Informatics in Primary Care (BCS, The Chartered Institute for IT)
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Autumn issue of Informatics in Primary Care: extending our understanding and the case for greater research capacity and capability in informatics
Get PDFImproving collaboration between primary care research networks using Access Grid technology
Get PDFAccess Grid (AG) is an Internet2-driven, high performance audio_visual conferencing technology used worldwide by academic and government organisations to enhance communication, human interaction and group collaboration. AG technology is particularly promising for improving academic multi-centre research collaborations. This manuscript describes how the AG technology was utilised by the electronic Primary Care Research Network (ePCRN) that is part of the National Institutes of Health (NIH) Roadmap initiative to improve primary care research and collaboration among practice- based research networks (PBRNs) in the USA. It discusses the design, installation and use of AG implementations, potential future applications, barriers to adoption, and suggested solutions
UK's National Programme for IT welcomes recommendation for a more sociotechnical approach to evaluation: a commentary on the Greenhalgh evaluation of the summary care record
Get PDFCurrent status and perceived needs of information technology in Critical Access Hospitals: a survey study
Get PDFThe US Congress established the designation of Critical Access Hospitals in 1997, recognising rural hospitals as vital links to health for rural and underserved populations. The intent of the reimbursement system is to improve financial performance, thereby reducing hospital closures. Informatics applications are thought to be tools that can enable the sustainability of such facilities. The aim of this study is to identify the current use of information and communication technology in Critical Access Hospitals, and to assess their readiness and receptiveness for the use of new software and hardware applications and their perceived information technology (IT) needs. A survey was mailed to the administrators of all Critical Access Hospitals in one US state (Missouri) and a reminder was mailed a few weeks later. Twenty-seven out of 33 surveys were filled out and returned (response rate 82%). While most respondents (66.7%) stated that their employees have been somewhat comfortable in using new technology, almost 15% stated that their employees have been somewhat uncomfortable. Similarly, almost 12% of the respondents stated that they themselves felt somewhat uncomfortable introducing new technology. While all facilities have computers, only half of them have a specific IT plan. Findings indicate that Critical Access Hospitals are often struggling with lack of resources and specific applications that address their needs. However, it is widely recognised that IT plays an essential role in the sustainability of their organisations. The study demonstrates that IT applications have to be customised to address the needs and infrastructure of the rural settings in order to be accepted and properly utilised
Relearning the lessons about the implementation of information systems in primary care: a report from the European Federation for Medical Informatics (EFMI) Special Topic Conference 2007 in Croatia
Get PDFThe identification of clinically important elements within medical journal abstracts: Patient_Population_Problem, Exposure_Intervention, Comparison, Outcome, Duration and Results (PECODR)
Get PDFBackground Information retrieval in primary care is becoming more difficult as the volume of medical information held in electronic databases expands. The lexical structure of this information might permit automatic indexing and improved retrieval.
Objective To determine the possibility of identifying the key elements of clinical studies, namely Patient_Population_Problem, Exposure_Intervention, Comparison, Outcome, Duration and Results (PECODR), from abstracts of medical journals.
Methods We used a convenience sample of 20 synopses from the journal Evidence-Based Medicine (EBM) and their matching original journal article abstracts obtained from PubMed. Three independent primary care professionals identified PECODR-related extracts of text. Rules were developed to define each PECODR element and the selection process of characters, words, phrases and sentences. From the extracts of text related to PECODR elements, potential lexical patterns that might help identify those elements were proposed and assessed using NVivo software.
Results A total of 835 PECODR-related text extracts containing 41 263 individual text characters were identified from 20 EBM journal synopses. There were 759 extracts in the corresponding PubMed abstracts containing 31 947 characters. PECODR elements were found in nearly all abstracts and synopses with the exception of duration. There was agreement on 86.6%of the extracts from the 20 EBM synopses and 85.0% on the corresponding PubMed abstracts. After consensus this rose to 98.4% and 96.9% respectively. We found potential text patterns in the Comparison, Outcome and Results elements of both EBM synopses and PubMed abstracts. Some phrases and words are used frequently and are specific for these elements in both synopses and abstracts.
Conclusions Results suggest a PECODR-related structure exists in medical abstracts and that there might be lexical patterns specific to these elements. More sophisticated computer-assisted lexical-semantic analysis might refine these results, and pave the way to automating PECODR indexing, and improve information retrieval in primary care
Assessing medical student learning in assessing the quality of health information on the internet and communicating the skill to patients
Get PDFBackground Patients increasingly turn to the internet for health information. However, seeking valid information can be difficult because of the speed of accumulation of information and lack of control. HealthInSite, the Canadian Health Network, the Health On the Net Foundation and the QUality Information ChecKlist have created criteria to assess internet health information. The fourth semester students at the Manipal College of Medical Sciences, Pokhara, Nepal, were taught to assess health information online and to communicate the same to simulated patients. Student feedback regarding the exercise was collected using a questionnaire.
Methods The exercise was carried out during the pharmacology practical sessions in small groups of seven or eight students each. The students developed their own checklist using information from the organisation websites mentioned above. Each group analysed a particular health website. During the second session the groups communicated the critical appraisal criteria to a simulated patient. Then the patient chose websites for a particular disease condition. Formative assessment of the sessions was carried out. A questionnaire was used to collect student feedback about the sessions. Basic demographic information was collected. Student attitude was studied by noting their degree of agreement with a set of seven statements using a Likert-type scale. The median score was calculated.
Results A total of 56 of the 73 fourth semester students participated. The gender ratio was equal. The common nationalities were Indians, Nepalese and Sri Lankans. The median score was 27 (maximum score 35) and the interquartile range was 4. There were no significant differences in the total scores among different subgroups of respondents. The students wanted similar sessions to be frequently incorporated during the course. Formative assessment revealed that the groups worked cohesively. They were able to analyse the given website appropriately and were successful in communicating the assessment criteria to the simulated patient.
Conclusions The sessions should be continued and strengthened and could be expanded to other semesters and especially to students during the clinical years of study. Preliminary feedback was positive but more detailed studies are required
Guidelines for computer security in general practice
Get PDFBackground As general practice becomes increasingly computerised, data security becomes increasingly important for both patient health and the efficient operation of the practice.
Objective To develop guidelines for computer security in general practice based on a literature review, an analysis of available information on current practice and a series of key stakeholder interviews. While the guideline was produced in the context of Australian general practice, we have developed a template that is also relevant for other countries.
Method Current data on computer security measures was sought from Australian divisions of general practice. Semi-structured interviews were conducted with general practitioners (GPs), the medical software industry, senior managers within government responsible for health IT (information technology) initiatives, technical IT experts, divisions of general practice and a member of a health information consumer group. The respondents were asked to assess both the likelihood and the consequences of potential risks in computer security being breached.
Results The study suggested that the most important computer security issues in general practice were: the need for a nominated IT security coordinator; having written IT policies, including a practice disaster recovery plan; controlling access to different levels of electronic data; doing and testing backups; protecting against viruses and other malicious codes; installing firewalls; undertaking routine maintenance of hardware and software; and securing electronic communication, for example via encryption. This information led to the production of computer security guidelines, including a one-page summary checklist, which were subsequently distributed to all GPs in Australia.
Conclusions This paper maps out a process for developing computer security guidelines for general practice. The specific content will vary in different countries according to their levels of adoption of IT, and cultural, technical and other health service factors. Making these guidelines relevant to local contexts should help maximise their uptake
Investigating patients' and general practitioners' views of computerised decision support software for the assessment and management of cardiovascular risk
Get PDFPurpose This paper reports an evaluation of the usability and acceptability of a computer-based decision support program (EMPOWERTM) for cardiovascular risk from the perspectives of both general practitioners (GPs) and consumers.
Methods A qualitative research design utilised semi-structured telephone interviews to assess the program from participants' perspectives. Qualitative approaches included the use of purposeful sampling, the collection of open-ended data, and the analysis of text and personal interpretation of findings. The theoretical foundations for the methods chosen are explained.
Results Consumers enjoyed being involved in the study and thought the program had benefits for encouraging confidence in seeking health care. Consumers reported feeling reassured about the processes followed during consultation. GPs found the application of the software program increased demands on their time but admired several features of the program, especially its educational advantages. Participants were of the opinion that the program would be of particular benefit to inexperienced GPs and newly diagnosed patients.
Conclusion Computer decision support programs are becoming more prevalent, but little is known about their usability and acceptability to both health professionals and consumers. The complexities of cardiovascular risk assessment and management can be adequately managed with such programs. As a contemporary report this study contributes to the growing knowledge required for developers of medical software and decision support systems to better understand the needs of endusers