Informatics in Primary Care (BCS, The Chartered Institute for IT)
Not a member yet
595 research outputs found
Sort by
Auditing quality in kidney disease and diabetes: is the precise the enemy of the good? A commentary on difficulties auditing pathology results containing 'greater than' or 'less than' signs
Full text link
Usability of computerised physician order entry in primary care: assessing ePrescribing with a new evaluation model
Full text linkBackground The incorrect use of medications may result from improper prescribing. The poor interface and design of computerised physician order entry (CPOE) systems may contribute. To improve the quality of electronic drug prescription, ePrescribing, there is a need for an evaluation model that is able to assess the quality of the CPOE, focusing on usability.
Objective To develop and apply a model to evaluate the usability of different CPOEs used for ePrescribing in electronic health records (EHRs) in primary care.
Method An evaluation model for CPOEs was designed by assembling existing quality criteria for ePrescribing, supplemented with new criteria. The evaluation model was used to assess CPOEs from seven EHRs in primary care.
Results The evaluation model included five categories comprising 73 single criteria. The model was found to be easy to use, and facilitated the assessment process. Evaluation of the EHRs revealed differences and similarities between the systems. None of the CPOEs was perfect in that all of them had distinct shortcomings. The most prominent deficiencies were a non-intuitive interface and incorrect dosage function.
Conclusion The model developed might be used not only to evaluate usability in ePrescribing, but also as a basis for studying the usability of other CPOEs. To reduce the risk of drugs being prescribed with incorrect dosages, the most urgent improvement is the development of a more consistent and intuitive interface for the EHRs and an improvement in the dosage function
A systematic evaluation of paediatric medicines information content in clinical decision support tools on smartphones and mobile devices
Full text linkBackground Medication information is often poorly delineated for paediatric patients, resulting in high off-label and non-licensed use of drugs in this population. Access to accurate medicines information in this population becomes a necessity in order to avoid medication errors. Clinical decision support tools (CDSTs), which are increasingly available on mobile devices (e.g. smartphones), can provide healthcare providers with convenient access to paediatric medicines information at point of care. However, to date no systematic evaluation of the content in these CDSTs has been conducted.
Objectives To evaluate paediatricmedicines information in CDSTs for smartphones and other mobile devices.
Method Evaluation of CDSTs according to scope and completeness was accomplished via weighted categories of 108 questions distributed evenly across three age groups: infants, children and adolescents.
Results Three paediatric-specific databases and six general databases were evaluated. The best performer provided 75.9% of the answers for scope and scored 69.7% for completeness. Databases generally performed less effectively in providing answers sourced from clinical guidelines compared with more conservative sources such as package inserts.
Conclusions Overall, general medicines information CDSTs performed better than paediatricspecific CDSTs in both scope and completeness. Results from this study may help guide CDST selection on mobile devices by healthcare professionalswhose patient populations include paediatrics
Construction and validation of a scoring system for the selection of high-quality data in a Spanish population primary care database (SIDIAP)
Full text linkBackground Computerised databases of primary care clinical records are widely used for epidemiological research. In Catalonia, the Information System for the Development of Research in Primary Care (SIDIAP) aims to promote the development of research based on high-quality validated data from primary care electronic medical records. Objective The purpose of this study is to create and validate a scoring system (Registry Quality Score, RQS) that will enable all primary care practices (PCPs) to be selected as providers of researchusable data based on the completeness of their registers.
Methods Diseases that were likely to be representative of common diagnoses seen in primary care were selected for RQS calculations. The observed/ expected cases ratio was calculated for each disease. Once we had obtained an estimated value for this ratio for each of the selected conditions we added up the ratios calculated for each condition to obtain a final RQS. Rate comparisons between observed and published prevalences of diseases not included in the RQS calculations (atrial fibrillation, diabetes, obesity, schizophrenia, stroke, urinary incontinence and Crohn's disease) were used to set the RQS cutoff which will enable researchers to select PCPs with research-usable data.
Results Apart from Crohn's disease, all prevalences were the same as those published from the RQS fourth quintile (60th percentile) onwards. This RQS cut-off provided a total population of 1 936 443 (39.6% of the total SIDIAP population).
Conclusions SIDIAP is highly representative of the population of Catalonia in terms of geographical, age and sex distributions. We report the usefulness of rate comparison as a valid method to establish research-usable data within primary care electronic medical records
Anything but engaged: user involvement in the context of a national electronic health record implementation
Full text linkBackground The absence of meaningful end user engagement has repeatedly been highlighted as a key factor contributing to 'failed' implementations of electronic health records (EHRs), but achieving this is particularly challenging in the context of national scale initiatives. In 2002, the National Health Service (NHS) embarked on a so-called 'top-down' national implementation strategy aimed at introducing commercial, centrally procured, EHRs into hospitals throughout England.
Objective We aimed to examine approaches to, and experiences of, user engagement in the context of a large-scale EHR implementation across purposefully selected hospital care providers implementing early versions of nationally procured software.
Methods We conducted a qualitative, case-study based, socio-technically informed, longitudinal investigation, purposefully sampling and collecting data from four hospitals. Our data comprised a total of 123 semi-structured interviews with users and managers, 15 interviews with additional stakeholders, 43 hours of non-participant observations of meetings and system use, and relevant organisation- specific documents from each case study site. Analysis was thematic, building on an existing model of user engagement that was originally developed in the context of studying the implementation of relatively simple technologies in commercial settings. NVivo8 software was used to facilitate coding.
Results Despite an enduring commitment to the vision of shared EHRs and an appreciation of their potential benefits, meaningful end user engagement was never achieved. Hospital staff were not consulted in systems choice, leading to frustration; they were then further alienated by the implementation of systems that they perceived as inadequately customised. Various efforts to achieve local engagement were attempted, but these were in effect risk mitigation strategies. We found the role of clinical champions to be important in these engagement efforts, but progress was hampered by the hierarchical structures within healthcare teams. As a result, engagement efforts focused mainly on clinical staff with inadequate consideration of management and administrative staff.
Conclusions This work has allowed us to further develop an existing model of user engagement from the commercial sector and adapt it to inform user engagement in the context of large-scale eHealth implementations. By identifying key points of possible engagement, disengagement and re-engagement, this model will we hope both help those planning similar large-scale EHR implementation efforts and act as a much needed catalyst to further research in this neglected field of enquiry
Leveraging electronic health records to support chronic disease management: the need for temporal data views
Full text linkBackground The ageing population worldwide is increasingly acquiring multiple chronic diseases. The complex management of chronic diseases could be improved with electronic health records (EHRs) tailored to chronic disease care, but most EHRs in use today do not adequately support longitudinal data management. A key aspect of chronic disease management is that it takes place over long periods, but the way that most EHRs display longitudinal data makes it difficult to trend changes over time and slows providers as they review each patient's unique course.
Methods We present five clinical scenarios illustrating longitudinal data needs in complex chronic disease management. These scenarios may function as example cases for software development.
Outputs For each scenario, we describe and illustrate improvements in temporal data views. Two potential solutions are visualisation for numerical data and disease-oriented text summaries for non-numerical data.
Conclusions We believe that development and widespread implementation of improved temporal data views in EHRs will improve the efficiency and quality of chronic disease management in primary care
The history of the Read codes: the inaugural James Read Memorial Lecture 2011
Full text linkGeneral practitioner (GP) computing has its origins in the 1970s when the benefits of clinical coding and prescribing were demonstrated. During the early 1980s Dr James Read, working with Abies Informatics Ltd, developed the eponymous Read Codes, which were broader and more comprehensive than other schemes, yet intuitive and easy to use. In 1988 a joint working party of the Royal College of General Practitioners (RCGP) and the British Medical Association (BMA) recommended that the Read Codes be adopted nationally.
The Read Codes have been used by almost all GPs in the UK since the mid-1990s. Many developments in general practice, including GP fundholding (where GPs held the budgets to commission elective care for their patients), the Quality and Outcomes Framework (QOF - pay for performance for improving chronic disease management) and GP commissioning (the current NHS reform in which primary care leads commissioning of services for their patients) would have been impossible without all GPs using a common clinical coding scheme.
Systematized Nomenclature For Medicine - Clinical Terms (SNOMED CT) is a merger of the Read Codes with SNOMED RT - the original SNOMED reference terminology developed by the American College of Pathologists
