Informatics in Primary Care (BCS, The Chartered Institute for IT)
Not a member yet
595 research outputs found
Sort by
Secondary uses of clinical data in primary care
Get PDFThis paper, presented as a panel at the American Medical Informatics Association (AMIA) Fall Symposium 2006, explores a number of secondary uses of primary care clinical data derived from point-of care systems, and the issues arising from those uses. The authors (from the USA and the UK) describe, compare and contrast some secondary uses: pay-for-performance, public disclosure, clinical audit, health resource planning, and clinical system usage; in various environments: national health system, network of small family practice offices, and university teaching centres. In the UK, such data are now being used in pay-for-performance for GPs, and approximately 35% of their salary has been put at risk, which has resulted in close scrutiny. In the USA, pay-for-performance is at an earlier stage but is increasingly prevalent and continues to be hotly debated. Some of the issues that arise from these uses of clinical data _data quality including accuracy, comparability, perverse incentives, effect of secondary uses on care provision, and security and confidentiality among others _were discussed. Finally, options and opportunities for improving secondary uses of data in the light of the issues covered earlier were considered
Information systems and the electronic health record in primary health care
Get PDFThe implementation of information systems into primary health care opened the possibilities of providing integrated and co-ordinated health care, improved in quality and focused on the healthcare user. The healthcare system, researchers, physicians, and patients have recognised the benefits offered by informatics, but also raised questions that have yet to be answered
Electronic health records: high-quality electronic data for higher-quality clinical research
Get PDFIn the decades prior to the introduction of electronic health records (EHRs), the best source of electronic information to support clinical research was claims data. The use of claims data in research has been criticised for capturing only demographics, diagnoses and procedures recorded for billing purposes that may not fully reflect the patient's condition. Many important details of the patient's clinical status are not recorded.
EHRs can overcome many limitations of claims data in research, by capturing a more complete picture of the observations and actions of a clinician recorded when patients are seen. EHRs can provide important details about vital signs, diagnostic test results, social and family history, prescriptions and physical examination findings. As a result, EHRs present a new opportunity to use data collected through the routine operation of a clinical practice to generate and test hypotheses about the relationships among patients, diseases, practice styles, therapeutic modalities and clinical outcomes.
This article describes the clinical research information infrastructure at four institutions: the University of Pennsylvania, Regenstrief Institute/Indiana University, Partners Healthcare System and the University of Virginia. We present models for applying EHR data successfully within the clinical research enterprise
Barriers to the use of e-health technology in nurse practitioner_patient consultations
Get PDFPurpose This paper examines primary care nurse practitioners' (NPs') use of information available via e-health technology (EHT) within consultations. It explores which information resources NPs use in clinical decision making, their comparative use of electronic versus paper-based and human information resources, the reasons behind their choices and how the use of different resources impacts on patient interactions.
Methods Semi-structured interviews were undertaken with 12 NPs recruited from 11 different general practitioner (GP) practices and five primary care trusts (PCTs) within the West Midlands South Strategic Health Authority, UK.
Findings The key finding was that for NPs an effective information resource is one that provides sufficient information to generate a patient management plan rapidly. Speed, familiarity and trust are vital ingredients for regular use. Paper-based information resources therefore retain a significant role, and together with human information resources are still more frequently used than most electronic, and particularly web-based, resources. The latter are not yet well established within the context of patient consultations. Electronic clinical support systems (such as Mentor, PRODIGY and GP notebook) are regularly used, however, because they are often linked electronically to patient records, and generate brief information in a form accessible to both nurses and patients. By contrast, searching for information from web-based resources was considered time-consuming, technically difficult and disruptive to patients. All NPs reported some negative effects on patients of using computers: mostly disrupted rapport and longer consultations. However, the majority had developed ways of working to overcome these difficulties and that helped them to maintain their patient-centred focus.
Conclusions Study NPs had received only very limited information technology (IT) training, but nevertheless were enthusiastic about computer use. This suggests that with further training they could adapt their practice to embrace more EHT, which would enhance their ability to be more autonomous and to base their practice on sound clinical evidence
UK and Croatia: family practice, its medical records and computerisation in the context of an enlarged Europe
Get PDFBackground Croatia and the UK have list-based general practice systems: patients register with a single practice. They are also progressively computerising family practice. We set out to identify and report where these countries might learn from each other's experience.
Method Experiences, similarities and differences were derived from a literature review and visits to practices in Croatia and the UK.
Results Both countries had developed unique but sophisticated paper-based primary care record systems. They have now moved to promote the computerisation of primary care; both countries see this as integral to patient safety, quality improvement and derivation of data for health service management. However, the development of primary care computing has been an organic process with small suppliers producing trial systems with natural selection of the more effective system.
Conclusions IT has the potential to improve patient safety and the quality and efficiency of primary care. The lack of a theoretical framework for the comparison of systems hampers the development and selection of an optimum system
The optimum granularity for coding diagnostic data in primary care: report of a workshop of the EFMI Primary Care Informatics Working Group at MIE 2005
Get PDFIntroduction The EFMI Primary Care Informatics Working Group held a workshop to explore interventions used across Europe to improve the data quality in primary care computerised medical records.
Method A plenary session reviewed the UK literature about improving data quality and then the session split into three small groups. Fifteen delegates from nine countries contributed to the workshop. These groups reported back at the end of the session.
Results The groups defined what they meant by data quality. The principal requirement was that data must be 'fit for purpose'. The participants felt this was particularly important for diagnostic data, while recognising that the purpose might not be known at the point of data recording. They also described the barriers to recording structured and coded data. The most important were an inappropriate interface with the coding system and inappropriate granularity of codes. There was a wide range of suggestions as to how to overcome these barriers, including providing feedback, links to expert systems, education and training, use of the data for care elsewhere in the health system and mandation of electronic data recording.
Conclusions The workshop developed a new characteristic of data quality: 'fit for purpose'. This is different from definitions that focus on completeness, accuracy, currency, or its positive predictive value and sensitivity. The group also highlighted the importance of data quality of diagnoses, as these data are important throughout the health system as well as acting as a prompt for other interventions within the individual consultation. More research is needed into appropriate levels of granularity for diagnostic recording in primary care
Is primary care ready to embrace e-health? A qualitative study of staff in a London primary care trust
Get PDFObjectives e-Health refers to the organisation and delivery of health services and information using the internet and related technologies. We investigated the perceptions of primary care staff towards e-health initiatives in the NHS Connecting for Health programme and whether front-line staff are ready to implement such changes.
Design Twenty participants from different professional groups were purposively selected for interview, based on their current computer usage. The same practice staff were subsequently observed in order to gain an insight into how they use computers.
Subjects Practice staff (doctors, nurses, practice managers and receptionists) who will be expected to use new information technology and primary care trust (PCT) staff who are involved in its implementation were selected to participate in this study.
Setting A north London PCT with 62 general practices. Four practices were selected for the study.
Results Analysis of the interviews and the observational data yielded six recurrent themes that have a bearing on readiness to use information and communication systems to support clinical care: perceptions of technology and NHS Connecting for Health; issues relating to resources; patient choice; matters relating to confidentiality and security; political pressures; and how information technology is currently used within primary care.
Conclusions At the time of the study the systems that form part of NHS Connecting for Health, apart from the Quality Management and Analysis System (QMAS), were not implemented across the PCT. All the practices in the study acknowledged the benefits new technology would bring to the workplace, but there were also some common concerns, which suggest that staff working in primary care practices are not ready for e-health. Successful implementation of the NHS Connecting for Health programme rests on identifying, acknowledging and overcoming these concerns. A different approach might be required for those practices that have made very little progress in using email or moving towards an electronic patient record. This study suggests that a mistrust of technology and fears as to the heavy initial workload involved in becoming fully computerised have dissuaded some practices from embracing e-health. If NHS Connecting for Health is to be a success, implementation teams might need to focus initially on practices that have been reluctant to use technology to support both clinical care and the day-to-day work of the practice
Patient and health care professional views and experiences of computer agent-supported health care
Get PDFObjectives To explore patient and health care professional (HCP) views towards the use of multiagent computer systems in their GP practice.
Design Qualitative analysis of in-depth interviews and analysis of transcriptions.
Setting Urban health centre in Dundee, Scotland.
Participants Five representative healthcare professionals and 11 patients.
Main outcome measures Emergent themes from interviews revealed participants' attitudes and beliefs, which were coded and indexed.
Results Patients and HCPs had similar beliefs, attitudes and views towards the implementation of multi-agent systems (MAS). Both felt modern communication methods were useful to supplement, not supplant, face-to-face consultations between doctors and patients. This was based on the immense trust these patients placed in their doctors in this practice, which extended to trust in their choice of communication technology and security. Rapid access to medical information increased patients' sense of shared partnership and self-efficacy. Patients and HCPs expressed respect for each other's time and were keen to embrace technology that made interactions more efficient, including for the altruistic benefit of others less technically competent.
Conclusions Patients and HCPs welcomed the introduction of agent technology to the delivery of health care. Widespread use will depend more on the trust patients place in their own GP than on technological issues
Sharing electronic health records: the patient view
Get PDFThe introduction of a national electronic health record system to the National Health Service (NHS) has raised concerns about issues of data accuracy, security and confidentiality. The primary aim of this project was to identify the extent to which primary care patients will allow their local electronic record data to be shared on a national database. The secondary aim was to identify the extent of inaccuracies in the existing primary care records, which will be used to populate the new national Spine. Fifty consecutive attenders to one general practitioner were given a paper printout of their full primary care electronic health record. Participants were asked to highlight information which they would not want to be shared on the national electronic database of records, and information which they considered to be incorrect. There was a 62% response rate (31/50). Five of the 31 patients (16%) identified information that they would not want to be shared on the national record system. The items they identified related almost entirely to matters of pregnancy, contraception, sexual health and mental health. Ten respondents (32%) identified incorrect information in their records (some of these turned out to be correct on further investigation). The findings in relation to data sharing fit with the commonly held assumption that matters related to sensitive or embarrassing issues, which may affect how the patient will be treated by other individuals or institutions, are most likely to be censored by patients. Previous work on this has tended to ask hypothetical questions concerning data sharing rather than examine a real situation. A larger study of representative samples of patients in both primary and secondary care settings is needed to further investigate issues of data sharing and consent
Routinely collected general practice data: goldmines for research? A report of the European Federation for Medical Informatics Primary Care Informatics Working Group (EFMI PCIWG) from MIE2006, Maastricht, The Netherlands
Get PDFBackground Much of European primary care is computerised and many groups of practices pool data for research. Technology is making pooled general practice data widely available beyond the domain within which it is collected.
Objective To explore the barriers and opportunities to exploiting routinely collected general practice data for research.
Method Workshop, led by primary care and informatics academics experienced at working with clinical data from large databases, involving 23 delegates from eight countries. Email comments about the write-up from participants.
Outputs The components of an effective process are:
the input of those who have a detailed understanding of the context in which the data were recordedan assessment of the validity of these data and any denominator usedcreation of anonymised unique identifiers for each patient which can be decoded within the contributing practicesdata must be traceable back to the patient record from which it was extractedarchiving of the queries, the look-up tables of any coding systems used and the ethical constraints which govern the use of the data.
Conclusions Explicit statements are needed to explain the source, context of recording, validity
check and processing method of any routinely collected data used in research. Data lacking detailed methodological descriptors should not be published