Informatics in Primary Care (BCS, The Chartered Institute for IT)
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A real-time, mobile phone-based telemedicine system to support young adults with type 1 diabetes
Get PDFTelemedicine systems have been proposed as a means of supporting people with diabetes in the self-management of their condition. Requirements for monitoring parameters of care, including glycaemic control, extent of analysis and interpretation of data, patient_clinician contacts, and involvement of a multidisciplinary care team with effective communication, can be addressed by telemedicine systems. We describe the development and implementation of an innovative real-time telemedicine system based around transmission and feedback of data to and from a mobile phone. Proprietary Java-based programs were used to link a blood glucose meter to a mobile phone. In addition to immediate transmission of blood glucose data, information about insulin dose, eating patterns and physical exercise were collected. Immediate feedback to the phone included a colour histogram to draw attention to levels of control over glycaemia over the previous two weeks. Clinicians supporting patients had access to summary screens identifying users not testing, and those with levels of blood glucose outside pre-defined limits. More detailed graphical displays of data were used to provide data about control of insulin dose and the degree to which it was modified in response to diet and exercise. The system has been evaluated in a clinical trial conducted in secondary care and is now being adapted for use in a trial in primary care, which is designed to assess its effectiveness in providing integrated management for the patient, general practitioner and pharmacist
Implementing electronic medical record systems in developing countries
Get PDFThe developing world faces a series of health crises including HIV/AIDS and tuberculosis that threaten the lives of millions of people. Lack of infrastructure and trained, experienced staff are considered important barriers to scaling up treatment for these diseases. In this paper we explain why information systems are important in many healthcare projects in the developing world. We discuss pilot projects demonstrating that such systems are possible and can expand to manage hundreds of thousands of patients. We also pass on the most important practical lessons in design and implementation from our experience in doing this work. Finally, we discuss the importance of collaboration between projects in the development of electronic medical record systems rather than reinventing systems in isolation, and the use of open standards and open source software
A system of metadata to control the process of query, aggregating, cleaning and analysing large datasets of primary care data
Get PDFBackground Metadata is data that describes other data or resources. It has a defined number of named elements that convey meaning. Medical data are complex to process. For example, in the Primary Care Data Quality (PCDQ) renal programme, we need to collect over 300 variables because there are so many possible causes of renal disease. These variables are not just single columns of data - all are extracted as code plus date, while others are code_date_value. Metadata has the potential to improve the reliability of processing large datasets.
Objective To define unique and unambiguous metadata headings for clinical data and derived variables.
Method We defined the look-up tables we would use as a controlled vocabulary to name the core clinical concepts within the metadata. We added six other elements to describe data: (1) the study or audit name; (2) the query used to extract the data; (3) the data collection number; (4) the type of data, including specifying the units; (5) the repeat number (if the variable was extracted more than once); and (6) a processing suffix that defines how the data have been processed.
Results The metadata system has enabled the development of a query library and an analysis syntax library that make data processing and analysis more efficient. Its stability means greater effort can be put into more complex data processing, and some semi-automation of processes. However, the system has had implementation problems. It has been particularly hard to stop clinicians using multiple synonyms for the same variable.
Conclusions The PCDQ metadata system provides an auditable method of data processing. It is a method that should improve the reliability, validity and efficiency of processing routinely collected clinical data. This paper sets out to demystify our data processing method and makes the PCDQ metadata system available to clinicians and data processors who might wish to adopt it
Designing and implementing an electronic health record system in primary care practice in sub-Saharan Africa: a case study from Cameroon
Get PDFObjective To review the key issues related to the design and implementation of an electronic health record (EHR) system in urban primary health care (PHC) practice in Cameroon.
Methodology The goal of the project was to assess EHR as a tool to improve providers' performance, quality and continuity of care, and the availability of data in PHC practice in Cameroon. A locally designed EHR system called MEDCAB was developed. The system was based on the International Classification for Primary Care (ICPC) and was designed taking into consideration the PHC practice environment in Cameroon. An original cohort of 14 users was involved in the experiment.
Results Users generally showed good acceptance of the system. Monitoring the use of the system at the early stages of implementation was important to ensure immediate response to users' comments and requests. Some of the key issues identified during the development and implementation of the system were: user involvement, the choice of an appropriate terminology, pre-existing data collection culture and leadership issues. Some positive achievements brought about by the system included promotion of good medical practice and routine availability of consultation data.
Conclusion Strengthening the medical record in general, and the EHR in particular, could contribute to its position as a valuable source of information for healthcare delivery, public health and policy making in Cameroon. Challenges to adoption are huge and successful implementation for any specific setting will require a comprehensive modelling of the local medical practice, the choice of an appropriate terminology and a co-ordinated approach involving all stakeholders
The CONTENT project: a problem-oriented, episode-based electronic patient record in primary care
Get PDFIn order to obtain a proper knowledge base in primary care, a form of electronic patient record is needed that takes into account the specific characteristics of the doctor_patient encounter, the patient population, the presentation of diseases and the associated prevalences. However, in real life this has not happened for several reasons. For the most part, existing patient records are determined by invoicing requirements rather than by endeavours to meet the intrinsic needs of primary care. CONTENT (CONTinuous morbidity registration Epidemiologic NeTwork) is an ambitious scientific project in Germany to establish a system for adequate record keeping and analysis in primary care. Based on a classification system designed for the special situation of primary care, a scientific network is being established consisting of participating surgeries, general practitioners, computer scientists and statisticians. The project is supported by the German Federal Ministry of Education and Research.
The aims are strictly scientific and the underlying hypothesis is that the knowledge-gaining process can be accelerated by combining the experience of many, especially with respect to complex interactions of factors and the analysis of rare events. Aside from maintaining a morbidity registry, within the CONTENT framework various prospective and retrospective studies on particular epidemiological and health economic research topics will be conducted
Minimalist knowledge representation of primary care diseases in the medrapid.info knowledge base
Get PDFBackground Communication media commonly used in medicine today no longer meet the needs brought on by the present knowledge explosion. The Heidelberg medrapid project has been developed to quickly communicate high-quality clinical knowledge to physicians.
Methods In this paper, medrapid is introduced as an online clinical knowledge resource, and the methods used by the 'knowledge entry' function for the minimalist representation of clinical knowledge in the knowledge base are discussed.
Results On average, fewer than 1.4 problems per disease arose during the input of the formal representation of clinical knowledge using the 'knowledge entry' function. However, representation of disease time processes, descriptions, warnings and graphics with the 'knowledge entry' function remains problematic.
Conclusions The 'knowledge entry' function allows fast formal representation of clinical knowledge (<14 minutes per disease) and testing using the integrated quality management system. In the near future, new measures must be found to improve the problematic representation of disease time processes, descriptions, warnings and graphics to formally represent clinical knowledge using the medrapid 'knowledge entry' function
Links between systems in Accident & Emergency and primary care
Get PDFThe hospital emergency department and other elements of rapid access primary care constitute an emergency care network. Integration aims to maximise the network's strengths and overcome its weaknesses. Taking the patient as a starting point, it is possible to envisage an objective data model that can operate at multiple levels within the network to describe its process efficiency and clinical effectiveness. Other means of integration are also identified. These contain significant subjective elements. In particular, the decision support system of NHS Direct has operated successfully to legitimise national and local intervention based on skill-mix, whereas its technical operation has been susceptible to human deviation from prescribed routine. As we scrutinise a system, we discover that it contains people who are doing things. Logical elements in the system turn out to be givers or recipients of deliberate and thoughtful care. Information systems in Accident & Emergency (A&E) and primary care can help accountable planners to measure and control aspects of the network's operation. Clinicians also need their systems to enable, rather than constrain, effective interactions
Design and development of a web-based application for diabetes patient data management
Get PDFA web-based database management system developed for collecting, managing and analysing information of diabetes patients is described here. It is a searchable, client-server, relational database application, developed on the WindowsTM platform using Oracle, Active Server Pages (ASP), Visual Basic Script (VB Script) and Java Script. The software is menu-driven and allows authorised healthcare providers to access, enter, update and analyse patient information. Graphical representation of data can be generated by the system using bar charts and pie charts. An interactive web interface allows users to query the database and generate reports. Alpha- and beta-testing of the system was carried out and the system at present holds records of 500 diabetes patients and is found useful in diagnosis and treatment. In addition to providing patient data on a continuous basis in a simple format, the system is used in population and comparative analysis. It has proved to be of significant advantage to the healthcare provider as compared to the paper-based system
INRstar: computerised decision support software for anticoagulation management in primary care
Get PDFComputerised decision support software (CDSS) for anticoagulation management has become established practice in the UK, offering significant advantages for patients and clinicians over traditional methods of dose calculation. The New GMS Contract has been partly responsible for this shift of management from secondary to primary care, in which INRstar has been the market leader for many years. In September 2004, INRstar received the John Perry Prize, awarded by the PHCSG for excellence and innovation in medical applications of information technology
Seniors' views on the use of electronic health records
Get PDFIn the Mauricie and Centre-du-Qu_bec region of the province of Quebec, Canada, an integrated services network has been implemented for frail seniors. It combines three of the best practices in the field of integrated services, namely: single-entry point, case management and personalised care plan. A shared interdisciplinary electronic health record (EHR) system was set up in 1998. A consensus on the relevance of using EHRs is growing in Quebec, in Canada and around the world. However, technology has outpaced interest in the notions of confidentiality, informed consent and the impact perceived by the clientele. This study specifically examines how frail seniors perceive these issues related to an EHR. The conceptual framework is inspired by the DeLone and McLean model whose main attributes are: system quality, information quality, utilisation modes and the impact on organisations and individuals. This last attribute is the focus of this study, which is a descriptive with quantitative and qualitative component. Thirty seniors were surveyed. Positive information they provided falls under three headings: (i) being better informed; (ii) trust and consideration for professionals; and (iii) appreciation of innovation. The opinions of the seniors are generally favourable regarding the use of computers and the EHR in their presence. Improvements in EHR systems for seniors can be encouraged