Informatics in Primary Care (BCS, The Chartered Institute for IT)
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Regional repositories, reintermediation and the new GMS contract: cardiovascular disease in Tayside
Get PDFBackground The new contract for general medical practitioners will make increasing demands on the primary care informatics community. There are a number of potential ways to provide reports which meet the requirements for data on the quality of care being provided by practices. In Scotland there are four components of the national information technology strategy which make meaningful comparisons of data possible.
Objective Using cardiovascular data as an example, to describe how the community health index number, managed clinical networks (MCNs), increasing consistency of Read codes, and regional repositories of data make the acquisition, processing and use of data more straightforward.
Method The cardiovascular MCN collects the majority of its data electronically and four properties are crucial to its success: automatic collection of electronic data from many sources, prioritisation of data derived from multiple sources, record linkage processes, and manual validation of electronic data.
Results Clinicians in primary and secondary care enter data during consultations and see the results of consultations recorded elsewhere. Because all data from the region are able to be Read coded according to prespecified templates, we are able to indicate to practices where they are in relation to the new contract targets and indicate which patients need to be seen, or excluded from, calculations.
Conclusion Effectively integrated management is facilitated by provision of regular prompted recall and review of people with chronic disease by multidisciplinary teams collaborating across the health service and into the community. In Scotland, use of newer informatics tools are proving to be useful contributions from primary care computing to equitable, evidence-based care
Funding an infrastructure to support primary care informatics
Get PDFStrong primary health care is essential to the future of overall health care in the US. This will require access to, and widespread use of, electronic information tools in primary ambulatory care, especially the use of electronic patient clinical records and the delivery of 'just in time' clinical information at the time and point of care. The use of such information tools in US primary care now lags far behind their use in other developed countries. It is doubtful that US primary care medical informatics will close this 'gap' unless specific emphasis and resources are directed to this goal.
A nationwide primary care informatics centralised co-ordinating group, funded by the federal government and/or private foundations, is a practical and achievable means toward this end
The 'self-organising system' as a model for primary health care - can local autonomy and centralisation co-exist?
Get PDFA balance is needed between central control of primary care and local autonomy. The aim should be to maximise local autonomy but conform to central policies and guidelines where appropriate. The British NHS has mistakenly tried to exercise strict control of professionals ('centralised micromanagement') and this has seriously eroded mutual trust and innovation. Self-organising systems involve circular processes that exist widely in nature, and primary care has the potential to be much more autonomous if feedback loops are developed at local level. This paper describes and discusses ways of enhancing self-organising and learning in primary care, in which new and emerging information technology will play a major part
The use of information technology in managing patients with coronary heart disease
Get PDFThe publication Information for Health provided a detailed exposition of the government's requirements for modernising the NHS from an information point of view.1 Furthermore, it described how information technology (IT) can be harnessed to support the process of patient care, involving the use of both the Electronic Patient Record (EPR) and Electronic Health Record (EHR). However, it is widely recognised that clinical computer systems in primary care are dramatically underutilised, and computerised patient records are of variable quality and reliability. One important factor has been the lack of training and support available to ensure greater use of IT (i.e. the clinical computer systems). Steps are being taken in Teesside to address this problem; the prime objective of which is to support practices to make greater use of their IT investment, and with particular reference to the national service framework (NSF) on coronary heart disease (CHD).
Supporting change management with PRIMIS
Get PDFThis paper describes the function of PRIMIS, and its role in supporting change management in primary care, especially with regard to changes brought about by the rapid implementation of information technology in the clinical environment. A number of approaches to managing change and supporting people through change are examined and recommended, and the pitfalls of disregarding a body of knowledge on managing change are demonstrated
The characteristics of users and non-users of a digital interactive television service - case study: the Living Health channel
Get PDFIn the Birmingham area, 35 000 households were provided with access to the Living Health television channel for a pilot period of six months. The transactional logs showed that over the period 13 718 people used the system and that an estimated third of subscribers (34%) chose to view the channel. A questionnaire survey (n = 723) in the third month of service showed that nearly a quarter (23%) of respondents had used the service.a The analysis seeks to reveal what types of people used the service during this period and why
Clinical user interfaces that learn from experience
Get PDFClinical data entry is one key to success in health information systems that is not a matter of technology alone, but of appropriateness and usability of design. We review the technology of adaptive user interfaces and learning agents. In these technologies we see the potential to improve the usability of general practice clinical workstations through machine-learnt adaptation to the user, the patient and the specific situation. Use of intelligent split menus that adapt based on past clinical encounters is one specific adaptive interface method that has shown potential by simulation. We are undertaking research in 'expert in the loop' use of data mining for iterative refinement of clinical workstation adaptation with an eye to significantly improving general practice data entry quality
A systems perspective on computing in the NHS
Get PDFThere has been a long history of poor performance of large-scale computing systems, particularly those associated with government departments and public services. There does not appear to be any real improvement in delivery, which suggests that at least one cause of failure remains undetected. The paper argues that this cause may be the way that all involved (clients, service providers, programmers and civil servants) think about the project and associated processes. By contrasting traditional and systems modes of thinking, several problem areas are identified. The ways in which adopting a systems approach might avoid these difficulties is also discussed
The impact of the Internet on the GP-patient relationship
Get PDFThis paper presents the results of a study of 560 randomly selected general practitioners in the United Kingdom to assess their perception of the effect of the Internet on the doctor-patient relationship. Responses indicate that meeting with a patient who has gathered information from the Internet is viewed as an opportunity for doctor-patient partnership, but that further information is needed on how to improve doctors' use of the Internet for their work. The findings also indicate that doctors feel that patient usage of the Internet challenges their knowledge, empowers patients in the consultation process, and leads to patients being better informed than their doctor on aspects of their care. There is concern that use of the Internet might confuse patients, increase the number of worried-well, and lead to unrealistic expectations. The majority of respondents did not consider themselves adequately prepared for the impact that the Internet may have on their work, and were unaware of any guidelines to assist them in determining appropriate Internet sites
A primary care physician perspective survey on the limited use of handwriting and pen computing in the electronic medical record
Get PDFEmpirical research has demonstrated that simple design modifications in the electronic medical record (EMR) can improve user acceptance. Changes, such as pagination, the use of wireless pen slate computers and the use of digital ink (the graphic representation of the pen across the computer screen), can make dramatic differences in user performance, reduce uncertainty and increase acceptability. No survey has asked primary care physicians (PCPs) their preference of computer type for use during a consultation. Neither has any investigation determined whether or not physicians believed they could benefit from the use of handwriting (in the entry form of digital ink) as a supplement to the EMR.
A survey was prepared to see if a group of PCPs in private practice was receptive to the use of digital ink, and what type of computer - desktop or wireless pen slate - would be preferred for use during a consultation. A wireless pen slate computer was described as having a screen large enough to display the same image seen on a desktop computer. Screen captures were used to demonstrate digital ink for handwriting and drawing.
One-hundred-and-fifty-six of the 411 physicians responded (37.95%). Five physicians (3.2%) used a computer during a consultation. Ninety-nine (63.46%) would be willing to use a computer during a consultation. One-hundred-and-twenty-one (77.56%) indicated that digital ink would be useful as a supplement to the EMR. Of those who would use a computer during a consultation, 91/99 (91.09%) preferred a wireless pen slate computer to a desktop computer. Subgroup analysis indicated that those physicians who had been in practice more than 25 years or those who had low volume practices were less likely to desire a computer for use during a consultation. No subgroup showed less than 73% support for the use of handwriting in the EMR. Lack of standards (47.68%) and costs (40.40%) were chosen as the major reasons for not purchasing an EMR. Sixty-one PCPs (36.42%) indicated that a lack of typing skills was an issue and 39 (25.83%) said they had no time to learn.
The use of handwriting in the EMR was broadly supported by this group of PCPs in private practice. Likewise, wireless pen computers were the overwhelming choice of computer for use during a consultation. In this group, older and lower volume physicians were less likely to desire a computer for use during a consultation. User acceptance of the EMR may be related to how closely it resembles the processes that are being automated. More surveys are required to determine the needs and expectations of physicians. The data also support other research studies that demonstrate the preference for handwriting and wireless computers, and the need for a limited, standardised and controlled vocabulary