Informatics in Primary Care (BCS, The Chartered Institute for IT)
Not a member yet
595 research outputs found
Sort by
Improving the measurement of longitudinal change in renal function: automated detection of changes in laboratory creatinine assay
Full text linkIntroductionRenal function is reported using the estimates of glomerular filtration rate (eGFR). However, eGFR values are recorded without reference to the particular serum creatinine (SCr) assays used to derive them, and newer assays were introduced at different time points across the laboratories in the United Kingdom. These changes may cause systematic bias in eGFR reported in routinely collected data, even though laboratory-reported eGFR values have a correction factor applied.DesignAn algorithm to detect changes in SCr that in turn affect eGFR calculation method was developed. It compares the mapping of SCr values on to eGFR values across a time series of paired eGFR and SCr measurements.SettingRoutinely collected primary care data from 20,000 people with the richest renal function data from the quality improvement in chronic kidney disease trial.ResultsThe algorithm identified a change in eGFR calculation method in 114 (90%) of the 127 included practices. This change was identified in 4736 (23.7%) patient time series analysed. This change in calibration method was found to cause a significant step change in the reported eGFR values, producing a systematic bias. The eGFR values could not be recalibrated by applying the Modification of Diet in Renal Disease equation to the laboratory reported SCr values.ConclusionsThis algorithm can identify laboratory changes in eGFR calculation methods and changes in SCr assay. Failure to account for these changes may misconstrue renal function changes over time. Researchers using routine eGFR data should account for these effects.
An algorithm to improve diagnostic accuracy in diabetes in computerised problem orientated medical records (POMR) compared with an established algorithm developed in episode orientated records (EOMR)
Full text linkAn algorithm that detects errors in diagnosis, classification or coding of diabetes in primary care computerised medial record (CMR) systems is currently available. However, this was developed on CMR systems that are “Episode orientated” medical records (EOMR); and don’t force the user to always code a problem or link data to an existing one. More strictly problem orientated medical record (POMR) systems mandate recording a problem and linking consultation data to them.
Journal of Innovation in Health Informatics: building on the 20-year history of a BCS Health peer review journal
Full text linkAfter 20-years as Informatics in Primary Care the journal is renamed Journal of Innovation in Health Informatics. The title was carefully selected to reflect that:(1) informatics provides the opportunity to innovate rather than simply automates;(2) implementing informatics solutions often results in unintended consequences, and many implementations fail and benefits and innovations may go unrecognised;(3) health informatics is a boundary spanning discipline and is by its very nature likely to give rise to innovation.Informatics is an innovative science, and informaticians need to innovate across professional and discipline boundaries
In this issue: Ontologies a key concept in informatics and key for open definitions of cases, exposures, and outcome measures
Full text linkPrimary care physicians’ perspectives on computer-based health risk assessment tools for chronic diseases: a mixed methods study
Full text linkBackground Health risk assessment tools compute an individual’s risk of developing a disease. Routine use of such tools by primary care physicians (PCPs) is potentially useful in chronic disease prevention. We sought physicians’ awareness and perceptions of the usefulness, usability and feasibility of performing assessments with computer-based risk assessment tools in primary care settings.Methods Focus groups and usability testing with a computer-based risk assessment tool were conducted with PCPs from both university-affiliated and community-based practices. Analysis was derived from grounded theory methodology.Results PCPs (n = 30) were aware of several risk assessment tools although only select tools were used routinely. The decision to use a tool depended on how use impacted practice workflow and whether the tool had credibility. Participants felt that embedding tools in the electronic medical records (EMRs) system might allow for health information from the medical record to auto-populate into the tool. User comprehension of risk could also be improved with computer-based interfaces that present risk in different formats.Conclusions In this study, PCPs chose to use certain tools more regularly because of usability and credibility. Despite there being differences in the particular tools a clinical practice used, there was general appreciation for the usefulness of tools for different clinical situations. Participants characterised particular features of an ideal tool, feeling strongly that embedding risk assessment tools in the EMR would maximise accessibility and use of the tool for chronic disease management. However, appropriate practice workflow integration and features that facilitate patient understanding at point-of-care are also essential.
Barriers and facilitators to health information exchange in low- and middleincome country settings: a systematic review protocol
Full text linkIntroductionThe ability to capture, exchange and use accurate information about patients and services is vital for building strong health systems, providing comprehensive and integrated patient care, managing public health risks and informing policies for public health and health financing. However, the organisational and technological systems necessary to achieve effective Health Information Exchange are lacking in many low- and middle-income countries (LMIC). Developing strategies for addressing this depends on understanding the barriers and facilitators to HIE at the individual, provider organisational, community, district, provincial and national levels. This systematic review aims to identify, critically appraise and synthesise the existing published evidence addressing these factors.ObjectiveTo assess what is known, from published / unpublished empirical studies, about barriers and facilitators to HIE in LMIC so as to identify issues that need to be addressed and approaches that can fruitfully be pursued in future improvement strategies.MethodsWe will conduct a systematic review to identify the empirical evidence base on the barriers and facilitators to HIE in LMIC. Two reviewers will independently search 11 major international and national databases for published, unpublished and in-progress qualitative, quantitative and mixed methods studies published during 1990-July 2014 in any language. These searches of scientific databases will be supplemented by looking for eligible reports available online. The included studies will be independently critically appraised using the Mixed Method Appraisal Tool (MMAT), version 2011. Descriptive, narrative and interpretative synthesis of data will be undertaken. Results These will be presented in a manuscript that will be published in the peer-reviewed literature. The protocol is registered with the International Prospective Register for Systematic Reviews (PROSPERO) CRD 4201400982
Minimally disruptive medicine is needed for patients with multimorbidity: time to develop computerised medical record systems to meet this requirement
Full text linkBackground Minimally disruptive medicine (MDM) is proposed as a method for more appropriately managing people with multiple chronic disease. Much clinical management is currently single disease focussed, with people with multimorbidity being managed according to multiple single disease guidelines. Current initiatives to improve care include education about individual conditions and creating an environment where multiple guidelines might be simultaneously supported. The patientcentred medical home (PCMH) is an example of the latter. However, educational programmes and PCMH may increase the burden on patients.Problem The cumulative workload for patients in managing the impact of multiple disease-specific guidelines is only relatively recently recognised. There is an intellectual vacuum as to how best to manage multimorbidity and how informatics might support implementing MDM. There is currently no alternative to multiple singlecondition- specific guidelines and a lack of certainty, should the treatment burden need to be reduced, as to which guideline might be ‘dropped’.Action The best information about multimorbidity is recorded in primary care computerised medical record (CMR) systems and in an increasing number of integrated care organisations. CMR systems have the potential to flag individuals who might be in greatest need. However, CMR systems may also provide insights into whether there are ameliorating factors that might make it easier for them to be resilient to the burden of care. Data from such CMR systems might be used to develop the evidence base about how to better manage multimorbidity.Conclusions There is potential for these information systems to help reduce the management burden on patients and clinicians. However, substantial investment in research-driven CMR development is needed if we are to achieve this
Connecting primary care clinics and community pharmacies through a nationwide electronic prescribing network: A qualitative study
Full text linkBackground The use of medication is at the heart of primary care, but is also the cause for major health concerns. It is therefore important to examine the prescription of medication process.Objective This study identifies the barriers and facilitators perceived by community pharmacists and primary care physicians concerning the adoption of a nationwide electronic prescribing (e-prescribing) network in the province of Quebec, Canada.Methods We used purposive sampling to identify the most intensive users of the e-prescribing network. We conducted phone and in-person interviews. Interviews were transcribed, and we analysed their content with NVivo, using the clinical adoption framework (CAF) for the codification of the data.Results We interviewed 33 pharmacists, 2 pharmacy technicians, 11 physicians and 3 clinic managers. Adoption of the e-prescribing network was fairly low. The respondents underlined adaptation of their work environment, openness to change and perception of benefits as facilitators to the adoption of the network. However, important barriers were perceived, including system quality issues and paper prescriptions being the only legal document in the prescribing process. Even if respondents recognised that the e-prescribing network can offer substantial benefits to the prescribing process, issues still persisted and raised barriers to the full use of such a network, especially in a context where different local information systems are connected within a nationwide e-prescribing network.Conclusion This study, based on the CAF, provides a better understanding of the factors related to the adoption of a nationwide e-prescribing network connecting primary care clinics and community pharmacies.
A simple clinical coding strategy to improve recording of child maltreatment concerns: an audit study
Full text linkBackground Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE) but there is evidence of substantial under-recording.Aim To determine whether a simple coding strategy improved recording of maltreatment-related concerns in electronic primary care records.Design and Setting Clinical audit of rates of maltreatment-related coding before January 2010–December 2011 and after January–December 2012 implementation of a simple coding strategy in 11 English family practices. The strategy included encouraging general practitioners to use, always and as a minimum, the Read code ‘Child is cause for concern’. A total of 25,106 children aged 0–18 years were registered with these practices. We also undertook a qualitative service evaluation to investigate barriers to recording.Method Outcomes were recording of 1) any maltreatment-related codes, 2) child protection proceedings and 3) child was a cause for concern.Results We found increased recording of any maltreatment-related code (rate ratio 1.4; 95% CI 1.1–1.6), child protection procedures (RR 1.4; 95% CI 1.1–1.6) and cause for concern (RR 2.5; 95% CI 1.8–3.4) after implementation of the coding strategy. Clinicians cited the simplicity of the coding strategy as the most important factor assisting implementation.Conclusion This simple coding strategy improved clinician’s recording of maltreatment-related concerns in a small sample of practices with some ‘buy-in’. Further research should investigate how recording can best support the doctor–patient relationshipHow this fits in Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE), but there is evidence of substantial underrecording. We describe a simple clinical coding strategy that helped general practitioners to improve recording of maltreatment-related concerns. These improvements could improve case finding of children at risk and information sharing
Using a self-service kiosk to identify behavioural health needs in a primary care clinic serving an urban, underserved population
Full text linkBackground Integration of behavioural health into primary care clinics is an established model of care and important approach to eliminating mental health disparities, but demands on provider time is a barrier to mental health screening. The purpose of this study was to determine the feasibility of using a kiosk placed in a primary care clinic to screen for multiple mental health disorders.Methods Quality improvement initiative with Plan-Do-Study-Act implementation and time series monitoring of utilisation outcomes.Results A total of 281 screens were completed identifying positive screens for depression (30%) and bipolar disorder (17%). Post-traumatic stress disorder and concerning substance use were less common.Conclusions Development of health information technology to facilitate behavioural health assessment in primary care is a promising approach to integrated care and provides additional benefits of population health monitoring.