Informatics in Primary Care (BCS, The Chartered Institute for IT)
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Technology and healthcare into the future
No full textInformation technology has been developing rapidly over the last two decades, and has already become essential to many aspects of health care delivery. Furthermore, the current NHS Information Strategy1 shows commitment at the highest level for revolutionising the delivery of health with the adoption of the latest information technology. This paper reviews a number of areas where information technology is being applied in new ways for health care, and explores some new and emerging technologies that may have an impact on health care provision in the future
A computerised clinical reference resource in primary care: How is it being used?
No full textDespite increasing interest in computerised decision support in general practice, there is little evidence about how such systems would be used. This study examined the use made by 128 GPs of a new computerised medical reference resource designed to be used as decision support tool. It found that, on average, GPs used the resource 1.35 times a day (range 0_12). The most common information used related to clinical problem solving. Some parts of the system, such as those relating to epidemiological information, appeared to be used infrequently. The reasons for the wide variation in the reported use of the system require further investigation
The Doctor's Desk One vision of how to deliver the future information and communication needs of General Practice
No full textMuch of General Practice education focuses on the need to practice Evidence-Based Medicine (EBM). Only in University Departments is access to the electronic databases and other electronic information needed to inform evidence-based choices made widely available. In The Doctor's Desk project we have tried to place the tools that enable the practice of EBM alongside the GP's computer system, as well as provide a conduit for electronic messaging.
GP computer suppliers have previously provided global solutions for their practice clients. These have tried, alongside their clinical databases, to provide other applications, some of which have been indifferent. Most GP clinical software is hard to integrate with office software such as word processors and spreadsheets, and electronic clinical measuring devices like ECG and Spirometry. Communication with hospitals is developing slowly, but currently most GP systems can only integrate with clinical software text messages.
The Doctor's Desk project integrates electronic information sources on a single computer screen. These include information databases, email and access to clinical information in both general practice and hospital computer systems. This system operates within NHSnet, to which the government has pledged to connect all GPs by 2002. We show in this pilot that not only is it possible to provide the tools of EBM and communication alongside any practice clinical system, but also that its provision promotes its use.
GPs should regard their clinical software as an application just like any other. They should look for ways of integrating it with other software they may wish to run, bearing in mind only that the fewer the number of stables that software and hardware are obtained from the easier it will be to achieve this integration
Exchanging Medical Records: The Hypermedata Solution
No full textThere is increasing demand for the exchange of medical records between hospitals and general practices1. The provision of such an exchange encounters formidable obstacles in terms of the format and the content of the exchanged records2. We describe an architecture and a representation for the exchange of medical records between different medical centres as used in Hypermedata3, a research and development project. It includes both simple data types and complex structures, thus allowing us to describe text, graphs, tables, photographs, scans, and digitised data. We describe how a reference model is used with a domain ontology in order to allow consistent semantics to be achieved4,5. Inherent in the design of Hypermedata's architecture is the certainty that local medical systems will always evolve in time, so Hypermedata detects when it is necessary to reconstruct the exchange schema for a new exchange2. The problems faced by Hypermedata are of a general nature for inter-operating systems and the proposed solutions are applicable to other systems
The Use of General Practice Computer Systems for Data Handling and Clinical Audit - A Survey of General Practices in Leicestershire
No full textObjectives: To determine the levels of computerisation and usage of GP computer systems amongst Leicestershire general practices. To establish perceived training needs of practices in order to inform a strategy to improve the use of GP computer systems.
Design: A postal two-part questionnaire was sent to all practice managers in Leicestershire.
Setting: All Leicestershire general practices (152).
Main outcome measures: Level of computerisation in Leicestershire practices. Assessment of utilisation of systems with respect to data recording, data use and the use of systems for clinical audit. Assessment of perceived training needs of practices.
Results: High response rates of 98% and 92% were obtained to part I and part II of the questionnaire respectively. 87% of Leicestershire practices use one of 22 computer systems. A number of important areas of information are not routinely recorded by more than 50% of practices. Practices reported under-utilisation of recorded data, such as repeat prescription data, patient results and health promotion data. Most practices reported difficulties with using their computers for clinical audit. 89% of practices identified at least one topic as a training need with 43% identifying 6_8 topics.
Conclusion: Despite considerable investment in GP computer systems there is evidence of both under-utilisation and inefficient use. Most practices identified a number of training needs. This suggests that lack of training is a barrier to the effective use of computers. Health authorities and general practices need urgently to develop strategies to improve computer skills
Characteristics of practices contributing to the MediPlus database and the implications for its use in epidemiological research
No full textReliability of central coding of patient reasons for encounter in general practice, using the International Classification of Primary Care
No full textObjective to assess the accuracy, intra- and inter-coder reliability of secondary, centralised coding of patient reasons for encounter (RFEs) with the International Classification of Primary Care (ICPC).
Design Almost 150,000 RFEs were secondarily coded with ICPC in a centralised central coding situation by trained coders. Efforts were made to gain high coder reliability. A random sample of 2,369 RFEs was independently assessed for coding accuracy. A further sample of 162 RFEs were tested for inter-coder reliability by comparison with a gold standard and for intra-coder reliability by matched comparison of double coded RFEs.
Setting primary health care.
Subjects doctor_patient contact records.
Main outcome measures Accuracy was qualitatively assessed as: absent; incorrect; acceptable but could be improved; correct.
Inter- and intra-coder reliability: mean percentage correct scores calculated at ICPC chapter level, at individual rubric level and within each ICPC chapter.
Results Only 1.8% of RFEs were missing, incorrect or needed improvement. Inter-coder reliability at ICPC chapter level was 91.7% and at rubric level, 81.8%. Intra-coder reliability was 96.2% at chapter level and 90.0% at rubric level. Reliability varied with ICPC chapter.
Conclusion High coder reliability can be gained with ICPC in a central, secondary coding environment but training, an improved index and coding rules are required
Using MIQUEST in General Practice
No full textThis paper describes ten months' experience with MIQUEST software used for the collection of data from computerised databases in General Practice. We report on the following: the MIQUEST software in use, the time costs to the practice, the completeness of confidentiality barriers and the accuracy of data collected using MIQUEST compared with similar data collected by the practice system (EMIS). There were no problems encountered with installation of MIQUEST-related software. With experience, MIQUEST was equal to the practice system for speed and ease of use. The confidentiality safeguards were found to be in accordance with the GMSC/RCGP Guidelines - patients could not be directly, or indirectly, identified from the data extracted by external searches. Inaccuracies in the data collected using MIQUEST were identified, but these were largely attributable to problems with the EMIS-written interpreter available on the practice system at the time, or with the coding schemes used by the practice. In an individual practice, MIQUEST represents an alternative data collection method to the practice-based software. For data collection from multiple general practices it should prove an invaluable tool for Health Authorities and research organisations