Informatics in Primary Care (BCS, The Chartered Institute for IT)
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The South Warwickshire NHS Care Records Service Demonstrator Project: lessons for the National Programme for IT
Get PDFThe NHS Care Records Service (CRS) is a major goal of the National Health Service (NHS) Modernisation Programme. It will provide for 24-hour access by clinicians to electronic patient records and the integration of information from previously separate databases, reducing the 'seams' between primary and secondary care, between out-of-hours and ordinary working hours, and ultimately between health and social care. Such integration is likely to affect not only individual patient care, but also public health including disease surveillance, and the monitoring of clinical activities including the achievement of clinical governance targets. The potential benefits for patients, practitioners and managers are numerous. However, the process raises issues over confidentiality, data protection and data quality. During 2003 a project was undertaken in South Warwickshire to develop an NHS CRS widely available to primary care clinicians in the region. This was part of a wider initiative funded by the NHS Connecting for Health (NHS CfH). Twenty-six out of 36 local practices took part, providing a combined database of 181 961 clinical records. All but one of the original objectives was achieved. Lessons were learned which could usefully inform the development of the CRS more generally in the NHS
The implementation of electronic services: planned or organic growth?
Get PDFThe literature on innovation suggests that projects are successful when rigorous project management is mixed judiciously with 'organic' development. This paper argues that organic growth can play a substantial role in the implementation of electronic services in healthcare settings. Evidence for organic growth is presented, based on a study of email use. Methods are presented for investigating email use in health service settings in the National Health Service (NHS) in Bradford, England. Geographical information systems (GIS) outputs and social network analyses are presented. The results demonstrate a fivefold increase in the use of email over a 13-month period, which is shown to be largely independent of the growth in the number of organisations using the network. They also demonstrate a marked increase in the complexity of the patterns of email use over the period
Development of functional requirements for electronic health communication: preliminary results from the ELIN project
Get PDFBackground User participation is important for developing a functional requirements specification for electronic communication. General practitioners and practising specialists, however, often work in small practices without the resources to develop and present their requirements. It was necessary to find a method that could engage practising doctors in order to promote their needs related to electronic communication.
Materials and methods Qualitative research methods were used, starting a process to develop and study documents and collect data from meetings in project groups. Triangulation was used, in that the participants were organised into a panel of experts, a user group, a supplier group and an editorial committee.
Results The panel of experts created a list of functional requirements for electronic communication in health care, consisting of 197 requirements, in addition to 67 requirements selected from an existing Norwegian standard for electronic patient records (EPRs). Elimination of paper copies sent in parallel with electronic messages, optimal workflow, a common electronic 'envelope' with directory services for units and end-users, and defined requirements for content with the possibility of decision support were the most important requirements.
Conclusions The results indicate that we have found a method of developing functional requirements which provides valid results both for practising doctors and for suppliers of EPR systems
How to sign up for a National Care Record Service Acceptable Use Policy: pitfalls and lessons
Get PDFThe Primary Care Electronic Library (PCEL) five years on: open source evaluation of usage
Get PDFBackground The Primary Care Electronic Library (PCEL) is a collection of indexed and abstracted internet resources. PCEL contains a directory of quality-assured internet material with associated search facilities. PCEL has been indexed, using metadata and established taxonomies. Site development requires an understanding of usage; this paper reports the use of open source tools to evaluate usage. This evaluation was conducted during a six-month period of development of PCEL.
Objective To use open source to evaluate changes in usage of an electronic library.
Method We defined data we needed for analysis; this included: page requests, visits, unique visitors, page requests per visit, geographical location of users, NHS users, chronological information about users and resources used.
Results During the evaluation period, page requests increased from 3500 to 10 000; visits from 1250 to 2300; and unique visitors from 750 to 1500. Up to 83% of users come from the UK, 15% were NHS users. The page requests of NHS users are slowly increasing but not as fast as requests by other users in the UK. PCEL is primarily used Monday to Friday, 9 a.m. to 5 p.m. Monday is the busiest day with use lessening through the week. NHS users had a different list of top ten resources accessed than non-NHS users, with only four resources appearing in both.
Conclusions Open source tools provide useful data which can be used to evaluate online resources. Improving the functionality of PCEL has been associated with increased use
A framework for mobile healthcare answers to chronically ill outpatient non-adherence
Get PDFNon-adherence (also known as 'non-compliance') is a major barrier undermining healing efforts within out-of-hospital self-management programmes, resulting in waste of human and social resources. This study suggests a theoretical framework of activities through which mobile patient solutions might address non-adherence determinants in a broader context of clinical interventions. The goal of the paper is to explore a dilemma associated with such interventions: the uncertainty regarding the level of patient involvement and technology support. We follow a critical orientation approach in discussing this multi-faceted conundrum: we summarise the latest vision on adherence factors, we suggest several types of interventions through which mobile healthcare solutions could address them, and we explore in detail the dilemma of patient and technology roles. We conclude that there is no universally optimal solution, and practical conditions depending on patient, disease, treatment and healthcare system are determining factors in prescribing the level of patient involvement and technology support.
Our work is intended to stimulate further research into the nature of mobile solutions in health care and, especially, into patient acceptance aspects, in an endeavour to contribute to improving adherence with minimum obtrusiveness
Potential impacts of patient access to their electronic care records
Get PDFThis paper examines the interest and expectations of patients having access to their electronic care records. Semi-structured prospective interviews were performed with 109 patients in a community setting in London where all records are stored digitally either as coded data, free text or scanned in from the paper original. A booth had recently been set up for patients to access their electronic records in the waiting room with secure access through fingerprint recognition technology. The interviews detailed history and levels of interest in access, impact on relationship with clinician, familiarity with digital media and issues of security and accuracy. Patients were more interested in seeing their electronic than their paper record; they felt it would improve their relationship with their clinician; they generally trusted in the security of their records; they anticipated that there would be some mistakes; they were enthusiastic about the idea of adding to the record themselves, but were divided about having access over the internet. Patients are confident in and anticipate the value of having access to their electronic records
Randomised studies in general practice: how to integrate the electronic patient record
Get PDFThe 'randomised database study' strategy was first proposed in 1997, with the aim of combining the generalisability of observational database studies based on electronic patient records (EPRs) with the validity of randomised clinical trials (RCTs). The key feature was to randomly assign treatments and to use routine care data, as available in the observational database, for patient identification and follow-up. To our knowledge, however, the idea of the randomised database study has not been implemented yet.
The conduct of a randomised study in an observational database requires adjustments to methods of medical information processing in the general practice. We developed a software system that facilitates the conduct of an RCT with observational databases based on EPRs. It identifies eligible subjects and presents them one by one to the physician once their EPR is accessed. The general practitioner can then start an interactive recruitment process; after completion, the computer randomises the patients. Follow-up is documented by normal routine care in the EPR.
Although the randomised database study has many methodological advantages, it has never been tested. Our software system is meant as a tool to implement and facilitate evaluation of the randomised database approach
