Informatics in Primary Care (BCS, The Chartered Institute for IT)
Not a member yet
595 research outputs found
Sort by
Primary care computing in England and Scotland: a comparison with Denmark
Get PDFThis paper compares the status of primary care computing in England and Scotland with that of Denmark. The rate of utilisation by Danish GPs is among the highest in the world and the MedCom national health network handles over 90% of the country's primary sector clinical communications. A high proportion of English and Scottish GPs also use computers in their clinical practices, and like their Danish colleagues, they benefit from more accurate and streamlined medications management, particularly in terms of repeat prescriptions. The historical forces and factors which influenced the development of primary care computing are identified and discussed
Primary care oncology: addressing the challenges
Get PDFThe last decade has seen an emerging clinical discipline known as 'primary care oncology' that describes the involvement of general practitioners (GPs) in preventing, diagnosing, treating and following up patients with cancer. This paper reports the experience of our team in investigating the information required to develop a shared electronic care record system to link GPs and cancer specialists in Wales in order to facilitate information sharing between them in a timely and effective manner. It identifies a potential minimum dataset that can provide the basis for the development of a Welsh primary care cancer dataset. It also addresses the associated challenges to be overcome at implementation, namely information, technical, cultural/ organisational and management challenges.
This work is a collaboration between the Department of Computer Science at Cardiff University and Velindre NHS Trust, the South East Wales Cancer Centre
Barriers to ambulatory EHR: who are 'imminent adopters' and how do they differ from other physicians?
Get PDFObjective Despite existing knowledge regarding electronic health record (EHR) barriers in the ambulatory setting, little is known, specifically, about physicians who are likely to adopt EHR imminently. The current study identifies these imminent adopters and compares their barriers to other physicians.
Design and measurements Mail survey of Florida physicians (n=14 921) about barriers to EHR and adoption intentions. The survey asked respondents to classify themselves as planning to adopt an EHR system within one year (herein referred to as 'imminent adopters'), as planning to adopt an EHR systembut not within one year ('interested adopters'), and as not considering an EHR system. Chi-square analysis and logistic regression models were used to identify trends among imminent adopters and to compare barriers among respondents in each of the adoption categories above.
Results A total of 4203 returned surveys represented a 28.2% response rate. Imminent adopters were significantly less likely to be in solo practice (19.6% vs. 40.0%, P<0.001) and more likely to be in an urban area (P=0.044) or in a multi-specialty practice (P=0.023). Imminent adopters were also more likely to be practising family medicine (P=0.014) or obstetrics/gyn_cology (P=0.038). When comparedwith their colleagues, imminent adopters perceived EHR barriers very differently. For example, imminent adopters were significantly less likely to consider upfront cost of hardware/software [OR=0.35 (0.30, 0.45)] or that an inadequate return on investment [OR=0.25 (0.19, 0.34)] was a major barrier to EHR. Moreover, imminent adopters differed from their colleagues with respect to numerous other productivity-related and technical-related barriers.
Conclusion Policy and decision makers interested in promoting the adoption of EHR among physicians should focus on the needs and barriers of those most likely to adopt EHR. Given that imminent adopters differ considerably from their peers, current EHR incentive programmes that focus on financial barriers only might prove sub-optimal in achieving immediate widespread EHR adoption
Computer literacy, skills and knowledge among dentists and dental care professionals (DCPs) within primary care in Scotland
Get PDFObjective To gain a better understanding of the level of literacy in information technology (IT) across the dental team working within primary care in Scotland, thus allowing appropriate planning of education and training for effective use of IT.
Design A postal questionnaire survey of all dentists and dental care professionals (DCPs) within primary care in Scotland; online reply was also an option.
Setting General dental practice and the salaried dental service, May 2004.
Subjects and methods 2679 dentists and 2861 DCPs were surveyed.
Results Forty-three percent of respondents considered their IT skills to be 'moderate', with a further one-third reporting 'nil' or 'low' skill level. Only a quarter of respondents had accessed a learning programme by computer.The majority of IT competence was self-acquired.
Conclusions 'Upskilling' the dental team in IT may be required in order to take advantage of e-learning opportunities available now and in the future
Analysing the doctor_patient_computer relationship: the use of video data
Get PDFThis paper examines the utility of using digital video data in observational studies involving doctors' and patients' use of computers in the consultation. Previous observational studies have used either direct observations or analogue videotapes. We describe a method currently in use in a study examining how doctors, patients and computers interact in the consultation. The study is set in general practice as this is the most clinically computerised section of the Australian healthcare system. Computers are now used for clinical functions in 90% of doctors' surgeries. With this rapid rise of computerisation, concerns have been expressed as to how the computer will affect the doctor_patient relationship. To assess how doctors, patients and computers interact, we have chosen an observational technique, namely to make digital videotapes of actual consultations. This analysis is based on a theoretical framework derived from dramaturgical analysis. Data are gathered from general practitioners who are high-level users of computers, as defined by their use of progress notes, as well as prescribing and test ordering. The subsequent digital data is then transferred onto computer and analysed according to our conceptual framework, making use of video-tagging software
Routinely-collected general practice data are complex, but with systematic processing can be used for quality improvement and research
Get PDFBackground UK general practice is computerised, and quality targets based on computer data provide a further incentive to improve data quality. A National Programme for Information Technology is standardising the technical infrastructure and removing some of the barriers to data aggregation. Routinely collected data is an underused resource, yet little has been written about the wide range of factors that need to be taken into account if we are to infer meaning from general practice data.
Objective To report the complexity of general practice computer data and factors that need to be taken into account in its processing and interpretation.
Method We run clinically focused programmes that provide clinically relevant feedback to clinicians, and overview statistics to localities and researchers. However, to take account of the complexity of these data we have carefully devised a system of process stages and process controls to maintain referential integrity, and improve data quality and error reduction. These are integrated into our design and processing stages. Our systems document the query, reference code set and create unique patient ID. The design stage is followed by appraisal of: data entry issues, how concepts might be represented in clinical systems, coding ambiguities, using surrogates where needed, validation and piloting. The subsequent processing of data includes extraction, migration and integration of data from different sources, cleaning, processing and analysis.
Results Results are presented to illustrate issues with the population denominator, data entry problems, identification of people with unmet needs, and how routine data can be used for real-world testing of pharmaceuticals.
Conclusions Routinely collected primary care data could contribute more to the process of health improvement; however, those working with these data need to understand fully the complexity of the context within which data entry takes place
Does a higher 'quality points' score mean better care in stroke? An audit of general practice medical records
Get PDFBackground The Royal College of Physicians (RCP) have produced guidelines for stroke management in primary care; this guidance is taken to be the gold standard for the care of people with stroke. UK general practitioners now have a quality-based contract which includes a Quality and Outcomes Framework (QOF). This consists of financially remunerated 'quality points' for specific disease areas, including stroke. Achievement of these quality points is measured by extracting a limited list of computer codes from practice computer systems.
Objectives To investigate whether a high stroke quality score is associated with adherence to RCP guidelines.
Design Examination of computer and written medical records of all patients with a diagnosis of stroke.
Setting Two general practices, one in southwest London, one in Surrey, with a combined practice population of over 20 000. Both practices had a similar age_sex profile and prevalence of stroke.
Results One practice scored 93.5% (29/31) of the available stroke quality points. The other practice achieved 73.4% (22.75/31), and only did better in one stroke quality target. However, the practice scoring fewer quality points had much better adherence to RCP guidance: 96% of patients were assessed in secondary care compared with 79% (P=0.001); 64% of stroke patients were seen the same day, compared with 44%; 56% received rehabilitation compared with 37%.
Conclusions Higher quality points did not reflect better adherence to RCP guidance. This audit highlights a gap between relatively simplistic measures of quality in the QOF, dependent on the recording of a narrow range of computer codes, and the actual standard of care being delivered. Research is needed to see whether this finding is generalisable and how the Quality and Outcomes Framework might be better aligned with delivering best practice
Decision support for health care: the PROforma evidence base
Get PDFCancer Research UK has developed PROforma, a formal language for modelling clinical processes, along with associated tools for creating decision support, care planning, clinical workflow management and other applications. The PROforma method has been evaluated in a variety of settings: in primary health care (prescribing, referral of suspected cancer patients, genetic risk assessment) and in specialist care of patients with breast cancer, leukaemia, HIV infection and other conditions. About nine years of experience have been gained with PROforma technologies. Seven trials of decision support applications have been published or are in preparation. Each of these has shown significant positive effects on a variety of measures of quality and/or outcomes of care. This paper reviews the evidence base for the clinical effectiveness of these PROforma applications, and previews the CREDO project _a multi-centre trial of a complex PROforma application for supporting integrated breast cancer care across primary and secondary care settings