Informatics in Primary Care (BCS, The Chartered Institute for IT)
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An ethical framework for sharing patient data without consent
Get PDFBackground There is no consensus on how to share patient records privately. Data privacy concepts are surveyed and a framework is presented for the safe sharing of sensitive data. It is argued that tailoring the data sharing to the privacy breach risks of each project holds out the best compromise for keeping the trust of the public and providing for the best quality data where detailed patient consent is not possible.
Objective To improve the protection of data by reducing privacy breaches and thus enable appropriate patient data sharing without consent.
Framework Any harm arising from data sharing must come from the data being identified, either fully or partially. The first step is an agreement on an acceptable privacy breach risk. Next, proceed to measure that risk for the proposed data when held by a given recipient. Finally, select from a menu of mitigation strategies (people, process and technical) to achieve acceptable risk. The framework is tested against the current UK approach administered by the Patient Information Advisory Group.
Discussion The hard problem of non-consented data sharing should be divided into the easier (though non-trivial) ones of data and recipient breach risk measurement. Directed research in these two areas will help move the data sharing problem into the 'solved' pile
The use of information technology to enhance diabetes management in primary care: a literature review
Get PDFBackground Evidence suggests that a more structured approach to diabetes care can lead to better health outcomes. We needed to develop an evidence based conceptual framework for the Chronic Disease Management Network (CDM-Net) project which aims to use information technology (IT) to optimally support diabetes care in the Barwon region of Victoria, Australia.
Objective This review aims to demonstrate the benefits of IT in supporting a systematic approach to diabetes management in general practice and to increase our understanding of perceived barriers to and facilitators to the use of IT in this context.
Methods The literature review was based on articles extracted from relevant databases by using search terms related to type 2 diabetes and IT. Eligible papers were those based on original studies which evaluated some form of IT intervention in medical practice and were published after 1996 in the English language. Studies evaluating the use of telemedicine were excluded.
Findings IT has been used to provide support to patients, enhance changes in healthcare delivery and provide clinicians with access to expertise and timely, useful data about individual patients and populations. IT use has been associated with a corresponding improvement in measures of diabetes care including HbA1c, blood pressure and lipids, and in the frequency of eye and foot exams. Important barriers to using IT in diabetes care include confidentiality concerns, inadequate funding, workforce shortages, lack of time and anxiety about change. Adequate training and integration into the usual process of care are essential facilitators to implementing IT.
Conclusions IT can be used to improve diabetes care by promoting a productive and informative interaction between the patient and the care team
Expectations for the next generation of electronic patient records in primary care: a triangulated study
Get PDFBackground Although primary care physicians are satisfied users of electronic patient records (EPRs) in Norway today, EPR systems may not have reached their full potential. We studied primary care physicians' needs and experiences in relation to EPRs and analysed potential improvements for today's EPR systems.
Respondents and methods This is a triangulatedstudy that compares qualitative and quantitative data from focus groups, observations of primary care encounters and a questionnaire survey.
Results General practioners (GPs) were not satisfied with the level of availability of information within EPR systems. They were especially concerned about follow-up for chronic disease and dealing with patients with multiple conditions. Many expressed a desire for reminders and easier access to clinical guidelines under normal working conditions, as well as the possibility of consultations with specialists from their EPR systems. GPs placed importance on the ability to communicate electronically with patients.
Conclusions Progress toward a problem-oriented EPR system based on episodes of care that includes decision support is necessary to satisfy the needs expressed by GPs. Further research could solve the problem of integration of functionality for consultation with specialists and integration with patient held records. Results from this study could contribute to further development of the next generation of EPRs in primary care, as well as inspire the application of EPRs in other parts of the health sector
A guideline-based computerised decision support system (CDSS) to influence general practitioners management of chronic heart failure
Get PDFObjectives To explore the influence of a guidelinebased computerised decision support system (CDSS) on general practitioners' (GPs') management of patient cases of chronic heart failure in a pragmatic clinical situation. We assessed changes in the GPs' confidence in the diagnosis, their considerations about investigations and medications and the support they perceived from using the CDSS.
Study design Five GPs assessed the medical records of 48 of their own authentic patient cases using a guideline-based CDSS accessible on the internet for the diagnosis and treatment of chronic heart failure, and completed a questionnaire for each case.
Outcome measures Number of cases where the GP reported a change in confidence in the diagnosis, where the GP considered further investigations or changes in medication and the perceived support marked on a visual analogue scale.
Results The GPs' confidence in the diagnosis changed in 25% of the cases, with equal numbers of increases and decreases in confidence. The GPs considered further investigations in 31% of the cases and medication changes in 19%. Fourteen of the 31 considered investigations and four of the ten considered changes in medications which were in agreement with the CDSS's suggestions. The GPs tended to consider further investigations more often in cases when the CDSS found the diagnosis uncertain. There was a wide range in the values for perceived support, but it could be described as substantial in 35% of the cases.
Conclusion Using a guideline-based CDSS for the GPs' own patient cases had an impact on the GPs' confidence in the diagnosis of chronic heart failure and their considerations about investigations and medications: they also perceived substantial support in every third case. Applying a CDSS developed using evidence-based guidelines for chronic heart failure in primary care could have a significant influence on GPs' disease management
Microsoft health patient journey demonstrator
Get PDFBackground As health care becomes more reliant on electronic systems, there is a need to standardise display elements to promote patient safety and clinical efficiency. The Microsoft' Health Common User Interface (MSCUI) programme, developed by Microsoft and the National Health Service (NHS) was born out of this need and creates guidance and controls designed to increase patient safety and clinical effectiveness through consistent interface treatments.
Objective The Microsoft Health Patient Journey Demonstrator is a prototype tool designed to provide exemplar implementations of MSCUI guidance on a Microsoft platform. It is a targeted glimpse at a visual interface for the integration of health-relevant information, including electronic medical records.
Method We built the demonstrator in Microsoft SilverlightTM 2, our application technology which brings desktop functionality and enriched levels of user experience to health settings worldwide via the internet. We based the demonstrator on an easily recognisable clinical scenario which offered us the most scope for demonstrating MSCUI guidance and innovation.
Output The demonstrator is structured in three sections (administration, primary care and secondary care) each of which illustrates the activities associated within the setting relevant to our scenario. The demonstrator is published on the MSCUI website www.mscui.net
Conclusion The MSCUI patient journey demonstrator has been successful in raising awareness and increasing interest in the CUI programme
The Single Shared Electronic Patient Record (SSEPR): problems with functionality and governance - Reply
Get PDFPrivacy and health information: health cards offer a workable solution
Get PDFCollections of computerised personal health data present a very real threat to privacy. Access control is difficult to manage in order to maintain privacy and at the same time to retain flexibility of usage. The legal situation is clear, imposing a requirement to respect personal privacy and human rights. Primary users (those whose access is based on a duty of care) may exceed their authorisation and access records where they have no duty of care or need to know. Secondary users (those generating analyses, research reports and financial management data) may be given access to datasets containing identifiers which are not required for their work. The 'owners' of the data (e.g. government) may use them in ways that are inconsistent with the permissions under which the datawere provided (e.g. by permitting links to other databases to create 'new' information), behind closed doors and without independent audit.
Currently there is a crisis emerging in which professionals are arguing that they are being compelled to compromise their ethical responsibilities to their patients, and government is responding that their measures are necessary to preserve access to quality data for research and planning. This paper proposes an integrated plan for managing these issues in a manner that is ethically sustainable, as well as in keeping with all provisions of the law, using a personal health card
Do general practice characteristics influence uptake of an information technology (IT) innovation in primary care?
Get PDFIntroduction Recent evaluations of IT innovations in primary care have highlighted variations between centres and practices in uptake and use. We evaluated whether structural characteristics of a general practice were associated with variations in use of a web-based clinical information system underpinning a Managed Clinical Network in diabetes, between the years 2001 and 2003.
Methods Using a computerised audit trail, we calculated the numbers of web-based operations that occurred in each practice, stratified by staff type and year, and adjusted for the numbers of registered diabetic patients. In regression analyses, we determined whether total use was associated with structural characteristics of the practice (total list size, training status, numbers of GPs (general practitioners), mean age of the GPs, numbers of female GPs, level of deprivation of the population and whether staff had received advanced training in diabetes care).
Results Initially there were a few practices which made very frequent use of the information system, with relatively high numbers of practices using the facility infrequently. However, overall use gradually became more evenly spread. This effect was particularly evident among nurse users. Frequent use by GPs was evident in only a smallnumber of practices, with meanGPuse decreasing over the three years. In linear regression analyses, none of the general practice variableswere associatedwithonlineuse, either overall or stratified by staff type, except for the numbers of diabetes-educated staff. This was consistently associated with increased use by nurses and GPs.
Conclusions The analyses show that structural characteristics of a practice are not associated with uptake of a new IT facility, but that its use may be influenced by post-graduate education in the relevant clinical condition. For this diabetes system at least, practice nurse use was critical in spreading uptake beyond initial GP enthusiasts and for sustained and rising use in subsequent years