Informatics in Primary Care (BCS, The Chartered Institute for IT)
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The development and evaluation of alternative communication strategies to facilitate interactions with Somali refugees in primary care: a preliminary study
Get PDFThe work reported in this paper forms part of a larger project to develop and evaluate alternative forms of communication to facilitate cross-cultural consultations in primary care. As a case study and proof-of-concept, work was conducted with Somali refugees who tend to experience significant communication difficulties in primary care consultations.
The alternative communication methods developed in this study originate from the field of Augmentative and Alternative Communication (AAC). These methods may include non-verbal communication or aided communication using a mix of pictographic symbols, bilingual text and digitised (recorded) or synthetic speech. These can be delivered on a range of paper-based or computer-based devices.
A paper-based and computer-based method was developed to assess whether a group of literate and illiterate Somalis were able to answer a set of questions using these tools. The purpose of this preliminary study was to assess whether either of these communication methods were suitable for further evaluation in primary care consultations.
Twenty Somalis were presented with three communication tools and were asked a set of general questions in Somali which they had to answer using each tool: (1) a paper-based communication book containing symbols and bilingual text labels; (2) a laptop PC with mouse pad containing the same symbols, text labels and augmented with digitised Somali speech; (3) a tablet PC w ith touch screen containing the same software and digitised Somali speech. These two computer-based delivery platforms were compared for ease of use among a participant group who are likely to have little computing experience.
Each task was timed and scored for level of correctness; feedback was gained from Somalis and experimenters' observations were noted. Participants clearly found the computerised devices with Somali speech output easier to use and more acceptable than the simpler paper-based device
Integrating data for learning disabilities service providers: are the barriers and solutions technical or organisational?
Get PDFSince the publication of the Government White Paper 'Valuing People: a new strategy for learning disability for the 21st century', the responsibility for providing health care for people with learning disabilities has shifted rapidly to primary care.1 However, people with learning disabilities are supported by a disparate group of providers, from health care through local authorities to the voluntary sector, with resultant difficulties in providing seamless care. There would seem to be considerable potential for 'joined-up' data and information services to improve this situation, and Semantic Web technologies offer many enticing possibilities in this regard. However, to be effective, many organisational and policy issues have to be addressed; not least among these is the concern of patient confidentiality. This is particularly pertinent given that people with learning disabilities might be less able to make informed decisions.
The approach that this paper takes is to review the policy and service scenarios that would benefit from 'joined-up' data, and then, based on user feedback from a series of seminars with stakeholders on these issues, explore what works well, what works less well, and to offer suggestions for future developments
Prometheus: the implementation of clinical coding schemes in French routine general practice
Get PDFBackground Clinical data are most useful, both at the individual level and collectively, if they are coded according to a standard classification system. However, clinicians often have little motivation to routinely code their consultation data. The main classification systems available in French primary care are the International Classification of Primary Care (ICPC)and the Dictionary of Consultation Results (DCR).
Objective To assess the feasibility of using the ICPC-2 and the DCR for coding health problems managed in routine general practice in France.
Methods Between December 2001 and June 2003, 61 volunteer general practitioners (GPs)from the Paris area prospectively recorded the health problems they managed at consultations, using either the ICPC (36 GPs)or the DCR (25 GPs), for a period of six months. They were equipped with one of three proprietary medical software applications specifically adapted for the study, or one open source utility, interfacing with five other, non-adapted, proprietary software programs. They had a two-day training session, were financially compensated, and were provided with electronic feedback.
Results The mean reported coding time per consultation was 2.5 minutes, but 28 physicians (46%) judged the coding time excessive and reported a maximum acceptable time of 1.2 minutes. Coding consultation data was considered more useful at the collective level (by 95% of physicians)than at the individual practice level (by 69%). Only 34 physicians (56%)expressed willingness to carry on routine coding after the end of the study. Some results differed depending on the classification system used, especially due to confounding factors, as some physicians could have previously used the given system.
Conclusions Coding health problems on a routine basis proved to be feasible. However, this process can be used on a more widespread basis and linked to other management data only if physicians are specially trained and rewarded, and the software incorporates large terminologies mapped with classifications
The Primary Care Electronic Library: RSS feeds using SNOMED-CT indexing for dynamic content delivery
Get PDFBackground Rich Site Summary (RSS) feeds are a method for disseminating and syndicating the contents of a website using extensible mark-up language (XML). The Primary Care Electronic Library (PCEL) distributes recent additions to the site in the form of an RSS feed. When new resources are added to PCEL, they are manually assigned medical subject headings (MeSH terms), which are then automatically mapped to SNOMED-CT terms using the Unified Medical Language System (UMLS) Metathesaurus. The library is thus searchable using MeSH or SNOMED-CT. Our syndicate partner wished to have remote access to PCEL coronary heart disease (CHD) information resources based on SNOMED-CT search terms.
Objective To pilot the supply of relevant information resources in response to clinically coded requests, using RSS syndication for transmission between web servers.
Method Our syndicate partner provided a list of CHD SNOMED-CTterms to its end-users, a list which was coded according toUMLS specifications. When the end-user requested relevant information resources, this request was relayed from our syndicate partner's web server to the PCEL web server. The relevant resources were retrieved from the PCEL MySQL database. This database is accessed using a server side scripting language (PHP), which enables the production of dynamic RSS feeds on the basis of Source Asserted Identifiers (CODEs) contained in UMLS.
Results Retrieving resources using SNOMED-CT terms using syndication can be used to build a functioning application. The process from request to display of syndicated resources took less than one second.
Conclusion The results of the pilot illustrate that it is possible to exchange data between servers using RSS syndication. This method could be utilised dynamically to supply digital library resources to a clinical system with SNOMED-CTdata used as the standard of reference
Communicating about medications during primary care outpatient visits: the role of electronic medical records
Get PDFObjectives To assess the role of electronic medical records (EMR) in facilitating the content and process of patient_provider exchanges about medications during outpatient primary care visits.
Methods Fifty encounters with six physicians using The EMR were videotaped, transcribed and content-analysed by applying conversation analysis and ethno-methodology techniques. The analysis focused on three aspects of medication communication: (1) process of care: practices by patients and physicians to implement medication decisions; (2) themes: medication topics that consistently emerge; and (3) names: ways patients and physicians refer to medications. In-depth analysis of 20 encounters examined the extent to which either or both parties initiated, expanded and concluded medication discussions.
Results On average 21.2 (range: 8_35; SD=7.4) distinct exchanges per encounter were observed. Of those, 33% were related to medication. Of the 350 medication-related exchanges throughout the encounters, 56% were categorised as routine medication discussion such as ordering and/or refilling medications. Mailing issues were the next most common medication-related exchanges (10.6%), followed by partial adherence (8.9%), self-regulation (7.4%), alternative therapy/over-the-counter medication (6.6%), side effects (6%) and formulary issues (4.6%). Patients and providers used three ways to name medications: generic/scientific name (42%); physical description (39.7%) and brand name (18.3%). Forty-one percent of exchanges included initiation by one or both parties but no further discussion of the issue; 42% included initiation and expansion by both parties but not conclusion; only 17% of exchanges contained complete medication exchanges (initiation, expansion and conclusion) by both parties.
Conclusions EMR facilitated content and process of communication regarding medications during outpatient encounters, especially among patients taking multiple medications and patients who used physical descriptions to identify their medications. EMR use stimulated medication exchanges, leading to further expansion about the topic. However, fewer than one-fifth of exchanges ended with clear conclusions by both parties regarding prescribed medication regimens
A knowledge management-based intranet: asset or EBM liability?
Get PDFThis paper summarises the presentation given at the British Computer Society Primary Health Care Specialist Group annual conference 2004. It outlines the four years of experience gained in implementing a knowledge management-based intranet across a local health community. Consideration is given to definitions of knowledge management and evidence-based medicine. The paper outlines the potential impacts and actual results over the four-year period, with reference to the wider issues involved
Information communications technology in general practice: cross-sectional survey in London
Get PDFObjective To determine the prevalence of use of a range of information and communications technology (ICT) applications in general practice in London, UK.
Design Cross-sectional postal questionnaire study.
Participants 996 general practitioners (GPs) working in 32 primary care trusts (PCTs) in London.
Main outcome measures Rates of self-reported use of paperless, paper-light and paper-based consultations in general practice, perceived barriers and facilitating factors relating to their use and current use or interest in using innovative ICT.
Results Questionnaires from 520 respondents (52%) were analysed. A computer was used in clinical consultations by 95% of respondents; 34% operated paper-light consultations, and 41% paperless consultations. An electronic record was always used in 76% of consultations and paper records were never used in 19%. Paper-light and paperless consultations were conducted more frequently in larger practices and those in more affluent PCTs. Numerous barriers to the implementation of ICT were identified, including lack of time, lack of training resources and negative attitudes to computers. Personal digital assistants were used by 18% of respondents and 72% were interested in their use in the future.
Conclusion We have shown that there has been a considerable increase in the rate of use of ICT in general practice in recent years, but these rates have fallen behind targets set by the NHS IT Strategy. Numerous barriers to the implementation of ICT exist, and further research is needed into means of overcoming them and on the evaluation of computer- supported consultations and other technologies in primary care
Identifying and establishing consensus on the most important safety features of GP computer systems: e-Delphi study
Get PDFOur objective was to identify and establish consensus on the most important safety features of GP computer systems, with a particular emphasis on medicines management.Weused a two-round electronic Delphi survey, completed by a 21-member multidisciplinary expert panel, all from the UK. The main outcome measure was percentage agreement of the panel members on the importance of the presence of a number of different safety features (presented as clinical statements) onGP computer systems.We found 90% or greater agreement on the importance of 32 (58%) statements. These statements, indicating issues considered to be of considerable importance (rated as important or very important), related to: computerised alerts; the need to avoid spurious alerts; making it difficult to override critical alerts; having audit trails of such overrides; support for safe repeat prescribing; effective computer_user interface; importance of call and recall management; and the need to be able to run safety reports. The high level of agreement among the expert panel members indicates clear themes and priorities that need to be addressed in any further improvement of safety features in primary care computing systems