Informatics in Primary Care (BCS, The Chartered Institute for IT)
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PC-based note taking in patient-centred diagnostic interviews: a thematic analysis of patient opinion elicited using a pilot survey instrument
Full text linkBackground Computers are used increasingly in patient_clinician consultations. There is the potential for PC use to have an effect on the communication process.
Objective The aim of this preliminary study was to investigate patient opinion regarding the use of PCbased note taking during diagnostic vestibular assessments.
Method We gave a simple four-item questionnaire to 100 consecutive patients attending for vestibular assessment at a secondary referral level primary care trust audiology service. Written responses to two of the questionnaire items were subject to an inductive thematic analysis.
Results Thequestionnairewasacceptable topatients, none refused to complete it. Dominant themes identified suggest that patients do perceive consistent positive benefits from the use of PC-based note taking.
Conclusion This pilot study's short survey instrument is usable and may provide insights into patients' perceptions of computer use in a clinical setting
Identification of patients with neuropathic pain using electronic primary care records
Full text linkBackground Chronic neuropathic pain is a common condition which is challenging to treat. Many people with neuropathic pain are managed in the community, so primary care records may allow more appropriate subjects to be recruited for clinical studies.
Objective We investigated whether primary care records can be used to identify patients with diseases associated with neuropathic pain.
Method We analysed demographic, diagnostic and prescribing data from over 100 000 primary care electronic patient records in one part of London, UK.
Results The prevalence of diagnoses associated with chronic neuropathic pain was 13 per 1000, with the elderly, women and white patients experiencing the greatest burden of disease.
Conclusion Computerised health records offer an excellent opportunity to improve the identification of patients for clinical research in complex conditions like chronic neuropathic pain. To make full use of data from these records, standardisation of clinical coding and consensus on diagnostic criteria are needed
Use of email in communication between the Finnish primary healthcare system and general practitioners
Full text linkBackground The volume of emails is rising rapidly everywhere. However, there is no data available concerning how primary healthcare physicians feel about the use of email communication between themselves, with their managers and with other people contacting them.
Objective The objective of this study was to find out what the attitudes of primary care physicians are towards email at work.
Methods The use of email was studied among a convenience sample of primary healthcare physicians.
Results Physicians thought that email was a good instrument for delivering information but not as an instrument for leadership. Physicians in lead positions thought more often than ordinary general practitioners (GPs) that email is good for information. The leaders used email more actively than other GPs. The contents of the emails received by the GPs differed depending on the site of work. The total number of emails was higher in urban areas than in rural areas. Emails relating to administration, educational information and meeting materials were more often sent in rural than in urban primary healthcare settings. Information about daily work arrangements and about social events were more frequently emailed in urban than in rural surroundings. Email was considered important for information inside the system but a somewhat difficult tool for discussing complicated subjects. Generally, it was agreed that there was some unimportant information filtering through this medium to the target GPs. GPs were uncertain whether important data reached everybody who needed it or not. Still, almost everybody used the email system regularly and the use of it was considered relatively easy. GPs were generally prone to adopt advice and instructions given via email and implemented those in their working routines. The use of the email system was related to technical ability to use the system. The easier the GP thought that the email system was the more he used it. Rural GPs were more critical in applying advice shared via email than their counterparts in urban areas. In general, physicians thought that email was a good method for reaching many people at the same time. However, the main points of the messages may be missed and the whole email may sometimes not be read.
Conclusion Especially during periods of change in the workplace, it is very important that management is conducted personally. Care must be taken so that disinformation does not spoil the informative value of email in the administration of primary health care. The needed technical assistance should be given to everyone in order to get the best advantage from the use of the email system
Perceptions on the quality of records received via the GP2GP electronic transfer service: pilot online questionnaire study
Full text linkAim To obtain insight into the perceived quality of electronic records received by GP2GP transfer, from the perspective of staff within the receiving practice.
Methods A pilot study using a self-completion online survey.We used textual analysis and descriptive statistics to report the findings.
Results Respondents considered a significantly higher proportion of their own records to be accurate, complete and useful compared with records transferred from other practices (P<0.0001). However, very few respondents felt that a large proportion of records were fully inaccurate, incomplete or useless. Perceived accuracy, completeness and usefulness were positively associated with the proportion of electronic records requiring no modification when reconciled with paper records, and negatively associated with the proportion of records requiring major additional information when reconciled with paper records. There were no significant differences in perceived accuracy or completeness of GP2GP records according to which brand of GP electronic patient record system was used.
Conclusion The results suggest that respondents value the GP2GP record transfer system. They perceive issues with record quality, which require significant resources to rectify. Textual analysis suggests that difficulties in mapping data structures between systems may underlie some of the perceived issues. Further research is needed to confirm these initial findings on differential perception and explore their underlying causes
Study of electronic prescribing rates and barriers identified among providers using electronic health records in New York City
Full text linkBackground Increased electronic prescribing (eRx) rates have the potential to prevent errors, increase patient safety, and curtail fraud. US Federal meaningful use guidelines require at least a 40% electronic prescribing rate.
Objective We evaluated eRx rates among primary care providers in New York City in order to determine trends as well as identify any obstacles to increased eRx rates required by meaningful use guidelines.
Methods The datawe analysed included automatic electronic data transmissions from providers enrolled in the Primary Care Information Project (PCIP) from 1 January 2009 to 1 July 2010 and follow-up telephone calls to a subset of these providers to identify potential barriers to increased eRx usage.
Results Over the course of the study, these providers increased the eRx rate from 12.9 to 27.5%, with an average rate of 24.1%. Conversations with providers identified their perceived barriers to increased eRx use as primarily patient preference for paper prescriptions and a belief that many pharmacies do not accept eRx.
Conclusions The data gathered from our providers indicate that there is an increasing trend in the eRx rate to 27.5% by July 2010, but still short of the 40% meaningful use level. However, obstacles to increased rates remain primarily providers' belief that many patients prefer paper prescriptions and many pharmacies are not yet prepared to accept electronic prescriptions
Making health information and communications technology (ICT) relevant and usable for quality improvement and research
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Defining datasets and creating data dictionaries for quality improvement and research in chronic disease using routinely collected data: an ontology-driven approach
Full text linkBackground The burden of chronic disease is increasing, and research and quality improvement will be less effective if case finding strategies are suboptimal.
Objective To describe an ontology-driven approach to case finding in chronic disease and how this approach can be used to create a data dictionary and make the codes used in case finding transparent.
Method A five-step process: (1) identifying a reference coding system or terminology; (2) using an ontology-driven approach to identify cases; (3) developing metadata that can be used to identify the extracted data; (4) mapping the extracted data to the reference terminology; and (5) creating the data dictionary.
Results Hypertension is presented as an exemplar. A patient with hypertension can be represented by a range of codes including diagnostic, history and administrative. Metadata can link the coding system and data extraction queries to the correct data mapping and translation tool, which then maps it to the equivalent code in the reference terminology. The code extracted, the term, its domain and subdomain, and the name of the data extraction query can then be automatically grouped and published online as a readily searchable data dictionary. An exemplar online is: www.clininf.eu/qickd-data-dictionary.html
Conclusion Adopting an ontology-driven approach to case finding could improve the quality of disease registers and of research based on routine data. It would offer considerable advantages over using limited datasets to define cases. This approach should be considered by those involved in research and quality improvement projects which utilise routine data
Using a data entry clerk to improve data quality in primary care electronic medical records: a pilot study
Full text linkBackground The quality of electronic medical record (EMR) data is known to be problematic; research on improving these data is needed.
Objective The primary objective was to explore the impact of using a data entry clerk to improve data quality in primary care EMRs. The secondary objective was to evaluate the feasibility of implementing this intervention.
Methods We used a before and after design for this pilot study. The participants were 13 community based family physicians and four allied health professionals in Toronto, Canada. Using queries programmed by a data manager, a data clerk was tasked with re-entering EMR information as coded or structured data for chronic obstructive pulmonary disease (COPD), smoking, specialist designations and interprofessional encounter headers. We measured data quality before and three to six months after the intervention. We evaluated feasibility by measuring acceptability to clinicians and workload for the clerk.
Results After the intervention, coded COPD entries increased by 38% (P = 0.0001, 95% CI 23 to 51%); identifiable data on smoking categories increased by 27% (P = 0.0001, 95% CI 26 to 29%); referrals with specialist designations increased by 20% (P = 0.0001, 95% CI 16 to 22%); and identifiable interprofessional headers increased by 10% (P = 0.45, 95 CI _3 to 23%). Overall, the interventionwas rated as being at least moderately useful and moderately usable. The data entry clerk spent 127 hours restructuring data for 11 729 patients.
Conclusions Utilising a data manager for queries and a data clerk to re-enter data led to improvements in EMR data quality. Clinicians found this approach to be acceptable