Informatics in Primary Care (BCS, The Chartered Institute for IT)
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Flagging fasting plasma glucose specimens: time to routinely label the context in which pathology specimens are recorded
Get PDFFurther changes are needed if the National Care Record Service (NCRS) implementation is to succeed
Get PDFThe Wellcome Trust Report: moving forward the use of general practice electronic patient records for research
Get PDFImminent adopters of electronic health records in ambulatory care
Get PDFBackground Although evidence suggests electronic health records (EHRs) can improve quality and efficiency, provider adoption rates in the US ambulatory setting are relatively low. Prior studies have identified factors correlated with EHR use, but less is known about characteristics of physicians on the verge of adoption.
Objective To compare characteristics of physicians who are imminent adopters of EHRs with EHR users and non-users.
Design and participants A survey was mailed (June - November 2005) to a stratified random sample of all medical practices in Massachusetts. One physician from each practice (n=1884) was randomly selected to participate. Overall, 1345 physicians (71.4%) responded to the survey, with 1082 eligible for analysis due to exclusion criteria. 'Imminent adopters' were those planning to adopt EHRs within 12 months.
Measurements We assessed physician and practice characteristics, availability of technology, barriers to adoption or expansion of health information technology (HIT), computer proficiency, and financial considerations.
Results Compared to non-users, imminent adopters were younger, more experienced with technology, and more often in practices engaged in quality improvement. More imminent adopters owned or partly owned their practices (57.4%) than users (33.5%; p<0.001), but fewer imminent adopters owned their practices than non-users (65.7%; p<0.001). Additionally, more imminent adopters (26.0%) reported personal financial incentives for HIT use than users (14.8%; p<0.001) and non-users (10.8%; p<0.001).
Conclusions Imminent adopters of EHRs differed from users and non-users. Financial considerations appear to play a major role in adoption decisions. Knowledge of these differences may assist policymakers and healthcare leaders as they work to increase EHR adoption rates
Variation in the recording of diabetes diagnostic data in primary care computer systems: implications for the quality of care
Get PDFBackground Diabetes mellitus (DM) is a serious, chronic condition affecting 2.3 million people in the UK and consuming over 5% of the total National Health Service (NHS) budget. The World Health Organization (WHO) has produced a classification of diabetes which should help ensure consistent diagnosis and management of cases. However, recent quality based targets for diabetes in the UK only allow for people with Type 1 or Type 2 diabetes to be included in the disease register.
Objective To analyse the codes offered when recording a diagnosis of diabetes in an electronic patient record (EPR) system and to assess what proportion of existing codes would map to known diagnostic categories.
Method Code-sets (4-byte, 5-byte, CTv3 and SNOMED-CT) were sourced using the NHS Triset Browser and the SNOMED-CT website. We analysed the variation in child codes listed under 'diabetes mellitus'. Picking lists were generated across four general practices, using eight search terms. We examined list length and the types of codes offered. An attempt was also made to map current codes to the WHO classification of diabetes, defining each as having a 'direct mapping', a 'possible mapping', or 'no clear mapping'.
Results SNOMED-CT provided a more concise list of codes (115) than the more widely used 5- byte code-set (177). There was considerable variation in the codes offered in picking lists, with variation occurring between systems, rather than between individual GP practices. In considering the potential for mapping between current code-sets and the WHO classification, there was a general downward trend in the number that had 'no clear mapping' (5-byte Read codes - 46.3%, SNOMEDCT - 19.1%).
Conclusion There is considerable variation in the different diabetic coding hierarchies and in the choices offered at the point of coding in an EPR system. This is likely to lead to inconsistent data recording. Migrating GP computer systems to SNOMED-CT or to another more limited coding system which would map to international disease classifications would enable primary care EPR systems to better support improved standards of care
Adoption of information technology in primary care physician offices in New Zealand and Denmark, part 3: medical record environment comparisons
Get PDFThis is the third in a series of five papers about the use of computing technology in general practitioner (GP) practices in Denmark and New Zealand. This paper looks at the environments within which electronic medical records (EMRs) operate, including their functionality and the extent to which electronic communications are used to send and receive clinical information. It also introduces the notion of a longitudinal electronic health record (versus an EMR)
Early experience of the use of short message service (SMS) technology in routine clinical care
Get PDFObjective To conduct a technical appraisal and qualitative interviews with short message service (SMS - mobile phone text message) users in mainstream health care.
Design Observation of service usage followed by in-depth semi-structured interviews.
Setting A National Health Service (NHS) general practice in Scotland.
Participants One hundred and eighty patients registered.
Main outcome measures Service utilisation and patients' views.
Results It was technically feasible to open up access to mainstream NHS general practice services using SMS for appointment booking, repeat prescription ordering, clinical enquiries and remote access to the core clinical summary.
Conclusion Patients were able to use SMS services responsibly and found automation of prescription ordering particularly useful. Service utilisation was modest and did not adversely impact on the workload of general practitioners (GPs) or their staff
Involving patients in checking the validity of the NHS shared record: a single practice pilot
Get PDFObjective To assess how involved patients wish to be in the compilation of their NHS core clinical record, and to assess the accuracy of general practitioner (GP) produced summaries.
Design, setting, method and participants In a Scottish urban practice of 6800 patients we compiled a core clinical summary based on historical paper and electronic records. We invited a 1 in 10 sample of our patients of all ages to request, view and checka copy of their core clinical record. We offered patients the chance to discuss and correct any inaccuracies in their core clinical summary by use of a response form, telephone or meeting.
Results Out of 646 patients, 258 (40% of our sample) responded to the invitation to checktheir core clinical summary. Of those, 187 (72.5%) of these summaries were accurate according to patients. There were 89 inaccuracies reported by patients. Of these, 42 (47%) were of obvious clinical importance including wrongly entered diagnoses, or missing major morbidity such as an operation, or errors in repeat medication. There were 47 (53%) inaccuracies in lifestyle data (smoking, alcohol history or weight), or dates of illnesses.
Conclusion Only a minority of patients chose to view and offer comment on their core clinical summaries. The majority of summaries were deemed to be accurate but there was a worrying level of omission and inaccuracy, including medication. It might be a better use of time to support doctors and patients working together to construct and check summaries rather than on information technology (IT) and the complex ethical debate surrounding the core clinical Spine
