Informatics in Primary Care (BCS, The Chartered Institute for IT)
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Using three-channel video to evaluate the impact of the use of the computer on the patient-centredness of the general practice consultation
Get PDFThe aim of this study was to assess the feasibility of using three-channel video to explore the impact of the computer on general practitioner (GP) consultations. A previous study had highlighted the limitations of using single-channel video: firstly, there was a lack of information about exactly how the computer was being used, and secondly difficulty in interpreting the body language of the consulting clinician. More information was needed to understand the impact of the computer on the consultation, and in this pilot three-channel video was used to overcome these constraints.
Four doctors consulted, with the patient's role played by an actor with a preset script and preloaded personal and family history record programmed into the computer. The output was analysed using the Roter Interaction Analysis System (RIAS) and observational methods were used to explore the effect of computers on aspects of verbal and non-verbal behaviour and the completeness of the computer data record.
Three-channel video proved to be a feasible and valuable technique for the analysis of primary care GP consultations, with advantages over single-channel video. Interesting differences in non-verbal and verbal behaviour became apparent with different types of computer use during the consultation. Implications for the three-channel video technique for training, monitoring GP competence and providing feedback are discussed
Improving the safety features of general practice computer systems
Get PDFGeneral practice computer systems already have a number of important safety features. However, there are problems in that general practitioners (GPs) have come to rely on hazard alerts when they are not foolproof. Furthermore, GPs do not know how to make best use of safety features on their systems. There are a number of solutions that could help to improve the safety features of general practice computer systems and also help to improve the abilities of healthcare professionals to use these safety features
How will practices cope with information for the new GMS contract? Coronary heart disease data recording in five Scottish practices
Get PDFObjectives To investigate whether practices will be ready for the data reporting requirements for the new General Medical Services (GMS) contract, using coronary heart disease (CHD) as an example.
Design Cross-sectional survey.
Data sources Electronic general practitioner (GP) records of all CHD patients in five Scottish practices, validated by manual searches in 50 randomly selected patients in each practice.
Main outcome measures Recording of family history, smoking status, blood pressure (BP), diabetes testing, aspirin therapy and cholesterol measurement.
Results It is extremely easy for practices with completely electronic patient records to extract a disease register (mean 10 min, range 38 sec to 3 hr 6 min). Extraction of a complete dataset takes several days if it involves checking through paper records, whereas setting up and running a search from electronic records is possible in less than two hours. If practices use the same clinical system and identical data entry templates, the data can be directly compared. Some items that are easily recorded as part of routine clinical practice, such as prescribing of aspirin, are well recorded, but others, such as BP recording, are more of a problem. One hundred percent of the CHD patients sampled had a BP recording within the previous year, but some practices had these data in the paper records where they were not readily accessible.
Conclusions We have shown that in Scotland there is a high level of testing and recording of all the important information regarding patients with recorded CHD, irrespective of whether practices have fully electronic records, paper-based records, or a mixture of the two. If practices have fully electronic patient records, the information can be extracted easily, but unless there is a standard template, the information can only be viewed in isolation and is of little value for comparative purposes
Generating information from electronic patient records in general practice: a description of clinical care and gender inequalities in coronary heart disease using data from over two million patient records
Get PDFObjectives To describe the epidemiology of coronary heart disease (CHD) in England and the activity of primary healthcare teams in managing patients with CHD, and also to demonstrate the utility of computerised patient records in providing access to epidemiological data and data reflecting healthcare activity.
Design A descriptive survey of CHD and related clinical data, recorded using computerised clinical records, entered by primary healthcare teams. Aspects reported include prevalence of CHD, together with additional data reflecting clinical monitoring activity, therapeutic interventions and comorbidity in patients affected by CHD.
Setting 317 general practices in 23 English primary care trusts (PCTs).
Data acquisition MIQUEST was used to interrogate 2 252 274 computerised patient records. Data were extracted in the form of sex and age aggregated counts of patients meeting a range of extraction criteria.
Results The observed crude prevalence of CHD is 40.3 per 1000 (males 46.6, females 34.2). A variety of findings are presented relating to the treatment, monitoring and comorbidities of CHD. Significant and systematic gender inequalities are demonstrated to exist in the monitoring and treatment of CHD.
Conclusions Extraction of data from computerised patient records is a valuable and practicable method of generating information to inform clinicians and National Health Service (NHS) organisations. Systematic gender disparities exist in the care delivered to patients with CHD.
Summary points
CHD affects approximately 4% of the population in England. A significant gender gradient exists with approximately 4.7% of males being affected and 3.4% of females.This study provides persuasive confirmatory evidence of previously demonstrated gender disparities in the monitoring and treatment of CHD. The data also strongly support the suggestion that such gender disparities are systematic in nature.The study provides evidence of feasibility and potential value of remote interrogation of computerized clinical records in primary care to provide detailed information about population health characteristics and clinical activity to both the clinical community and NHS organisations
Health informatics and modernisation: bridging the gap
Get PDFThis pilot initiative uses an approach that focuses on improving the whole business of primary care, its processes and its people. The Health Informatics Programme for Coronary Heart Disease (HIP for CHD) addresses the two faces of clinical governance but has a prime focus on the development of learning organisations. The project has developed a methodology and an associated set of tools that it has tested and evaluated in a small number of pilot sites. The work of HIP for CHD is focused on coronary heart disease but the methodology is equally applicable to other clinical areas. In particular, HIP for CHD provides an approach that allows the diverse strands of all of the National Service Frameworks to be handled in a joined-up way in primary care
Do information systems meet the needs of primary care trusts?
Get PDFTo function effectively, primary care trusts (PCTs) need information from a range of sources. The general practice clinical record is a key source of information for PCTs but has often proved to be of variable quality.
PCTs have developed rapidly and now have responsibility for 75% of the healthcare budget. They have a range of information needs that must be met if they are to ensure that healthcare provision meets the needs of patients. Since the abolition of health authorities PCTs have full responsibility for developing practice systems as well as having a key role to play in developing information management and technology (IM&T) within local health economies.
The paper describes the problems PCTs face in accessing information to support their core functions and the progress they have made in retrieving data to support service development. It also describes the progress and developments in information and information systems within general practice using data from the National Tracker Survey of Primary Care Groups and Trusts (PCG/Ts).
The survey began in 1999 when PCGs were established and has tracked the progress of PCG/Ts over three years. This paper presents the findings from the third survey relating to the development of information to support the needs of PCG/Ts.
The findings show that information available to PCG/Ts does not meet their needs in a range of key areas. Many PCG/Ts are collecting data to support the Coronary Heart Disease National Service Framework (CHD NSF) and monitoring some areas of service provision in general practice. The use of information management tools has risen significantly since the second survey and involvement in the Primary Care Information Services (PRIMIS) initiative has more than doubled.
The paper concludes that although PCG/Ts and general practices have made substantial progress, there is a long way to go before information providers generate high-quality information to support the needs of PCTs
Delivering primary care in prison: the need to improve health information
Get PDFBackground Electronic patient records and access to electronic information resources are the cornerstones of delivery of modern primary care, and they will be necessary to deliver effective evidence-based patient care, provide needs-driven health care, assist research and improve quality of services. However, prison health needs assessments carried out in the South East region suggested that modern information technology was lacking in prison primary care. This is despite the fact that the principle of 'equivalence of care' has been guiding the recent prison healthcare reforms in response to concerns about quality of prison healthcare services.
Methods We visited all four male adult prisons in the Thames Valley area and conducted one-to-one semi-structured interviews with healthcare staff to investigate the information available to them, the quality and uses of the data, and their current information systems. We also ran a workshop with prison healthcare managers and other healthcare staff from prisons in the Thames Valley area.
Results Primary care staff in prisons record almost all clinical data on paper and do not have access to electronic clinical records nor to the internet. The main perceived barriers to implementing health information technology in prisons were concerns about potential breaches of security and discipline in prisons, anxiety about data security and a culture that gives low priority to health in prisons.
Conclusions To provide 'equivalence of care' for prisoners, primary care trusts need to implement full electronic clinical records in prisons and ensure staff have access to resources on the internet
Applying new thinking from the linked and emerging fields of digital identity and privacy to information governance in health informatics
Get PDFRecent work in the emerging field of network or digital identity suggests a new approach to the design of informatics systems, in which the individual becomes the guardian of their own personal data, and is assisted in controlling access to it by an infrastructure that is aware of roles, such as 'doctor', and relationships, such as 'doctor_patient'. For these purposes, an 'identity' is defined as the history of a relationship between two entities, and thus encompasses not only name and address but also data that would usually be regarded as part of an electronic patient or health record. This paper presents a description of how such a true person-centric architecture might work, and shows how it can be seen as an evolution of current plans in the NHS for a national patient data spine. One application, the electronic transmission of prescriptions, is described in detail. Other applications, both within and without the healthcare field, are described in outline. The implementation of such a person-centric system requires a modest degree of technical innovation, but significant change in organisational and business models. It is suggested that there is a need for one or more not-for-profit trusts, each with a remit to act as host for an individual's digital identity, and as the individual's true agent. Service providers - such as healthcare organisations - will pay the trust for provision of authentication, and for the storage and transmission of a patient's data; the trust in turn will pay implementation partners, such as smart card issuers and providers of communication channels, acting on behalf of the individual
Comparing the use of health information/advice in Birmingham and Hull: a case study of digital health information delivered via the television
Get PDFPostal questionnaire surveys were carried out with users of two digital interactive television (DiTV) providers of health content to investigate the use made of each service and the users' reactions to service content and its usefulness to them. The research indicated that health information on DiTV was used and, on the whole, rated favourably.
There was some evidence also that such information might be used by some people as a substitute for going to the doctor, though information from their general practitioner (GP) or practice nurse still carries more weight for most people than any other health information source.
This study forms part of an ongoing research project which has, as part of its aim, the task of identifying particular users with the information sources that may be most appropriate for them