Informatics in Primary Care (BCS, The Chartered Institute for IT)
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Five key strategic priorities of integrating patient generated health data into United Kingdom electronic health records
Full text linkThe integration of patient/person generated health data into clinical applications is a key strategic priority internationally. However, despite agreement on the overall direction of travel, there are still a range of challenges that inhibit progress in this area. These include technology-related factors (such as interoperability), use-related factors (such as data overload) and characteristics of the strategic environment (such as existing standards). Building on important policy deliberations from the United States that aim to navigate these challenges, we here apply emerging policy frameworks to the United Kingdom and outline five key priority areas that are intended to help policy makers make important strategic decisions in attempting to integrate patient/person generated data into electronic health records
A mixed method observational study of strategies to promote adoption and usage of an application to support asthma self-management
No full textBACKGROUND: Apps can potentially support asthma self-management, however attracting downloads and encouraging on-going adherence is challenging.OBJECTIVES: We observed the impact of different recruitment strategies and app features on adoption and continued use.METHODS: Practice nurses in five practices in Lothian/Oxford approached adults with active asthma to try out a prototype app. We also advertised the app via social media (Asthma UK; AUK Centre for Applied Research). We observed patients’ download and retention rates and sent pre- and post-trial questionnaires. We sampled 15 patients for interviews before and after using our app for one month to explore motivations, triggers and barriers to adoption and usage. Interviews were transcribed and analysed thematically with reference to the Fogg behaviour model.RESULTS: Social media attracted 87 users, but only 15 (17%) used the app for 30 days. Practices recruited 24 patients, 13 (54%) continued for 30 days. Successful adoption was dependent on ease of downloading and sufficient motivation. Some patients needed technological assistance with downloading the app and starting to use the features. Adherence was dependent on motivation derived from a sense that the healthcare professional and/or researcher was interested in the results, and that using an app to support their self-management could improve their asthma control.CONCLUSION: Social media attracted more downloads in a short time. However, most patients stopped using the app within a month. Practices recruited fewer patients, but patents adhered longer to the app. Dual promotion strategies (social media with practice support) may be the optimal approach to encourage adoption and adherence to telehealth
Automated conflict resolution between multiple clinical pathways: a technology report
Full text linkBackground: The number of people in the UK with three or more long-term conditions continues to grow and the management of patients with co-morbidities is complex. In treating patients with multimorbidities, a fundamental problem is understanding and detecting points of conflict between different guidelines which to date has relied on individual clinicians collating disparate information.Objective: We will develop a framework for modelling a diverse set of care pathways, and investigate how conflicts can be detected and resolved automatically. We will use this knowledge to develop a software tool for use by clinicians that can map guidelines, highlight root causes of conflict between these guidelines and suggest ways they might be resolved.Method: Our work consists of three phases. First, we will accurately model clinical pathways for six of the most common chronic diseases; second, we will automatically identify and detect sources of conflict across the pathways and howthey might be resolved. Third, we will present a case study to prove the validity of our approach using a team of clinicians to detect and resolve the conflicts in the treatment of a fictional patient with multiple common morbidities and compare their findings and recommendations with those derived automatically using our novel software.Discussion: This paper describes the development of an important software-based method for identifying a conflict between clinical guidelines. Our findings will support clinicians treating patients with multimorbidity in both primary and secondary care settings
Telemedicine: Is it really worth it? A perspective from evidence and experience.
Full text linkBackground: Although the formal evidence base is equivocal, practical experience suggests that implementations of technology that support telemedicine initiatives can result in improved patient outcomes, better patient and carer experience and reduced expenditure.Objective: To answer the questions “Is an investment in telemedicine worth it?” and “How do I make a telemedicine implementation work?”Methods: Summary of systematic review evidence and an illustrative case study. Discussion of implications for industry and policy.Results: Realisation of telemedicine benefits is much less to do with the technology itself and much more around the context of the implementing organisation and its ability to implement.Conclusion: We recommend that local organisations consider deployment of telemedicine initiatives but with a greater awareness of the growing body of implementation best practice. We also recommend, for the NHS, that the centre takes a greater role in the collation and dissemination of best practice to support successful implementations of telemedicine and other health informatics initiatives
Real World Evidence to an eHealth tool: The 2017 top ten papers from Journal of Innovation in Health Informatics
Full text linkWe report the top ten papers published by the Journal ofInnovation in Health Informatics in 2017
The Heimdall Framework for Supporting Characterisation of Learning Health Systems
Full text linkBackground: Learning Health Systems (LHS) can focus population medicine and Evidence Based Practice; smart technology delivering the next generation of improved healthcare described as Precision Medicine, and yet researchers in the LHS domain presently lack the ability to recognise their relevant works as falling within this domain.Objective: To review LHS literature and develop a framework describing the domain that can be used as a tool to analyse the literature and support researchers to identify health informatics investigations as falling with the domain of LHS.Method: A scoping review is used to identify literature on which analysis was performed. This resolved the ontology and framework. The ontology was applied to quantify the distribution of classifications of LHS solutions. The framework was used to analyse and characterise the various works within the body of LHS literature.Results: The ontology and framework developed was shown to be easily applicable to the literature, consistently describing and representing the goals, intentions and solutions of each LHS investigation in the literature. More proposed or potential solutions are described in the literature than implemented LHS. This suggests immaturity in the domain and points to the existence of barriers preventing LHS realisation.Conclusion: The lack of an ontology and framework may have been one of the causes for the failure to describe research works as falling within the LHS domain. Using our ontology and framework, LHS research works could be easily classified, demonstrating the comprehensiveness of our approach in contrast to earlier efforts
Can we trust Electronic health records? The Smoking Test for Commission Errors.
Full text linkBackground: Considerable interest exists on using general practice electronic health records (EHR) for research and other uses. There is also concern on their quality.Aim: We suggest a simple test to assess errors of commission and in consequence overall EHR data quality that can be done on a periodical basis.Method: Patient records with simultaneous entries of three different stages on smoking were studied. The codes “Never smoked tobacco”, “smoker” and “ex-smoker” should follow this chronological order. It should then be possible to extrapolate the overall level of errors of commission for the organisation.Results: The Smoking Test in our sample found errors in 169 patients, with 60 cases where dual errors were discovered. We express it as an estimated error of commission level of 2.6% related to the total population of the practice.Conclusions: Considering the constant and regular entries on smoking status (83.59% of the entries were done over last month), we can conclude smoking entries analysis can serve as a simple test to periodically assess the overall EHR data quality, and any trends
What to expect from electronic patient record system implementation; lessons learned from published evidence
Full text linkBackground: Numerous studies have examined specific factors related to success, failure and implications of Electronic patient record (EPR) system implementations, but usually limited to specific aspects. Objective: To review the published peer-reviewed literature and present findings regarding factors important in relation to successful EPR implementations and likely impact on subsequent clinical activity.Method: Literature reviewResults: 312 potential articles were identified on initial search of which 117 were relevant and included in the review. Several factors were related to implementation success, such as good leadership and management, infrastructure support, staff training and focus on workflows and usability. In general, EPR implementation is associated with improvements in documentation, and screening performance, and reduced prescribing errors, whereas there are minimal available data in other areas such as effects on clinical patient outcomes. The peer-reviewed literature appears to under-represent a range of technical factors important for EPR implementations, such as data migration from existing systems and impact of organisational readiness.Conclusion: The findings presented here represent synthesis of data from peer-reviewed literature in the field and should be of value to provide the evidence-base for organisations considering how best to implement an EPR system
Influence of previous work experience and education on Internet use of people in their 60s and 70s
Full text linkBackground: Internet use among the elderly is influenced by various demographic backgrounds, social life and health factors.Objective: This study aims to identify the impact of several demographic features on 60- to 79-year-old individuals’ intention to use the Internet.Method: Finland population data (N = 2508) from the 2012 IKIPOSA project was used with two cohorts: 60s group (n = 1515) and 70s group (n = 990). Descriptive statistic and two binomial logistic regressions have been used with the unadjusted effect and Forward LR method to measure each predictor’s contribution to the model. In addition, a preliminary analysis to measure the multicollinearity was performed.Result: Of the 18 independent variables, only nine predictors, namely, age, education, financial situation, having children, entrepreneurship, a leadership position, a higher level white-collar worker and a lower level white-collar worker, were significant factors in predicting the Internet use. Meanwhile, gender, having grandchildren, living alone, marital status, house location and type, stay-at-home mother or father, blue-collar worker, agricultural entrepreneur and social relations satisfaction were not significant predictors. The most significant predictors were education and age, which contributed 19% and 10%, respectively, to the model. Other significant predictors, lower level white-collar worker, higher level white-collar worker and financial situation, had less impact with only around 6%.Conclusion: Education and age were influential factors among elderly to use the Internet in their later life. Certain work experiences affect elderly people’s engagement with the Internet after retirement
The WHAAM Application: a Tool to Support the Evidence-Based Practice in the Functional Behaviour Assessment
Full text linkBackground: The most recent computing technologies can promote the application of evidence-based practice (EBP) in the field of Applied Behavior Analysis (ABA).Objective: The study describes how the use of technology can simplify the application of evidence-based practices in applied behaviour analysis.Methods: The WHAAM application demonstrates this in the following two case studies. We are monitoring dysfunctional behaviours, collecting behavioural data, performing systematic direct observations, creating a visual baseline and intervention charts and evaluating the planned interventions using the TAU-U statistical index. Results: Significant positive changes of children's problem behaviours are observed and recorded. Both the duration of the identified behaviour "to get out of bed in time" (r = -.79, TAU-U = -.58, p < .05) and the frequency of the behaviour "interrupting others" (r= -.96, TAU-U = -.82, p < .01) decreased. Conclusion: the WHAAM application is an effective tool to support functional behaviour assessments and it is an example of how technology can support practitioners by facilitating the application of evidence-based practices and increasing the communication among clinical, educational and family environments