Informatics in Primary Care (BCS, The Chartered Institute for IT)
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A first step towards translating evidence into practice: heart failure in a community practice-based research network
Get PDFObjective To determine the validity of an electronic health record (EHR) in the identification of patients with left ventricular dysfunction in a primary care setting.
Design A cross-sectional study.
Setting Nine clinics participating from the Providence Research Network (PRN) comprising 75 physicians serving approximately 200 000 patients. All clinics utilise the Logician™ EHR for all patient care activities.
Patients The study included all PRN patients with an active chart.
Interventions All patients with a heart failure diagnosis in the problem list were identified by database query. Left ventricular ejection fraction (LVEF) data were identified through query of local cardiology and hospital echocardiography databases. Additional LVEF data were sought in a manual search of paper charts.
Measurements and main results To determine the problem list coding accuracy for a heart failure (HF) diagnosis we evaluated sensitivity, positive predictive value and related derived statistical measures using documented LVEF as the ‘gold standard’.Of 205 755 active PRN patients, 1731 were identified with a problem list entry of HF. Based on comparison with documented LVEF, the sensitivity for problem list entry was 43.9% and 54.4% when HF was defined as an LVEF ≤55% and ≤40%, respectively.
Conclusion The validity of an EHR problem list entry of HF was poor. The problem list validity could be enhanced through reconciliation with other data sources. Inaccurate EHR problem lists may have clinical consequences, including underprescribing of beneficial therapies
Primary care physician attitudes towards using a secure web-based portal designed to facilitate electronic communication with patients
Get PDFBackground Patient demand for email contact with physician practices is high. If physicians met this demand, improvements in communication, quality of care and patient satisfaction could result. However, physicians have typically been hesitant to communicate electronically with patients, largely due to concerns relating to workload, security and lack of compensation.
Goal To assess physician attitudes towards electronic communication with patients six months after the implementation of an application called Patient Gateway. Patient Gateway allows patients to access an extract of their medical record and facilitates online communication with medical practices.
Methods A paper-based survey was administered to the 43 primary care physicians in one integrated delivery system, with a 56% (24/43) response rate.
Results Overall, physicians felt that Patient Gateway’s impact on their practices was positive, especially in the areas of refill and referral request management and appointment scheduling. However, physicians are still hesitant to increase general electronic communication with patients; none opted to use Patient Gateway’s general messaging function with patients, and those who had previously used outside systems to exchange emails with some patients continued to communicate with only a small proportion of their patient panel in this way. However, 38% of physicians already communicate with their own physicians via email, and another 19% would like to do so.
Conclusions Physicians’ fears about being overwhelmed with messages were not realised. While physicians were generally enthusiastic about the application, none used it directly to communicate with patients. Over three-quarters of respondents indicated that they would be more enthusiastic about electronic communication with patients if this time were compensated
Identification of high-quality consultation practice in primary care: the effects of computer use on doctor–patient rapport
Get PDFIf the practitioner uses a clinical computer during consultation with the patient there may be adverse effects on the quality of interpersonal communication in the consultation. Greatbach et al showed in 1995 that these adverse effects might be minimised when the practitioner is well-practised and able to put in the background the tasks involving the computer.1 In the subsequent seven years, as clinical computer systems have become more sophisticated, the clinician may be called on to pay more attention to the content displayed on the computer screen. This study shows that this required level of attention cannot be put in the background, and that general practitioners (GPs) are not able to multitask at this level. Clinicians can use specific communication skills to manage the consultation, so that they are not called on to concentrate on the computer screen and the patient at the same time. The two tasks can be accomplished in the same consultation, but not simultaneously
Info-tsunami: surviving the storm with data quality probes
Get PDFAs a result of the rapid expansion of electronically available clinical knowledge, clinicians are faced with potential information overload (info-tsunami). The use of data quality probes (DQPs) in primary care can encourage clinicians' awareness of, and improvement in, data quality entry over time. DQPs can also highlight areas of potential error or omission as well as good practice, which can impact directly upon the quality of patient care. In this paper, five specific conditions have been subjected to the use of a series of DQPs over a five-year period in order to assess and measure the performance of different initiatives on the quality of data capture and patient care
Using email as a research tool in general practice: starting to implement the National Service Framework for Mental Health
Get PDFIntroduction The first primary care trust milestone for implementation of Standard 2 of the National Service Framework for Mental Health is the use of a formal diagnostic approach to the assessment of the severity of common psychiatric illnesses. Whilst developing a diagnostic tool to assess depressive symptoms, based on the ICD-10 classification of disease, we surveyed the current usage of such diagnostic aids by general practitioners (GPs) in Birmingham. According to the Birmingham Health Authority IT Directorate, 477 GP principals in the city had personal access to email at their practices through the NHSnet.
Method All GPs were sent a short questionnaire by email. They were asked to indicate their responses to four yes/no answers and return the email by pressing the 'Reply' icon. Non-respondents were then sent the questionnaire by post.
Results We had a total response rate of 67%. We received an email response from 105 GPs, or 22%. A further 216 out of a possible 372 GPs (58%) then responded by post. Forty-seven (22%) of the postal respondents had received the email, but 38 of them had problems replying; 150 (69%) said that they had never seen the email.
Conclusions The overall response rate to the questionnaire suggests that the topic was considered sufficiently relevant for GPs to reply and was not the reason for the poor email response. There were no obvious differences in the answers to the questionnaire to suggest that the mental health topic had identified a separate email-using GP population. Although four out of every five Birmingham GPs have access to email, only one in five feels confident or competent to use it as a regular means of professional communication. It is not yet appropriate to use email as the only conduit for obtaining GP opinion
Moving to paperlessness: a case study from a large general practice
Get PDFThis case study reports the reasons why this large, multi-site general practice decided to move towards paperless practice in late 2001, and describes the progress and lessons learned to date.
The principal operational reasons for this decision were problems associated with moving paper medical records between surgeries, and the realisation that resources to improve the computerised medical record could only come from redeploying the time spent handling paper records.
A comprehensive plan was put in place to shift toward paperlessness. Motivating and changing working practices for clinical and support staff was as a great a challenge as upgrading the technology.
The practice upgraded its computer system, and has installed scanning and automated generation of referral and other letters. The support staff skills have evolved from moving records to scanning documents and coding data. All clinical staff now consult on their computer, and code diagnoses and key clinical data. A networked digital dictation system allows typing to be centralised at one location, with the networking allowing printing at any site. Audit and quality improvement activities have increased, as the output from computer searches increasingly represents the quality of care provided.
The implications of this case study are that a committed general practice can achieve a largely paperless environment in approximately two years. The practice is now fit to be part of any move towards integration of records within its local health community, and can demonstrate from its computer records that it meets the quality targets for primary care
Three steps to data quality
Get PDFBackground The quality of data in general practice clinical information systems varies enormously. This variability jeopardises the proposed national strategy for an integrated care records service and the capacity of primary care organisations to respond coherently to the demands of clinical governance and the proposed quality-based general practice contract. This is apparent in the difficulty in automating the audit process and in comparing aggregated data from different practices. In an attempt to provide data of adequate quality to support such operational needs, increasing emphasis is being placed on the standardisation of data recording.
Objective To develop a conceptual framework to facilitate the recording of standardised data within primary care.
Method A multiprofessional group of primary care members from the South Thames Research Network examined leading guidelines for best practice. Using the nominal group technique the group prioritised the information needs of primary care organisations for managing coronary heart disease according to current evidence.
Results Information needs identified were prioritized and stratified into a functional framework.
Conclusion It has been possible within the context of a primary care research network to produce a framework for standardising data collection. Motivation of front-line clinicians was achieved through the incorporation of their views into the synthesis of the dataset
A methodology for the functional comparison of coding schemes in primary care
Get PDFThere has been massive investment in the development of clinical terminologies for use in electronic patient records. However, there has been little published evidence for the added value for primary care that implementation of such a terminology would offer. This paper outlines a methodology that has been used to compare two existing coding schemes (Read codes 5 byte set and Clinical Terms Version 3 - CTV3) and demonstrates their relative performance using a certainty_agreement diagram. In the study described, CTV3 offers improved accuracy and consistency with improved usability. The potential advantages of the recently released terminology, SNOMED Clinical Terms, are briefly considered in this context
How could primary care meet the informatics needs of UK Biobank? A Scottish proposal
Get PDFUK Biobank is an ambitious post-genomic project involving the recruitment and follow-up of 500 000 volunteers aged 45 to 69 years. Many primary care teams will be involved in the study directly or indirectly. The programme of research will use at least five data sources: paper-based questionnaires, blood samples, genotype information derived from the bloods, clinical/prescribing data from the medical records, and data on deaths. We describe three of the key challenges to primary care informatics posed by this project: patient recruitment, confidentiality, and data management. We then describe solutions proposed in Scotland, based on existing technologies. Some of these may be applicable elsewhere in the other Regional Collaborating Centres and other largescale collaborative projects which rely on primary care informatics