensure a successful implementation of any project.

According to the information on SEHA’s corporate website, its mission reads as “to continuously improve patient’s care to recognized international standards” (SEHA, n. d.). SEHA’s core values include transparency, accountability, ethical practices, efficiency, and equitability. SEHA focuses more on patients’ satisfaction and specific needs of the community through quality outcomes, reliability, accessibility, affordability, cultural sensitivity, compassionate relations, and respect. SEHA claims to be innovative through education research programs, empowered and satisfied staff/workforce, partnerships, and alliances.

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The integration of information technology (IT) for the provision of healthcare services is currently a widely accepted and practiced healthcare information strategy. The accessibility and usability of such informative applications and technologies broadly determines how effective and satisfying they are to end users. The idea of creating and integrating the information technology for healthcare service provision is always aimed at saving time, cutting costs, and improving efficiency among others. These factors are obviously essential to service quality and overall enhancement of the medical practice at any given organization that uses strategic information systems. Dr. Omar Al Dhoori, who led the Cerner project in SEHA, stated that “Cerner has been able to meet the accessibility criteria the SEHA team anticipated. The e-referral system has proven to be an effective tool, regardless of where or when it is being accessed.” He further claimed that it improved the level of effective communication among the healthcare providers.

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According to Aiden Malone, one of the Cerner’s Senior Directors for European Consulting in Cerner’s London Office, technology implementation is fairly straightforward, but the success of any system or program depends partially on the people and the process of exploitation in real time, and that is where the challenge lies (Cerner Newsroom, n.d.). If the challenge continues in such a direction, then the staff training is necessary to be conducted as frequently as possible to ensure a confident and convincing end user satisfaction. Cerner Newsroom (n. d.) shares one of their success stories by indicating that the Spanish hospital Marina Salud in Denia, Spain, now works completely paperless. Part of the success achieved includes a forty percent decrease in sepsis mortality rate and the hospital staff utilizing the technology in real time. The success story of the Spanish hospital started from collecting patient information electronically, and since then, the process has since been repeated routinely with ease. According to Cerner Newsroom (n. d.), their efforts are focused on data liquidity: wherever data is needed, it should follow the patient. Once the information is stored in the system, it can be used to establish several layers of intelligence; this intelligence is then used to improve the decision-making.

Cerner: System Developer’s Optimism and Feedbacks

Success stories and news display that,information technology has made patient information documentation and data storage processes easier. The idea has driven many hospital management teams to the point of assuming that the acquisition, implementation, and exploitation processes are all very simple. According to Brown, Stone, and Patrick (2005), in the past, the management of some hospitals/clinics deliberated single-handedly on what kind of design was preferable to the medical organization without consulting the end users about what they would like to experience working with strategic information processing and storage systems, which led to chaos during the implementation stage. A typical situation occurred at the Los Angeles Cedar-Sinai Medical Center where the immediate response after the implementation was negative (Brown et al., 2005). Although the management involved about forty doctors to donate and share ideas during the design process, they were forced to stop the further usage of the new system due to the overwhelming negative response (Brown et al., 2005).


All vital members of a medical organization should be involved in the design process of the patient information processing and storage (PIPS) systems in order to maximize the positive integration, implementation, and exploitation process of relevant and respective IT resources. The vital members in this case should be comprised of the medical center’s management team and the end users of such systems. The end users could be doctors or patients themselves, depending on the situation. At SEHA, most of the staff and the management seem to be satisfied with the e-referral system.