Informatics in Primary Care (BCS, The Chartered Institute for IT)
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Radiological exposure evaluation through the computerised electronic records system as decisional support to X-ray examination justification in family medicine
Get PDFBackground In recent decades, patients' exposure to ionising radiation (IR) during diagnostic examinations has increased a great deal. X-ray requests do not always conform to the principle of 'justification', which emphasises the real utility and necessity of the examination. Databases maintained by general practitioners usually record all requests for radiological examinations of their patients and could be configured to assess the radiological risk for each patient.
Objective To show, through the analysis of the data extracted from a database commonly used by Italian general practitioners, whether it is possible to measure patients' exposure to IR in the previous five years, so that doctors are aware of thiswhen they refer patients for examination involving further exposure to radiation.
Method Records of 120 patients from an Italian general practice were randomly extracted from the practice database. The patients were a mix of male and female, aged from 15 to 64 years. All radiological examinations performed in the previous five years were recorded in a special spreadsheet, which had been created for computing the exposure to ionising radiation in milliSiviert.
Results The calculated cumulative exposure of the 120 patients showed a very different perspective, which could help doctors when applying the principle of justification and allow accurate information to be communicated to the patient concerning their relevant health problem.
Conclusions Databases maintained by general practitioners could easily be configured to automatically compute the radiological risk for each patient and to alert the doctor when an X-ray examination is prescribed, giving the doctor crucial decisional support for its justification
Implementation of an electronic medical record in family practice: a case study
Get PDFBackground Electronic medical records (EMRs) have the potential to foster a safer, more effective and more efficient healthcare system. However, their implementation in primary care practice remains a challenge.
Objective This study aims at exploring factors that have influenced the successful implementation of an EMR system in a family medicine group (FMG) in the Province of Qu_bec, Canada.
Methods A case study approach was selected to get a deep understanding of the phenomenon in its context. The case was chosen on the basis that it was the first FMG in Qu_bec to implement a full EMR used by all clinicians. Fifteen semi-structured interviews were conducted with key informants.
Results Factors that have influenced the success of the EMR implementation were classified under three broad themes: a project leader who combined the roles of clinical, technology and knowledge champion; an organisation that was open to and supportive of change; and an evidence-based implementation strategy tailored to the local context and adoption pace.
Conclusions This study underscores the importance of a champion for successful EMR implementation. It proposes a set of roles and characteristics that could be found in a champion as well as other elements for a successful EMR implementation strategy
Vault, cloud and agent: choosing strategies for quality improvement and research based on routinely collected health data
Get PDFCreating a diabetes foot reminder-based registry using the electronic medical record
Get PDFObjective We created a new diabetes foot examination clinical reminder to directly populate a foot risk registry and examined its accuracy versus administrative data.
Methods A pre- and post-test design assessed accuracy of coding foot risk and clinician acceptability. The intervention hospital's reminder was replaced with a dialogue tick box containing the International Diabetic Foot Classification System to populate risk using health factors.
Results There were no hospital agreement differences for each foot condition except diabetes and peripheral neuropathy, demonstrating higher agreement at the intervention hospital. There were no differences in service agreement adherence or consulting rates although both demonstrated significantly lower consulting rates at study end. The intervention hospital had a significantly lower patient cancellation rate (1% v. 5%, P=0.01) and better coding for grade 3 patients. The new reminder demonstrated high acceptability.
Conclusions The registry system resulted in improved discrimination of the highest foot risk. Further testing is recommended
Use of drug information resources by the community pharmacist in Penang, Malaysia
Get PDFPurpose This study aimed to identify the types of drug information resources used by community pharmacists in daily practice in Penang, Malaysia.
Method A cross-sectional based survey was conducted among randomly selected community pharmacists in Penang state, Malaysia. Data was analysed using the Statistical Package for Social Science Students SPSS 13'. Face-to-face interviews were conducted. A total of 85 community pharmacists were approached for this study. Of these, 65 pharmacists participated in the questionnaire survey, a response rate of 78.3%.
Results Tertiary drug resources were used by the majority. About 18% were retrieving drug information from the primary drug information resources. Other sources used to provide drug information were leaflets provided by company representatives, professional peers and drug seminars organised by pharmaceutical companies.
Conclusion The use of tertiary sources of drug information was more common among community pharmacists in Penang, despite the benefits of using primary information
Implementing an integrated computerised information system about foot problems in diabetes is not enough to ensure adoption. Commentary on: General practitioners' and nurses' experiences of using computerised decision support in screening for diabetic foot disease: implementing Scottish Clinical Information - Diabetes Care in routine clinical practice
Get PDFDisparities in health-related internet use by US veterans: results from a national survey
Get PDFBackground The internet can contribute to improved access to information and services among underserved populations. Little is known about veterans' use of the internet for health, and how it is affected by socio-demographic characteristics. This knowledge gap is acute given the US Department of Veterans Affairs' (VA's) deployment of a major patient portal/personal health record system.
Objectives To assess the frequency and correlates of veterans' use of the internet and identify personal characteristics impeding veterans' health-related internet use.
Methods Survey of 12 878 randomly selected adults from a panel of 60 000 US households. Veterans were oversampled.
Results Of the 3408 veterans responding, 54% had used the internet and 29% had used the internet specifically for health. In multi-variable analyses, general internet use was positively associated with younger age (OR = 0.03, CI = 0.01_0.06, oldest versus youngest group), higher income (OR = 3.12, CI = 2.10_4.63, _25 000), more education (OR = 4.2, CI = 2.92_6.02, most versus least educated group), and better health (OR = 0.59, CI = 0.42_83, fair/poor versus very good/excellent). Health-related internet use was positively associated with more education (OR = 2.32, CI = 1.45_3.74, most versus least educated group), urban location (OR = 2.41, CI = 1.66_3.50), and worse health (OR = 1.85, CI = 1.16_2.95, fair/poor versus very good/ excellent).
Conclusions In the first large, systematic survey of veterans' internet usewe found that more education and urban location were strongly, and positively, associated with veterans' health-related internet use, even after controlling for multiple socio-demographic characteristics. Interventions may be needed for less educated and rural veterans, e.g. by providers discussing internet use with their patients, or by the VA training veterans in health-related internet use
Adoption and use of health information technology in physician practice organisations: systematic review
Get PDFBackground Health information technology (HIT) has the potential to improve clinical outcomes, increase health provider productivity and reduce healthcare costs. Over half of all patient care is delivered in physician practice organisations, yet adoption and utilisation of HIT in these groups lags behind inpatient facilities.
Objective To better understand current utilisation rates along with benefits and barriers to HIT adoption in physician practice organisations.
Methods Published literature on the adoption and use of HIT in physician practice organisations within the USA between 12 January 2004 and 12 January 2009 and indexed in MEDLINE and EMBASE was included in the systematic review. Grey literature was also searched. Studies related to the adoption and use of HIT in hospitals and community health centres were excluded.
Results A total of 119 articles were eligible for inclusion in the review. Adoption rates across physician groups remain low, with between 9% and 29% of practices having implemented electronic medical records. HIT improves clinical outcomes, increases the use of vaccinations and improves medication adherence. Furthermore, HIT adoption leads to cost savings for physician groups, improves staff productivity and enriches patient_provider interactions. The largest barrier to HIT adoption in physician groups is the high initial and ongoing costs of electronic systems. Lack of sufficient training, a disorganised or non-receptive practice culture and technological problems such as inadequate connectivity appear to impede effective HIT use.
Conclusions HIT has the potential to positively impact on physician practice organisations, although significant and diverse barriers block adoption. Research into these obstacles should be coupled with efforts to understand barriers to effective implementation after HIT adoption
Automated processing of electronic medical records is a reliable method of determining aspirin use in populations at risk for cardiovascular events
Get PDFBackground Low-dose aspirin reduces cardiovascular risk; however, monitoring over-the-counter medication use relies on the time-consuming and costly manual review of medical records. Our objective is to validate natural language processing (NLP) of the electronic medical record (EMR) for extracting medication exposure and contraindication information.
Methods The text of EMRs for 499 patients with type 2 diabetes was searched using NLP for evidence of aspirin use and its contraindications. The results were compared to a standardised manual records review.
Results Of the 499 patients, 351 (70%) were using aspirin and 148 (30%) were not, according to manual review. NLP correctly identified 346 of the 351 aspirin-positive and 134 of the 148 aspirin-negative patients, indicating a sensitivity of 99% (95% CI 97_100) and specificity of 91% (95% CI 88_97). Of the 148 aspirin-negative patients, 66 (45%) had contraindications and 82 (55%) did not, according to manual review.NLP search for contraindications correctly identified 61 of the 66 patients with contraindications and 58 of the 82 patients without, yielding a sensitivity of 92% (95% CI 84_97) and a specificity of 71% (95% CI 60_80).
Conclusions NLP of the EMR is accurate in ascertaining documented aspirin use and could potentially be used for epidemiological research as a source of cardiovascular risk factor information
