Informatics in Primary Care (BCS, The Chartered Institute for IT)
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Computer visualisation of patient safety in primary care: a systems approach adapted from management science and engineering
Get PDFPatient safety and medical errors in ambulatory primary care are receiving increasing attention from policy makers, accreditation bodies and researchers, as well as by practising family physicians and their patients.While a great deal of progress has been made in understanding errors in hospital settings, it is important to recognise that ambulatory settings pose a very large and different set of challenges and that the types of hazards that exist and the strategies required to reduce them are very different.
What is needed is a logical theoretical model for understanding the causes of errors in primary care, the role of healthcare systems in contributing to errors, the propagation of errors through complex systems and, importantly, for understanding ambulatory primary care in the context of the larger healthcare system. The authors have developed such a model using a formal 'systems engineering' approach borrowed from the management sciences and engineering. This approach has not previously been formally described in the medical literature.
This paper outlines the formal systems approach, presents our visual model of the system, and describes some experiences with and potential applications of the model for monitoring and improving safety. Applications include providing a framework to help focus research efforts, creation of new (visual) error reporting and taxonomy systems, furnishing a common and unambiguous vision for the healthcare team, and facilitating retrospective and prospective analyses of errors and adverse events. It is aimed at system redesign for safety improvement through a computer-based patient-centred safety enhancement and monitoring instrument (SEMI-P). This model can be integrated with electronic medical records (EMRs)
Codes, classifications, terminologies and nomenclatures: definition, development and application in practice
Get PDFThe Primary Care Informatics Working Group of EFMI is working to help develop the core theory of primary care informatics (PCI). Codes, classifications, terminologies and nomenclatures form an important part of the science of PCI, as they allow clinical information to be readily stored and processed in information systems.
This article provides definitions and a history of the International Classification for Primary Care (ICPC), and of the Read code and the Systematized Nomenclature for Medicine (SNOMED).
The Working Group wishes to encourage shared definitions and an understanding of the practical application of structured data to improve quality in clinical practice
Adoption and perception of electronic clinical communications in Scotland
Get PDFObjectives To determine the uptake of multiple eHealth facilities enabled by the NHS Scotland Electronic Clinical Communications Implementation Programme (ECCI) and to ascertain primary and secondary care users' perceptions.
Design Prospective monthly measurement of 37 indicators of roll-out and adoption. Retrospective questionnaire survey of users.
Setting Scottish health board regions. Quantitative implementation indicators were gathered in primary and secondary care across all 16 regions. Questionnaire data were obtained from recorded users in five representative regions (112 general practices, 92 secondary care units).
Outcome measures Change in uptake levels of ECCI facilities over a 15-month period. Users' perceptions of benefits, facilitators and barriers.
Results All health boards participated in the monthly data set collection. The response rate to the survey was 62% in primary care and 37% in secondary care. Across Scotland as a whole, the process of implementation was gradual. While there were marked gains inthe availability of ECCI facilities over the observation period, rates of adoption lagged behind and varied across alternative facilities. Electronic results were widely used, with most laboratories offering them and around half of general practices receiving them. More modest rates of adoption were observed for e-discharge letters, e-referrals, e-clinic letters and clinical email. E-booking was used very little. Among engaged users responding to the survey, electronic access to test results was the most frequently utilised facility and electronic outpatient booking the least. Perceived benefits of ECCI facilities included convenience, ease of use, time-saving and provision of an audit trail. Perceived barriers included the need to duplicate data entry where new systems were not universally implemented, technological difficulties, time, training and resources.
Conclusions Significant progress was observed in the implementation of ECCI facilities across Scotland. Users reported that these improved communication and were beneficial, but system reliability, incompatibility and duplication of data hindered more widespread uptake. Data were collected at a transitional phase of the programme. Whilst, among users of ECCI facilities, perceptions of the programme and its potential benefits were generally positive, its full impact will not become evident until the new electronic tools are implemented nationally and have been more fully integrated into normal work routines
Application of fuzzy classification in modern primary dental care
Get PDFThis paper describes a framework for implementing fuzzy classifications in primary dental care services. Dental practices aim to provide the highest quality services for their patients. To achieve this, it is important that dentists are able to obtain patients' opinions about their experiences in the dental practice and are able to accurately evaluate this. We propose the use of fuzzy classification to combine various assessment criteria into one general measure to assess patients' satisfaction with primary dental care services. The proposed framework can be used in conventional dental practice information systems and easily integrated with those already used. The benefits of using the proposed fuzzy classification approach include more flexible and accurate analysis of patients' feedback, combining verbal and numeric data. To confirm our theory, a prototype was developed based on the Microsoft TM SQL Server database management system for two criteria used in dental practices, namely making an appointment with a dentist and waiting time for dental care services
Web-based health applications provide useful and cost-effective tools; however, they should include key clinical variables and incorporate a coding or classification system
Get PDFIntegrating data to facilitate clinical research: a case study
Get PDFThe integration of routine clinical administrative activities into ongoing rigorous clinical research poses challenges for both clinicians and researchers. This case study describes the development of a responsive database system used to facilitate comprehensive longitudinal research into the outcomes of patients waiting for hip and knee replacement surgery in a large public teaching hospital. The initial research procedure was paper-based, with manual patient matching and data entry. This process was time-consuming and associated with substantial risk of error and omissions, necessitating the design of a better system. An integrated database system was designed to receive daily electronic updates of the orthopaedic waiting-list and scheduled clinic and surgery dates. Using readily available software (Microsoft Access), new patients were identified through specifying inclusion and exclusion criteria which allowed rapid and complete recruitment at time of entry to the waiting-list. The integrated system specified the appropriate timing of multiple follow-up assessments, provided prompt information on recruitment for reporting purposes and integrated multiple linked research projects within one database. Seamless exporting of data to statistical programs for analysis was also enabled. This simple integrated approach facilitated efficient execution of a longitudinal study from recruitment to statistical analysis while maximising confidentiality and minimising resources required. This case study describes the development and design of a simple system which could be easily adapted for database management in hospital or clinic-based settings according to local requirements
Implementing the National Programme for IT: what can we learn from the Scottish experience?
Get PDFThe National Programme for IT (NPfIT) promises to revolutionise the delivery of health care by enabling seamless and secure electronic exchange of clinical information within the NHS. Challenges to NPfIT highlighted in the media and academic commentary are common to such initiatives worldwide. This paper offers key messages and recommendations derived from a comparable electronic clinical communications programme in Scotland, and elsewhere, as a means to aid the implementation process
Multi-ontology sense making: a new simplicity in decision making
Get PDFImagine organising a birthday party for a group of young children. Would you agree a set of learning objectives with their parents in advance of the party? Would those objectives be aligned with the mission statement for education in the society to which you belong? Would you create a project plan for the party with clear milestones associated with empirical measures of achievement? Would you start the party with a motivational video so that the children did not waste time in play not aligned with the learning objectives? Would you use PowerPoint to demonstrate to the children that their pocket money is linked to achievement of the empirical measures at each milestone? Would you conduct an after-action review at the end of the party, update your best practice database and revise standard operating procedures for party management?
No! Instead, like most parents, you would create barriers to prevent certain types of behaviour, you would use attractors (party games, a football, a videotape) to encourage the formation of beneficial largely self-organising identities; you would disrupt negative patterns early, to prevent the party becoming chaotic, or necessitating the draconian imposition of authority. At the end of the party you would know whether it had been a success, but you could not have defined (in other than the most general terms) what that success would look like in advance
Pandora's electronic box: GPs reflect upon email communication with their patients
Get PDFBackground Global access to information technology has increased dramatically in the past decade, with electronic health care changing medical practice. One example for general practitioners (GPs) is communication with patients via electronic mail (email). GPs face issues regarding e-communication with patients, including how and when it should it be used.
Objective The study aims were to assess the extent that GPs communicate with patients by email and explore their attitudes to this mode of communication.
Methods Design: telephone interview survey. Setting: primary care, largest urban and suburban area in New Zealand (NZ). Subjects: randomly selected GPs from the Auckland region. Main outcome measure: description of email use; analysis of issues by telephone survey. Data analysed using SPSS-12 and by thematic content analysis.
Results At data saturation, 80 GPs had been interviewed. The majority (68%) had not used email with patients. Only 4% used it regularly. However, there was strong interest in this method. Perceived advantages were the ability to communicate at a distance and time convenient to both doctor and patient; communication where disability affected traditional methods; information-giving (for example, web links); passing on normal results. Identified problems involved inequity of access; linking of electronic data; security; unsuitability for some topics; medico-legal concerns; time; remuneration.
Conclusion Study sample closely mirrored current NZ GP population. Although few GPs emailed with patients, many might once barriers are addressed. GPs had a collective view of the appropriate boundaries for email communication, routine tasks and the transmission of information. GPs would encourage professional debate regarding guidelines for good practice, managing demand and remuneration