Informatics in Primary Care (BCS, The Chartered Institute for IT)
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Developing an Electronic Social Care Record: a tale from the Tyne
Get PDFThis paper reports on the development process of an Electronic Social Care Record (ESCR), which used an adapted approach to Participatory Design (PD). PD is an established range of methodologies and principles for involving users in the design and implementation of systems or products. University researchers worked as part of a wider team including corporate social service stakeholders, a multidisciplinary children's social service team, and a technology provider, to develop a system that supports the integration of information of various teams/disciplines which need to work together to intervene with children who are in need. Using action research and ethnographic techniques, the researchers sought to understand and address the challenges faced by the various stakeholders when designing a system to deliver an ESCR
The patient's perspective of computerised records: a questionnaire survey in primary care
Get PDFBackground The general practice consultation today has become a three-way process where patient, doctor and computer interact. Some studies have shown that the introduction of the computer has caused concern to some patients, possibly affecting their behaviour. If patients are less frank about their problems in a computer-mediated consultation this may cause concerns among doctors and become a barrier to computer use.
Objectives A questionnaire was developed to test the prevalence of worries among patients about confidentiality breaches of computer records and to identify whether those worries translated into a reduction in patients' frankness.
Results The study had a 62% response rate. Almost 48% of responders had experienced confidentiality worries during past consultations. All responders denied withholding any relevant information from their general practitioner (GP) as a result of confidentiality worries. Gender, computer literacy, knowledge of computer uses in consultation and patients' perceptions of computer record safetywere selected covariates in the multivariate logistic regression model explaining patients' worry. Thirty-three percent of patients stated they always understand what their GP is doing at the computer during consultation, 9.7% stated they did not ever know; though 64% judged it important to knowwhat their GPs were doing.
Conclusions Patients worry about the confidentiality of their computer record and it seems that those less familiar with computers, females and those less aware of their GP's actions at the computer worry more. Patients' understanding of their GPs' actions at the computer during consultation is far from complete and they seem to place great importance on this. Those patients who place greatest importance on needing an understanding of their GP's actions are those most likely to worry about confidentiality
A qualitative analysis of an electronic health record (EHR) implementation in an academic ambulatory setting
Get PDFObjectives To determine pre-implementation perspectives of institutional, practice and vendor leadership regarding best practice for implementation of two ambulatory electronic health records (EHRs) at an academic institution.
Design Semi-structured interviews with ambulatory care network and information systems leadership, medical directors, practice managers and vendors before EHR implementation. Results were analysed using grounded theory with ATLAS.ti version 5.0.
Measurements Qualitative data on perceived benefits of EHRs as well as facilitators and barriers to successful implementation.
Results Interviewees perceived data accessibility, quality and safety measurement, improvement and reporting as benefits of EHR use. Six themes emerged for EHR implementation best practice: effective communication; successful system migration; sufficient hardware, technical equipment, support and training; safeguards for patient privacy; improved efficiency; and a sustainable business plan.
Conclusions Achieving the benefits of EHRs identified by our interviewees depends on successful implementation and use. Further identification of best implementation practices for EHRs is required, given the financial and clinical consequences of poor implementation
A concept for a visual computer interface to make error taxonomies useful at the point of primary care
Get PDFEvidence suggests that the quality of care delivered by the healthcare industry currently falls far short of its capabilities. Whilst most patient safety and quality improvement work to date has focused on inpatient settings, some estimates suggest that outpatient settings are equally important, with up to 200 000 avoidable deaths annually in the United States of America (USA) alone.
There is currently a need for improved error reporting and taxonomy systems that are useful at the point of care. This provides an opportunity to harness the benefits of computer visualisation to help structure and illustrate the 'stories' behind errors.
In this paper we present a concept for a visual taxonomy of errors, based on visual models of the healthcare system at both macrosystem and microsystem levels (previously published in this journal), and describe how this could be used to create a visual database of errors. In an alphatest in a US context, we were able to code a sample of 20 errors from an existing error database using the visual taxonomy.
The approach is designed to capture and disseminate patient safety information in an unambiguous format that is useful to all members of the healthcare team (including the patient) at the point of care as well as at the policy-making level
Design and implementation of a web-based patient portal linked to an electronic health record designed to improve medication safety: the Patient Gateway medications module
Get PDFIn this article we describe the background, design, and preliminary results of a medications module within Patient Gateway (PG), a patient portal linked to an electronic health record (EHR). The medications module is designed to improve the accuracy of medication lists within the EHR, reduce adverse drug events and improve patient_provider communication regarding medications and allergies in several primary care practices within a large integrated healthcare delivery network. This module allows patients to view and modify the list of medications and allergies from the EHR, report nonadherence, side effects and other medication-related problems and easily communicate this information to providers, who can verify the information and update the EHR as needed. Usage and satisfaction data indicate that patients found the module easy to use, felt that it led to their providers having more accurate information about them and enabled them to feel more prepared for their forthcoming visits. Further analyses will determine the effects of this module on important medication-related outcomes and identify further enhancements needed to improve on this approach
Adoption of information technology in primary care physician offices in New Zealand and Denmark, part 1: healthcare system comparisons
Get PDFDenmark and New Zealand are two small countries whose primary care physicians are at the forefront of the use of electronic medical records (EMRs). This is the first of a series of five papers which contrasts the health care systems in Denmark and New Zealand. Though the delivery of care at the patient level is virtually the same in New Zealand and Denmark the way in which the health care is financed; administered and managed does vary. This paper highlights the differences; particularly in terms of the approaches taken to primary care and out-of-office-hours services
Data confidentiality and data handling in research: a workshop report
Get PDFBackground Medical records are not only a vital tool for the delivery of health care to individual patients but also hold information with significant potential for research. However, patient records contain personal information, and some medical details may be particularly sensitive. The Wellcome Trust produced a draft consensus statement for the use of patient data in research as a result of discussions with GPs, researchers and patient groups. The purpose of this document, produced in May 2008, was to provide guidelines for best practice when general practice records are used for research.
Method The recommendations made in the consensus statement were discussed by academic primary care researchers, National Health Service (NHS) research and development (R and D) department staff, and UK primary care research network managers at aworkshop held at the Society for Academic Primary Care (SAPC) Annual Conference 2008 in Galway.
Outputs Workshop delegates were largely supportive of the recommendations made in the draft consensus document. Key recommendations included: a campaign at a national and local level highlighting the need to use personal patient records to inform research; standard operating procedures to ensure clearly defined processes are being followed; and the requirement for all patient data to be treated as confidential
Achieving benefit for patients in primary care informatics: the report of a international consensus workshop at Medinfo 2007
Get PDFBackground Landmark reports suggest that sharing health data between clinical computer systems should improve patient safety and the quality of care. Enhancing the use of informatics in primary care is usually a key part of these strategies.
Aim To synthesise the learning from the international use of informatics in primary care.
Method The workshop was attended by 21 delegates drawn from all continents. There were presentations from USA, UK and the Netherlands, and informal updates from Australia, Argentina, and Sweden and the Nordic countries. These presentations were discussed in a workshop setting to identify common issues. Key principles were synthesised through a post-workshop analysis and then sorted into themes.
Results Themes emerged about the deployment of informatics which can be applied at health service, practice and individual clinical consultation level:
1 At the health service or provider level, success appeared proportional to the extent of collaboration between a broad range of stakeholders and identification of leaders.
2 Within the practice much is currently being achieved with legacy computer systems and apparently outdated coding systems. This includes prescribing safety alerts, clinical audit and promoting computer data recording and quality.
3 In the consultation the computer is a 'big player' and may make traditional models of the consultation redundant.
Conclusions We should make more efforts to share learning; develop clear internationally acceptable definitions; highlight gaps between pockets of excellence and real-world practice, and most importantly suggest how they might be bridged. Knowledge synthesis from different health systems may provide a greater understanding of how the third actor (the computer) is best used in primary care
The role of the electronic medical record (EMR) in care delivery development in developing countries: a systematic review
Get PDFObjective Most countries in Europe and the USA are increasingly using an electronic medical record (EMR) to help improve healthcare quality. Unfortunately, most developing countries face many challenges ranging from epidemics and civil wars to disasters: they also lack a robust healthcare infrastructure in the form of information and communications technology (ICT) to ensure continuity of patient health which many research studies consider a lifesaving resource. The aim of this systematic review is to examine the benefits of anEMR and its contribution to the development of healthcare delivery in developing countries.
Methods We searched MEDLINE, PubMed, CINAHL, COMPENDEX and Academic Search Premier as well as systematically searching the reference lists of included studies and relevant reviews. Inclusion criteria were that studies should relate to the importance and challenges of an EMR system, paper-based medical records, development and implementation of an EMR system in developing countries or EMR impact on care delivery in developing countries.
Results A total of 23 articles were identified that met the eligibility criteria. Articles identified were grouped into five non-exclusive areas: EMR benefits (n=4), challenges (n=6), transition from paperbased to EMR (n=5), EMR in developing countries (n=8) and pilot projects (n=5). Nine articles were excluded because three were not published in English and six were studies on EMR in developed countries.
Conclusions The potential of EMR systems to transform medical care practice has been recognised over the past decades, including the enhancement of healthcare delivery and facilitation of decisionmaking processes. Some benefits of an EMR system include accurate medication lists, legible notes and prescriptions and immediately available charts. In spite of challenges facing the developing world such as lack of human expertise and financial resource, most studies have shown how feasible it could be with support from developed nations to design and implement an EMR system that fits into this environment
Implementation of an electronic medical record system in previously computer-naïve primary care centres: a pilot study from Cyprus
Get PDFBackground The computer-based electronic medical record (EMR) is an essential new technology in health care, contributing to high-quality patient care and efficient patient management. The majority of southern European countries, however, have not yet implemented universal EMR systems and many efforts are still ongoing. We describe the development of an EMR system and its pilot implementation and evaluation in two previously computer-na've public primary care centres in Cyprus.
Methods One urban and one rural primary care centre along with their personnel (physicians and nurses) were selected to participate. Both qualitative and quantitative evaluation tools were used during the implementation phase. Qualitative data analysis was based on the framework approach, whereas quantitative assessment was based on a nine-item questionnaire and EMR usage parameters.
Results Two public primary care centres participated, and a total often health professionals served as EMR system evaluators. Physicians and nurses rated EMR relatively highly, while patients were the most enthusiastic supporters for the new information system. Major implementation impediments were the physicians' perceptions that EMR usage negatively affected their workflow, physicians' legal concerns, lack of incentives, system breakdowns, software design problems, transition difficulties and lack of familiarity with electronic equipment.
Conclusion The importance of combining qualitative and quantitative evaluation tools is highlighted. More efforts are needed for the universal adoption and routine use of EMR in the primary care system of Cyprus as several barriers to adoption exist; however, none is insurmountable. Computerised systems could improve efficiency and quality of care in Cyprus, benefiting the entire population