Informatics in Primary Care (BCS, The Chartered Institute for IT)
Not a member yet
595 research outputs found
Sort by
How do GPs versus GP trainees adapt to electronic health records? A Portuguese pilot study
Full text linkBackground This study compares general practitioners (GPs) and general practice trainees (GPTs) on the adaptation to the electronic health records (EHRs) and how they perceive its impact on medical consultations.Methods Cross-sectional, descriptive study. The link for an online questionnaire was sent to mainland Portuguese health care centre groups.Results A total of 147 physicians (100 females and 47 males). GPs had more learning difficulties in using the EHR (P < 0.05), greater difficulty in keeping regular updated records (P < 0.001) and a more noticeable fear of the possibility of occurring prescription errors (P < 0.05), when compared with GPTs. Most GPs (75%) and GPTs (80.4%) are satisfied with how they use the EHR.Conclusions Most participants have adhered to the EHR, and are satisfied with its use. A negative impact on medical consultations was not observed. However, it is the group of GPs that is less adapted to the electronic system
Approaches and challenges to optimising primary care teams’ electronic health record usage
Full text linkBackground Although the presence of an electronic health record (EHR) alone does not ensure high quality, efficient care, few studies have focused on the work of those charged with optimising use of existing EHR functionality.Objective To examine the approaches used and challenges perceived by analysts supporting the optimisation of primary care teams’ EHR use at a large U.S. academic health care system.Methods A qualitative study was conducted. Optimisation analysts and their supervisor were interviewed and data were analysed for themes.Results Analysts needed to reconcile the tension created by organisational mandates focused on the standardisation of EHR processes with the primary care teams’ demand for EHR customisation. They gained an understanding of health information technology (HIT) leadership’s and primary care team’s goals through attending meetings, reading meeting minutes and visiting with clinical teams. Within what was organisationally possible, EHR education could then be tailored to fit team needs. Major challenges were related to organisational attempts to standardise EHR use despite varied clinic contexts, personnel readiness and technical issues with the EHR platform. Forcing standardisation upon clinical needs that current EHR functionality could not satisfy was difficult.Conclusions Dedicated optimisation analysts can add value to health systems through playing a mediating role between HIT leadership and care teams. Our findings imply that EHR optimisation should be performed with an in-depth understanding of the workflow, cognitive and interactional activities in primary care
Getting on with your computer is associated with job satisfaction in primary care: entrants to primary care should be assessed for their competency with electronic patient record systems
Full text linkJob satisfaction in primary care is associated with getting on with your computer. Many primary care professionals spend longer interacting with their computer than anything else in their day. However, the computer often makes demands rather than be an aid or supporter that has learned its user’s preferences. The use of electronic patient record (EPR) systems is underrepresented in the assessment of entrants to primary care, and in definitions of the core competencies of a family physician/general practitioner. We call for this to be put right: for the use of the EPR to support direct patient care and clinical governance to be given greater prominence in training and assessment. In parallel, policy makers should ensure that the EPR system use is orientated to ensuring patients receive evidence-based care, and EPR system suppliers should explore how their systems might better support their clinician users, in particular learning their preferences
Mapping French terms in a Belgian guideline on heart failure to international classifications and nomenclatures: the devil is in the detail
Full text linkIntroduction With growing sophistication of eHealth platforms, medical information is increasingly shared across patients, health care providers, institutions and across borders. This implies more stringent demands on the quality of data entry at the point-of-care. Non-native English-speaking general practitioners (GPs) experience difficulties in interacting with international classification systems and nomenclatures to facilitate the secondary use of their data and to ensure semantic interoperability.Aim To identify words and phrases pertaining to the heart failure domain and to explore the difficulties in mapping to corresponding concepts in ICPC-2, ICD-10, SNOMED-CT and UMLS.Methods The medical concepts in a Belgian guideline for GPs in its French version were extracted manually and coded first in ICPC-2, then ICD-10 by a physician, an expert in classification systems. In addition, mappings were sought with SNOMED-CT and UMLS concepts, using the UMLS SNOMED-CT browser.Results We identified 143 words and phrases, of which 128 referred to a single concept (1-to-1 mapping), while 15 referred to two or more concepts (1-to-n mapping to ICPC rubrics or to the other nomenclatures). In the guideline, words or phrases were often too general for specific mapping to a code or term. Marked discrepancy between semantic tags and types was found.Conclusion This article shows the variability of the various international classifications and nomenclatures, the need for structured guidelines with more attention to precise wording and the need for classification expertise embedded in sophisticated terminological resources. End users need support to perform their clinical work in their own language, while still assuring standardised and semantic interoperable medical registration. Collaboration between computational linguists, knowledge engineers, health informaticians and domain experts is needed
The collection and utilisation of patient ethnicity data in general practices and hospitals in the United Kingdom: a qualitative case study
Full text linkBackground Although the collection of patient ethnicity data is a requirement of publicly funded healthcare providers in the UK, recording of ethnicity is sub-optimal for reasons that remain poorly understood.Aims and objectives We sought to understand enablers and barriers to the collection and utilisation of ethnicity data within electronic health records, how these practices have developed and what benefit this information provides to different stakeholder groups.Methods We undertook an in-depth, qualitative case study drawing on interviews and documents obtained from participants working as academics, managers and administrators within the UK.Results Information regarding patient ethnicity was collected and coded as administrative patient data, and/or in narrative form within clinical records. We identified disparities in the classification of ethnicity, approaches to coding and levels of completeness due to differing local, regional and national policies and processes. Most participants could not identify any clinical value of ethnicity information and many did not know if and when data were shared between services or used to support quality of care and research.Conclusions Findings highlighted substantial variations in data classification, and practical challenges in data collection and usage that undermine the integrity of data collected. Future work needs to focus on explaining the uses of these data to frontline clinicians, identifying resources that can support busy professionals to collect standardised data and then, once collected, maximising the utility of these data
Using information to deliver safer care: a mixed-methods study exploring general practitioners’ information needs in North West London primary care
Full text linkBackground The National Health Service in England has given increasing priority to improving inter-professional communication, enabling better management of patients with chronic conditions and reducing medical errors through effective use of information. Despite considerable efforts to reduce patient harm through better information usage, medical errors continue to occur, posing a serious threat to patient safety.Objectives This study explores the range, quality and sophistication of existing information systems in primary care with the aim to capture what information practitioners need to provide a safe service and identify barriers to its effective use in care pathways.Method Data were collected through semi-structured interviews with general practitioners from surgeries in North West London and a survey evaluating their experience with information systems in care pathways.Results Important information is still missing, specifically discharge summaries detailing medication changes and changes in the diagnosis and management of patients, blood results ordered by hospital specialists and findings from clinical investigations. Participants identified numerous barriers, including the communication gap between primary and secondary care, the variable quality and consistency of clinical correspondence and the inadequate technological integration.Conclusion Despite attempts to improve integration and information flow in care pathways, existing systems provide practitioners with only partial access to information, hindering their ability to take informed decisions. This study offers a framework for understanding what tools should be in place to enable effective use of information in primary care.
Undertaking sociotechnical evaluations of health information technologies
Full text linkThere is an increasing international recognition that the evaluation of health information technologies should involve assessments of both the technology and the social/organisational contexts into which it is deployed. There is, however, a lack of agreement on definitions, published guidance on how such ‘sociotechnical evaluations’ should be undertaken, and how they distinguish themselves from other approaches. We explain what sociotechnical evaluations are, consider the contexts in which these are most usefully undertaken, explain what they entail, reflect on the potential pitfalls associated with such research, and suggest possible ways to avoid these
Effects of exam room EHR use on doctor-patient communication: a systematic literature review
Full text linkBackground High levels of funding have been invested in health information technologies, especially electronic health records (EHRs), in an effect to coordinate and organize patient health data. However, the effect of EHRs in the exam room on doctor–patient communication has not been sufficiently explored.Objective The purpose of this systematic review was to determine how physician use of EHRs in medical consultations affects doctor–patient communication, both in terms of patient perceptions and actual physician behaviours.Method The reviewer conducted a comprehensive online database search in March 2013 of EMBASE, MEDLINE, and SCOPUS, using a combination of synonyms of the terms “patient”, “doctor”, “communication”, and “EHR” or “computing”. For inclusion in this review, articles had to be published in English, take place in an outpatient setting and demonstrate an empirical investigation into whether EHR affects doctor–patient communication. The reviewer then analysed 13 articles that met the inclusion criteria.Results Studies showed EHR use encouraged biomedical questioning of the patient, and encouraged patient-led questioning and doctor-led information provision. EHR-related behaviours such as keyboarding and screen gaze impaired relationships with patients, by reducing eye contact, rapport, and provision of emotional support. EHRs negatively affected physician-led patient-centred communication. Computer use may have amplified existing physician behaviours regarding medical record use.Conclusion We noted both positive and negative effects of EHR use. This review highlights the need for increased EHR-specific communication training to mitigate adverse effects and for continued acknowledgement of patient perspectives
Using the Internet as a source of information and support: a discussion paper on the risks and benefits for children and young people with long-term conditions
Full text linkChildren and young people who have long-term conditions are likely to seek healthrelated information via the Internet. Because of their continuing contact with children with such conditions, primary care practitioners may be well placed to discuss with them and their families the risks and benefits of accessing information online. This includes not only the relative merits of particular sites but also more general online safety issues. To achieve this, it may be helpful for primary care practitioners to consider how they view risk in general, the risks associated with the Internet and the vulnerabilities of children and young people, particularly those with long-term conditions
In this issue - How informatics contributes across the domains of the chronic care model
No full textIn this issue we include a range of important papers that contribute across the domains of the chronic care model (CCM). The chronic care model was described in Bodenheimer et al. in the second of two seminal papers back in 2002; they describe what should be the components of a health system that is better adapted to manage chronic disease