Informatics in Primary Care (BCS, The Chartered Institute for IT)
Not a member yet
595 research outputs found
Sort by
How often do GPs use rapid computer access to laboratory results? A description of 18 months’ use by 72 practices in Tayside
Get PDFThis paper describes the uptake and usage by a group of general medical practices in Tayside, Scotland of a novel system designed to give rapid access to laboratory results in primary care.
The speed of access to laboratory results from primary care is one factor that determines how laboratory results are both requested and used. Without easy and timely access to laboratory results, general practitioners (GPs) are not able to make the most efficient use of laboratory tests, and this therefore impinges on whether those tests are requested. Fountain was designed to provide a front end for GPs to gain rapid and easy access to laboratory results in a manner familiar to them. It was initially made available in primary care in the region to 72 practices, with 272 GP desktops having immediate access to results when they are ready.
The pattern of use and uptake was monitored remotely after the system was introduced, and the first 18 months of use are described here. Initial use varied widely between practices with rates of access varying from 160 hits per 1000 population to none at all.However, the access rate gradually conformed to a more standard rate of around 20 hits per 1000 population per month, regardless of the initial rate of use.
This pattern conforms to that describing the introduction of new technologies in other settings. Continued use in practice and the concordance of usage between practices confirms that rapid and reliable access to laboratory reports from primary care is both useful and used
Problems with primary care data quality: osteoporosis as an exemplar
Get PDFObjective To report problems implementing a data quality programme in osteoporosis.
Design Analysis of data extracted using Morbidity Information Query and Export Syntax (MIQUEST) from participating general practices’ systems and recommendations of practitioners who attended an action research workshop.
Setting Computerised general practices using different Read code versions to record structured data.
Participants 78 practices predominantly from London and the south east, with representation from north east, north west and south west England.
Main outcome measures Patients at risk can be represented in many ways within structured data. Although fracture data exists, it is unclear which are fragility fractures. T-scores, the gold standard for measuring bone density, cannot be extracted using the UK’s standard data extraction tool, MIQUEST; instead manual searches had to be implemented. There is a hundredfold variation in data recording levels between practices. Therapy is more frequently recorded than diagnosis. A multidisciplinary forum of experienced practitioners proposed that a limited list of codes should be used.
Conclusions There is variability in inter-practice data quality. Some clinically important codes are lacking, and there are multiple ways that the same clinical concept can be represented. Different practice computer systems have different versions of Read code, making some data incompatible. Manual searching is still required to find data. Clinicians with an understanding of what data are clinically relevant need to have a stronger voice in the production of codes, and in the creation of recommended lists
Modelling the relationship of clinical governance and informatics: matching competencies to aid development
Get PDFThe authors outline an a priori model relating clinical and informatics competencies. They discuss the implications for both informatics training and governance, suggesting areas for research, and recommend a joined-up approach to assessment and delivery
Professional values and informatics: what is the connection?
Get PDFGeneral practitioners (GPs) need to feel that they are doing a good job in providing care of high quality in a humane manner – that they are ‘good’ doctors. The General Medical Council booklet Good Medical Practice is full of imperatives, but short on values that are the determinants of behaviour. Much has been written on doctors’ professional values in the past decade, but it is not easy for individual GPs and teams to define their own values and consider to what extent they live up to them. Values and informatics, at first glance, might seem to have little in common, or even to be mutually antipathetic, and this is possible within the limitations of current technology. However, providing high-quality care involves the application of knowledge, evidence and guidelines, as well as auditing outcomes. For all these tasks, informatics provides the essential means of discovering whether we, as individuals and teams, are living up to our espoused values so that they become values-in-action that drive behaviour. Application of advanced informatics has the potential to improve and measure diagnostic and therapeutic skills. Technical advances are impressive, but their application lags. The next logical step would seem to be a comprehensive and easy-to-use knowledge-based decision support (KBDS) system in a convenient format. Locally based KBDS could facilitate self-audit and provide a step towards the ideal of a ‘self-organising system’ requiring little external audit
An eight-step method for assessing diagnostic data quality in practice: chronic obstructive pulmonary disease as an exemplar
Get PDFBackground Chronic obstructive pulmonary disease (COPD) is an important cause of mortality and morbidity. Its management is shifting from the secondary to the primary care setting. The quality of data is known to vary between practices, and individual practices need to be able to assess their data quality.
Objectives To measure the quality of diagnostic data in COPD.
Subjects 10 975 patients registered with a computerized general practice in the south of England, and 190 patients likely to have COPD.
Methods An eight-step method was developed: (1) research the expected prevalence of the diagnosis and define audit criteria; (2) find out how the diagnosis might be coded – look at the terminology and the codes presented by the computer interface; (3) examine the characteristics of the practice population; (4) calculate the prevalence and infer its reliability; (5) investigate the completeness; (6) accuracy; (7) currency and consistency; and (8) calculate sensitivity and positive predictive value of the data.
Results The prevalence of COPD in the literature ranges between 3% and 10%. The coding for bronchitis and COPD is complex and it is easy to select an incorrect code. The test population is younger but of similar social class to the national average. The prevalence of COPD in this study was 1.3%. The data were incomplete and some were inaccurate; patients with COPD had to be identified from additional searches. The sensitivity of the use of the diagnostic code was 79%, and the positive predictive value 75.3%.
Conclusions The method provides a tool to help practices and localities assess their diagnostic data quality
Pregnancy information and advice on Sky television: an evaluation
Get PDFThis paper is one of a series produced as part of an evaluation of a number of digital interactive television (DiTV) health pilots funded by the Department of Health during 2001/2002. This paper is concerned with two pregnancy health services produced by Channel Health and hosted on Sky television. The study aimed to discover the success or otherwise of health information on pregnancy in this form and on this medium or ‘platform’. In particular we were interested in what kinds of people on the broader national stage viewed the Bush Babies programme. Data were obtained through a telephone questionnaire of Channel Health users. More than 250 people took part. More than 175 000 households watched the programmes, a large audience for this type of programme. Bush Babies attracted a sizeable audience with over a quarter of Channel Health viewers in this study having seen it. There proved to be marked differences between the types of people using the service and in the patterns of their use – and not always in the ways one might have expected. As expected, people who were single, older or male were less likely to view Bush Babies, while younger, married or cohabitants and females were more likely to watch the programme. More unexpectedly, perhaps, the fact that the person was pregnant was not a predictor of whether they saw a Bush Babies programme or the number of the programmes watched
Does IT ‘cut the mustard’ in primary care?
Get PDFBackground General practice faces something of a computer revolution with the appointment of new regional suppliers and the prospect of new and as yet untried systems being imposed upon it in the next few years.
Objective To investigate the current use, acceptance of, and the real potential of information technology in the 23 general practices in one primary care trust.
Method Personal interview with the manager of computing in each practice.
Results Apart from their perceived advantages in the clarity of records and help with prescribing, the use of computers has tended to follow demand from above for the provision of data. Very few practices have a strong attraction to the use of computers as a flexible tool and the ancillary staff that manage the systems are overworked, unsupported in most cases, and generally not well served by their system suppliers. Innovation tends to be tolerated rather than welcomed since the advantages to patients and daily users are seldom promoted.
Conclusion Despite the piecemeal way that computing was introduced into primary care it has achieved great success in the absence of significant external support and shows no sign, overall, of being helped by the new information technology (IT) strategy in the NHS as it applies to that sector
Assessing patient safety awareness and needs in rural hospitals in one US state
Get PDFSeveral initiatives have addressed patient safety by enabling electronic voluntary reporting of adverse events within academic medical centres in urban settings. Such initiatives are lacking in the rural context, and it remains unknown whether the same challenges and solutions apply to rural hospitals.
The purpose of this study is to provide insight into the organisational culture and level of readiness to adopt patient safety strategies in a rural setting, as well as to identify critical issues pertaining to the rural context that need to inform the design of such strategies.
We conducted telephone interviews with administrators and healthcare providers of rural hospitals in one US state. Questions referred to the respondents’ current reporting mechanism, its advantages and disadvantages, and organisational patient safety culture. A total of 16 administrators and 14 providers of eight rural hospitals in the state of Missouri were interviewed.
Findings indicate that very few administrators felt that there was a timely response to adverse event reports. Half of the administrators stated that the current mechanism is an appropriate and adequate outlet to ensure patient safety. None of the healthcare providers found errors and adverse events to be over-reported; the majority believe that they are being under-reported. Only 36% of the care providers interviewed have themselves reported an error or adverse drug event during their tenure with their organisation.
The study findings demonstrate a definite need for improvement of the current infrastructure of rural hospitals in order to enable an effective outlet for ensuring patient safety