Informatics in Primary Care (BCS, The Chartered Institute for IT)
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XML-based clinical data standardisation in the National Health Service Scotland
Get PDFThe objective of this paper is to clarify the role that socio-economic factors played in shaping the development of XML-based clinical data standards in the National Health Service in Scotland from 2000 to 2004. The paper discusses the NHS Scotland approach to clinical data standardisation, emphasising the actors involved, their choices during the standard development process and the factors that have shaped these choices. The case suggests that the NHS Scotland approach to clinical data standardisation is shaped by strong political pressures for fast development of an integrated electronic patient care system, economic pressures for high efficiency and cost reductions, and organisational requirements for strong clinical support. Such economic, political and organisational pressures explain the informal approach to standard development, the emphasis on fast system development and strong clinical involvement. At the same time, market factors explain the low commitment of the IT vendors, which might have otherwise put significant pressure onNHSScotland to pursue a more formalised standardisation approach within an internationally recognised standard-setting body
Online discussions mirroring family life during pregnancy
Get PDFObjective The aim of this study was to find out what aspects of their parenthood parents revealed, and how they expressed their thoughts concerning maternity care services on an online communication forum.
Background The 'Information Society' offers a growing variety of health services as part of public primary health care via the internet. Little is known about the contents produced online by pregnant families, and how they reflect on both family life and maternity care services.
Methods The data for this study were obtained from online discussions between families (n=21) in Net Clinic, an internet-based service designed for public maternity care. The data included experiences of family life during pregnancy, childbirth and parenting, and was analysed by inductive content analysis.
Results While maturing into parenthood, both women and men recognised the uniqueness of their new role and wanted to prepare for safe childbirth. Online communication in the home environment nourished new social networks among families who were expecting their first, second or third child. In addition, families reflected on maternity care services on the Net Clinic's communication forum. This provided realistic feedback to maternity care professionals.
Conclusions Today, the relationship between clients and professionals is inevitably changing. More online services and advocacy are needed if families are to have access to online health services. The role of professionals is diversifying from being authorities to supporting and facilitating clients' individual self-care. Based on direct client feedback, the quality of maternity care can be improved
Smoking status recording in GP electronic records: the unrealised potential
Get PDFObjective To investigate the recording of smoking status and factors associated with the recording of smoking status in general practitioner (GP) electronic medical records (EMRs) in New Zealand, and the suitability of this source as a prevalence measure.
Setting General practices affiliated with an Auckland-based primary health organisation.
Population Patients registered with 84/107 (78.5%) eligible GPs who had used EMRs for at least a year and had PREDICT-CVD,a web-based cardiovascular disease risk assessment and management decision support program, integrated with their practice software.
Design Audit of EMRs using data from an evaluation of PREDICT-CVD.
Main outcome measures The proportion of EMRs audited (Maori, non-Maori) with smoking status
recorded and, among those with smoking status recorded,al so Read-coded, and factors associated with greater recording of smoking status.
Results Smoking status was recorded among 49.6% of Maori and 38.3% of non-Maori prior to the installation of PREDICT-CVD. Among those with smoking status recorded, smoking status was also Read-coded among 49.8% of Maori and 62.3% of non-Maori. Factors associated with greater recording of smoking status were installation of PREDICT-CVD, male sex, Maori ethnicity, cardio-vascular disease and diabetes. Age was also associated with the recording of smoking status.
Conclusion General practitioner electronic medical records in New Zealand are currently not a suitable source of smoking prevalence data, even if manually searched, as a large proportion of records did not have smoking status recorded. Such records are an even less suitable source of smoking prevalence if data extraction by remote querying (using Read codes) is relied upon. The potential to estimate the prevalence of smoking from GP records has not yet become a reality. Installation of electronic decision support systems, such as PREDICT-CVD, could improve the recording and Read-coding of smoking status, and thereby the availability and accessibility of these data
Software design to facilitate information transfer at hospital discharge
Get PDFDischarge communication between inpatient and outpatient physicians is often an inefficient and error-prone process. Adverse events result from poor communication at the time of discharge. The objective of this study was to describe development of discharge software to overcome communication barriers. The secondary objective was to assess factors that influence the time to complete tasks with the software. Methods were a performance improvement model and database analysis of 336 discharges. Software design specifications included computerised physician order entry, immediate utility, minimal development and deployment costs, acceptability to physician-users, and satisfaction of primary care physicians, patients and pharmacists. Design features included simple 'just-in-time' prompts and point-of-care prescribing resources. The dependent variable for analysis was physician time to complete discharge prescriptions and instructions while using the software. General linear and mixed-effects regression models adjusted for physician effects and other predictors. Results revealed that physician factors significantly affected the time to complete a discharge while using the software. As the number of accesses (log-ins) and free text typing increased, then time to complete the computerised discharge increased. Patient-related factors that increased physician time were discharge diagnoses, prescriptions and length of stay. In conclusion, discharge software can help inpatient physicians transfer timely, complete and legible information to outpatient physicians, pharmacists and patients. Physician and patient factors influence the time to complete discharges using the software
Liverpool Telecare Pilot: case studies
Get PDFTelecare services use information and communications technology (ICT) to support the provision of care to people in their own homes. This paper describes a pilot telecare service employed by Liverpool (UK) City Council to support a sample of their frail and elderly social services users. The pilot has been running for over two years and has been deployed for 21 individuals in Liverpool. In this paper we present the pilot system and provide real example cases which help to illustrate the benefits of such a system
Estimating the value of information in strategies for identifying patients at high risk of cardiovascular disease
Get PDFBackground There are many different potential strategies for identification of patients eligible for primary prevention of cardiovascular disease. The ability to use a more efficient strategy has a value. This paper models the costs and benefits of a number of identification strategies and estimates the additional value of an information-based strategy.
Design Modelling study.
Methods Ten-year Framingham cardiovascular risk was calculated for each individual in a population of 4471 persons aged 35_74 drawn from the Health Survey for England (equivalent to a total practice population of 12 000). Estimated Framingham risk was calculated using limited risk factor information and default risk factors. Costs of risk factor assessment were calculated using standard NHS costs. The outcomes of risk factor assessment were the total number of patients identified as eligible for treatment and the total burden of cardiovascular disease in eligible patients. Several strategies for prioritising patients for assessment were defined: opportunistic, diabetics and treated hypertensives first, ranked by estimated cardiovascular risk. The costs and outcomes of assessing increasing numbers of patients under each strategy were presented in graphical form.
Results To identify 70% of the burden of cardiovascular disease in this population opportunistically costs '82 102; under a 'diabetics and hypertensives first' strategy it costs '72 916; under a strategy prioritising by estimated cardiovascular risk, '27 795. The value of information in this scenario is therefore at least '45 121.
Conclusions Because strategies prioritising patients by estimated cardiovascular risk dominate alternative strategies, it is possible to estimate the value of information in terms of reduced resources to achieve the same results. These resource savings largely represent savings in staff time
Liverpool Telecare Pilot: telecare as an information tool
Get PDFThe role of telecare systems is normally seen as identifying, and drawing attention to, situations of concern in the homes of service users. While this may currently be the primary reason for deploying such systems, the scope of telecare should not be limited to such an alarm generation role. The role of telecare in enhancing community-based care provision may be broadened by using similar, or identical, technology for providing relevant information to the carers of service users. In this paper we present a technical overview and discussion of an information provision approach to telecare which was trialled as one aspect of a pilot service in Liverpool, UK. The service used data collected by the telecare system to produce visual daily behavioural profiles and presented these to carers. The recipients for these profiles included social workers, occupational therapists and relatives of the service users. In this paper we discuss the visual profiles together with the benefits offered by such an information provision approach, including the perspective of a occupational therapist based in Liverpool
Examining the adoption of electronic health records and personal digital assistants by family physicians in Florida
Get PDFPurpose The purpose of this paper is to comprehensively characterise the current use of electronic health records (EHRs) and personal digital assistants (PDAs) among family physicians in Florida; and to compare family physicians with other doctors with respect to the functions commonly used on their EHR and PDA systems.
Methods A postal survey was sent to family physicians (n=2076) and other doctors with a clear and active licence in Florida (total n=14 921). To examine factors among family physicians related to EHR and PDA use, binary logistic regression modelling techniques were utilised. Chi-square analysis was used to compare EHR and PDA functions between family physicians and other doctors.
Results A total of 4203 responses, of which 756 were from family physicians, were available for the current study (28.2% overall response rate). EHR use among family physicians was significantly related to large practice size, urban location and young physician age, after controlling for confounders. Likewise, PDA usage among family physicians was independently associated with male gender and younger physician age. Additionally, even though no differences in overall EHR adoption were found, family physicians, when compared with other physicians, were significantly more likely to be using a more robust set of EHR functions. This included allergy and medication lists, diagnosis, problem lists, patient scheduling and educational materials, preventive services reminders and access to reference material.
Conclusions Even though family physicians utilise many EHR and PDA functions more commonly than other physician groups, the overall level of EHR adoption among family physicians remains low. Until more barriers to the use of EHR are minimised, the goals of the Future of Family Medicine Report to broadly implement EHR and other health IT functions will not be fully realised