Informatics in Primary Care (BCS, The Chartered Institute for IT)
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Computerisation of general practice in the Republic of Croatia: experience gained in general practice use
Get PDFWell-organised medical records are the prerequisite for achieving a high level of performance in primary healthcare settings. Recording balanced structured and coded data as well as free text can improve both quality and organisation of work in the office. It provides a more substantiated support of financial transactions and accountancy, allows better communication with other facilities and institutions, and is a source of valuable scientific research material. This article is the result of an individual experience gained in general practice use of various programs/ systems employed within the family medicine frame, and the frame of evaluation of available and commonly- exploited program solutions. The use of various programs allows for systematic adjustments as to the increasingly complex requirements imposed on electronic medical records (EMRs). The experience of a general practitioner, presented in this paper, confirms the assumption that an adequate program to be employed with EMRs should be developed, provided that family medicine practitioners, that is, the final users, have been involved in each and every stage of its development, adjustment, implementation and evaluation
The challenge of electronic health records (EHRs) design and implementation: responses of health workers to drawing a 'big and rich picture' of a future EHR programme using animated tools
Get PDFBackground and aim To investigate the use of animation tools to aid visualisation of problems for discussion within focus groups, in the context of healthcare workers discussing electronic health records (EHRs).
Method Ten healthcare staff focus groups, held in a range of organisational contexts. Each focus group was in four stages: baseline discussion, animator presentation, post-animator discussion and questionnaire. Audio recordings of the focus groups were transcribed and coded and the emergent analytic themes analysed for issues relating to EHR design and implementation. The data allowed a comparison of baseline and post-animator discussion.
Results The animator facilitated discussion about EHR issues and these were thematically coded as: Workload; Sharing Information; Access to Information; Record Content; Confidentiality; Patient Consent; and Implementation.
Conclusion We illustrate that use of the animator in focus groups is one means to raise understanding about a proposed EHR development. The animator provided a visual 'probe' to support a more proactive and discursive localised approach to end-user concerns, which could be part of an effective stakeholder engagement and communication strategy crucial in any EHR or health informatics implementation programme. The results of the focus groups were to raise salient issues and concerns, many of which anticipated those that have emerged in the current NHS Connecting for Health Care Records programme in England. Potentially, animator- type technologies may facilitate the user ownership which other forms of dissemination appear to be failing to achieve
Variation in clinical coding lists in UK general practice: a barrier to consistent data entry?
Get PDFBackground Routinely collected general practice computer data are used for quality improvement; poor data quality including inconsistent coding can reduce their usefulness.
Objective To document the diversity of data entry systems currently in use in UK general practice and highlight possible implications for data quality.
Method General practice volunteers provided screen shots of the clinical coding screen they would use to code a diagnosis or problem title in the clinical consultation. The six clinical conditions examined were: depression, cystitis, type 2 diabetes mellitus, sore throat, tired all the time, and myocardial infarction. We looked at the picking lists generated for these problem titles in EMIS, IPS, GPASS and iSOFT general practice clinical computer systems, using the Triset browser as a gold standard for comparison.
Results A mean of 19.3 codes is offered in the picking list after entering a diagnosis or problem title. EMIS produced the longest picking lists and GPASS the shortest, with a mean number of choices of 35.2 and 12.7, respectively. Approximately three-quarters (73.5%) of codes are diagnoses, one-eighth (12.5%) symptom codes, and the remainder come from a range of Read chapters. There was no readily detectable consistent order in which codes were displayed. Velocity coding, whereby commonly-used codes are placed higher in the picking list, results in variation between practices even where they have the same brand of computer system.
Conclusions Current systems for clinical coding promote diversity rather than consistency of clinical coding. As the UK moves towards an integrated health IT system consistency of coding will become more important. A standardised, limited list of codes for primary care might help address this need
Perceived barriers to completing an e-learning program on evidence-based medicine
Get PDFPurpose The Continuing Professional Development Center of the Faculty of Medicine at Laval University offers an internet-based program on evidence-based medicine (EBM). After one year, only three physicians out of the 40 who willingly paid to register had completed the entire program. This descriptive study aimed to identify physicians' beliefs regarding their completion of this online program.
Methods Using theoretical concepts from the Theory of Planned Behaviour, a semi-structured telephone interview guide was developed to assess respondents' attitudes, perceived subjective norms, perceived obstacles and facilitating conditions with respect to completing this internet-based program. Three independent reviewers performed content analysis of the interview transcripts to obtain an appropriate level of reliability. Findings were shared and organised according to theoretical categories of beliefs.
Results A total of 35 physicians (88% response rate) were interviewed. Despite perceived advantages to completing the internet-based program, barriers remained, especially those related to physicians' perceptions of time constraints. Lack of personal discipline and unfamiliarity with computers were also perceived as important barriers.
Conclusions This study offers a theoretical basis to understand physicians' beliefs towards completing an internet-based continuing medical education (CME) program on EBM. Based upon respondents' insights, several modifications were carried out to enhance the uptake of the program by physicians and, therefore, its implementation
National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care
Get PDFIn order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1) to provide efficient healthcare-related data management in support of decision-making processes; (2) to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS) on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories) into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution
Cast iron promises
Get PDFDuring the Victorian era, a fiercely competitive industry emerged to build and operate Britain's railways. Many of the design and construction skills required were still fairly rudimentary, and were typically developed through practical experience. The resulting mix of entrepreneurship and new technology reshaped the landscape, but often in ways which proved hazardous for passengers. Minor accidents were commonplace, and a number of major failures occurred, one such being the collapse of the Tay Bridge, in 1879.
Events in the ten years prior to this disaster still have some resonance today. Ambitions to exploit new technology are not always matched by foresight in the planning, financing or management of projects. Contracts may be based on wrong assumptions, and prove difficult to enforce. Once a project has gathered momentum, those working on it may fear that any attempt to draw attention to risks or defects will be seen as disloyal. When work is completed, it cannot be assumed that formal inspections will reveal potential flaws, or that those using the technology will appreciate the need to follow the procedures laid down for them. Some possible parallels with recent experiences in NHS computing are noted
The twinning of Scottish general practices and Malawian clinics: the provision of email and internet services
Get PDFMany patients and health care professionals in the developed world are uncomfortable about doing nothing in the face of the glaring inequities in health care between their own environment and that of Africa. In an effort to 'think global, act local' a Scottish GP practice used personal contacts to build a twinning link with a clinic serving a township in Malawi. This article describes the experience of establishing e-mail and internet services for Malawian health care staff to afford them the same level of access as developed world staff enjoy in accessing educational materials and professional supports. Using our twin link as an exemplar we are now matching other Scottish General Practices to Malawian Clinics around a common theme of modern communication media
Two years and ~196 million later: where is Choose and Book?
Get PDFBackground and objectives Introduced in 2004, Choose and Book was one of the National Programme for Information Technology's vanguard initiatives. It was to transform the old booking system by combining, for the first time, electronic booking with patient choice of their first hospital appointment. However, doctors' use of the system has been reported as being persistently low. This study, carried out in London, endeavoured to explore doctor's views about the system and to see how far it has progressed.
Method A questionnaire was devised and administered via an email invitation, to doctors. It was sent to 1800 and completed by 105 hospital consultants and general practitioners.
Results Most doctors thought that the concept of electronic booking itself was a good idea. The benefits that have been observed so far include an improvement in patient attendance at their appointments and the ability of doctors to track referrals. The biggest problems were described as an increased workload, technical problems and an uneven distribution of appointments between hospitals. In addition, most doctors thought that patient choice was a misguided concept in electronic booking and most reported that they were unsatisfied with Choose and Book overall.
Limitations The 6% response rate may make the results less likely to be representative of the whole survey population. The authors acknowledge this and have made recommendations as to how to more comprehensively test the objectives of this study, in future.
Conclusion In general, Choose and Book is still poorly perceived by doctors - particularly with respect to technical problems. There is still some support for the concept of electronic booking; however the patient choice element faces more resistance. Additional research is needed on this topic to further investigate the use of electronic systems in the health service
Health informatics research in Australia: retrospective analysis using PubMed
Get PDFObjective To obtain an overview of Australian health informatics (HI) research through a bibliometric analysis using PubMed.
Method Australian HI publications from 1970 to 2005 were downloaded in Medline format using PubMed queries. These were written to a Microsoft Access database using a software application, PubMed Grabber/Analyzer,devel oped by us. Search Query Language and online PubMed queries were used for further analysis.
Results Publications increased from three (1970) to 335 (2005), with the rate increasing since 2002. Medical Journal of Australia (177), Australian Family Physician (66) and Australasian Physical and Engineering Sciences in Medicine (64) are the top three journals publishing HI articles. Coiera EW (21), Metcalfe P (19), Ebert MA (17), Kron T (16) and Westbrook JI (16) were the five most frequent authors. Of the 2350 total publications categorised according to PubMed publication types, there were 231 reviews, 137 clinical or randomised controlled trials, 64 letters, 44 editorials and 12 meta-analyses. From 1990 to 2005, Australian HI publications in PubMed increased 10-fold (34_335), compared with the total world HI publications, which increased from 2777 to 15 353. It also compared favourably with other medical discipline publications: general practice (69_346), cardiology (440_928) and public health (1779_5724).
Discussion Australian HI publications in PubMed increased consistently throughout the period 1970-2005, which is on a par with world trends in HI publications. In Australia, most HI publications are in general medical journals. Lack of consistency in author names and failure to include the country name and even the state are the main obstacles to PubMed bibliometric analysis
Prevention of errors and user alienation in healthcare IT integration programmes
Get PDFThe design, development and implementation stages of integrated computer projects require close collaboration between users and developers, but this is particularly difficult where there are multiple specialties, organisations and system suppliers. Users become alienated if they are not consulted, but consultation is meaningless if they cannot understand the specifications showing exactly what is proposed. We need stringent specifications that users and developers can review and check before most of the work is done. Avoidable errors lead to delays and cost over-runs. The number of errors is a function of the likelihood of misunderstanding any part of the specification, the number of individuals involved and the number of choices or options.
One way to reduce these problems is to provide a conceptual design specification, comprising detailed Unified Modelling Language (UML) class and activity diagrams, data definitions and terminology, in addition to conventional technology-specific specifications. A conceptual design specification needs to be straightforward to understand and use, transparent and unambiguous. People find structured diagrams, such as maps, charts and blueprints, easier to use than reports or tables. Other desirable properties include being technology independent, comprehensive, stringent, coherent, consistent, composed from reusable elements and computer-readable (XML).
When users and developers share the same agreed conceptual design specification, this can be one of the master documents of a formal contract between the stakeholders. No extra meaning should be added during the later stages of the project life cycle