Informatics in Primary Care (BCS, The Chartered Institute for IT)
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595 research outputs found
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Assessing the readiness of precision medicine interoperabilty: An exploratory study of the National Institutes of Health genetic testing registry
Full text linkBackground: Precision medicine involves three major innovations currently taking place in healthcare: electronic health records, genomics, and big data. A major challenge for healthcare providers, however, is understanding the readiness for practical application of initiatives like precision medicine.Objective: To better understand the current state and challenges of precision medicine interoperability using a national genetic testing registry as a starting point, placed in the context of established interoperability formats.Methods: We performed an exploratory analysis of the National Institutes of Health Genetic Testing Registry. Relevant standards included Health Level Seven International Version 3 Implementation Guide for Family History, the Human Genome Organization Gene Nomenclature Committee (HGNC) database, and Systematized Nomenclature of Medicine – Clinical Terms (SNOMED CT). We analyzed the distribution of genetic testing laboratories, genetic test characteristics, and standardized genome/clinical code mappings, stratified by laboratory setting.Results: There were a total of 25472 genetic tests from 240 laboratories testing for approximately 3632 distinct genes. Most tests focused on diagnosis, mutation confirmation, and/or risk assessment of germline mutations that could be passed to offspring. Genes were successfully mapped to all HGNC identifiers, but less than half of tests mapped to SNOMED CT codes, highlighting significant gaps when linking genetic tests to standardized clinical codes that explain the medical motivations behind test ordering. Conclusion: While precision medicine could potentially transform healthcare, successful practical and clinical application will first require the comprehensive and responsible adoption of interoperable standards, terminologies, and formats across all aspects of the precision medicine pipeline
Understanding the use of geographical information systems (GIS) in health informatics research: A review
Full text linkBackground: The purpose of this literature review is to understand geographical information systems (GIS) and how they can be applied to public health informatics, medical informatics, and epidemiology.Method: Relevant papers that reflected the use of geographical information systems (GIS) in health research were identified from four academic databases: Academic Search Complete, BioMed Central, PubMed Central, and Scholars Portal, as well as Google Scholar. The search strategy used was to identify articles with “geographic information systems”, “GIS”, “public health”, “medical informatics”, “epidemiology”, and “health geography” as main subject headings or text words in titles and abstracts. Papers published between 1997 and 2014 were considered and a total of 39 articles were included to inform the authors on the use of GIS technologies in health informatics research.Results: The main applications of GIS in health informatics and epidemiology include disease surveillance, health risk analysis, health access and planning, and community health profiling. GIS technologies can significantly improve quality and efficiency in health research as substantial connections can be made between a population’s health and their geographical location.Conclusions: Gains in health informatics can be made when GIS are applied through research, however, improvements need to occur in the quantity and quality of data input for these systems to ensure better geographical health maps are used so that proper conclusions between public health and environmental factors may be made
Informatics for Health 2017: Advancing both science and practice
Full text linkIntroduction: The Informatics for Health congress, 24-26 April 2017, in Manchester, UK, brought together the Medical Informatics Europe (MIE) conference and the Farr Institute International Conference. This special issue of the Journal of Innovation in Health Informatics contains 113 presentation abstracts and 149 poster abstracts from the congress.Discussion: The twin programmes of “Big Data” and “Digital Health” are not always joined up by coherent policy and investment priorities. Substantial global investment in health IT and data science has led to sound progress but highly variable outcomes. Society needs an approach that brings together the science and the practice of health informatics. The goal is multi-level Learning Health Systems that consume and intelligently act upon both patient data and organizational intervention outcomes.Conclusions: Informatics for Health demonstrated the art of the possible, seen in the breadth and depth of our contributions. We call upon policy makers, research funders and programme leaders to learn from this joined-up approach
Creating a climate that catalyses healthcare innovation in the United Kingdom – learning lessons from international innovators
Full text linkBackground: The United Kingdom (UK) lags behind other high-income countries in relation to technological innovation in healthcare. In order to inform UK strategy on how to catalyse innovation, we sought to understand what national strategies can help to promote a climate for innovation in healthcare settings by extracting lessons for the UK from international innovators.Methods: We undertook a series of qualitative semi-structured interviews with senior international innovators from a range of health related policy, care/service delivery, commercial and academic backgrounds. Thematic analysis helped to explore how different stakeholder groups could facilitate/inhibit innovation at individual, organisational, and wider societal levels.Results: We conducted 14 interviews and found that a conducive climate for healthcare innovation comprised of national/regional strategies stimulating commercial competition, promoting public/private relationships, and providing central direction (e.g. incentives for adoption and regulation through standards) without being restrictive. Organisational attitudes with a willingness to experiment and to take risks were also seen as important, but a bottom-up approach to innovation, based on the identification of clinical need, was seen as a crucial first step to construct relevant national policies.Conclusions: There is now a need to create mechanisms through which frontline National Health Service staff in relation can raise ideas/concerns and suggest opportunities for improvement, and then build national innovation environments that seek to address these needs. This should be accompanied by creating competitive health technology markets to stimulate a commercial environment that attracts high-quality health information technology experts and innovators working in partnership with staff and patients
The challenge of involving elderly patients in primary care by using an electronic communication tool with their professionals: a mixed methods study
Full text linkBackground: Elderly patients in primary care often have multiple health problems,with different healthcare professionals involved. For consistency in care, it is required that communication amongst professionals and patient-systems (patient and informal-carers) be well tuned. Electronic-communication can make it easier for patient-system to be active in care.Objective: To examine whether an e-communication tool (Congredi) designed for professionals, including a care plan and secure e-mail, is usable for patient-systems and what their experiences are.Methods: In a multi-method study, home-dwelling elderly patients with two or more professionals were invited to use Congredi; data were gathered from the system after 42 weeks. Also semi-structured interviews were undertaken with patient-systems with topics retrieved from literature. Analysis took place by two researchers independently; the themes were extracted together by consensus.Results: Data about actual use of the tool were gathered from 22 patients. Four profiles of Congredi-users were distinguished, varying in intensity of use. Data from interviews with members of patient-systems (n = 7) showed that they were motivated and able to use Congredi. Barriers in daily use were limited participation of professionals, unanswered e-mail and not being alerted about actions. Despite limitations, patient-systems retained their motivation.Conclusion: Congredi was usable for patient-systems. The barriers found seem not to be tool-related but primarily user-related. An important barrier for daily use was limited active participation of involved professionals in a complete feedback loop. Potential for future implementation was found, as patient-systems were intrinsically motivated for better feedback with the professionals, even though in this study it only partly met their expectations
“It’s like texting at the dinner table”: A qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals
No full textBackground: Electronic health records (EHRs) may reduce medical errors and improve care, but can complicate clinical encounters.Objective: To describe hospital-based physicians’ perceptions of the impact of EHRs on patient-physician interactions and contrast these findings against office-based physicians’ perceptionsMethods: We performed a qualitative analysis of comments submitted in response to the 2014 Rhode Island Health Information Technology Survey. Office- and hospital-based physicians licensed in Rhode Island, in active practice, and located in Rhode Island or neighboring states completed the survey about their Electronic Health Record use.Results: The survey’s response rate was 68.3% and 2,236 (87.1%) respondents had EHRs. Among survey respondents, 27.3% of hospital-based and 37.8% of office-based physicians with EHRs responded to the question about patient interaction. Five main themes emerged for hospital-based physicians, with respondents generally perceiving EHRs as negatively altering patient interactions. We noted the same five themes among office-based physicians, but the rank-order of the top two responses differed by setting: hospital-based physicians commented most frequently that they spend less time with patients because they have to spend more time on computers; office-based physicians commented most frequently on EHRs worsening the quality of their interactions and relationships with patients.Conclusion: In our analysis of a large sample of physicians, hospital-based physicians generally perceived EHRs as negatively altering patient interactions, although they emphasized different reasons than their office-based counterparts. These findings add to the prior literature, which focuses on outpatient physicians, and can shape interventions to improve how EHRs are used in inpatient settings
Designing Health Information Technology Tools to Prevent Gaps in Public Health Insurance
Full text linkBackground: Changes in health insurance policies have increased coverage opportunities, but enrollees are required to annually reapply for benefits which, if not managed appropriately, can lead to insurance gaps. Electronic health records (EHRs) can automate processes for assisting patients with health insurance enrollment and re-enrollment.Objective: We describe community health centers' (CHC) workflow, documentation, and tracking needs for assisting families with insurance application processes, and the health information technology (IT) tool components that were developed to meet those needs.Method: We conducted a qualitative study using semi-structured interviews and observation of clinic operations and insurance application assistance processes. Data were analyzed using a grounded theory approach. We diagramed workflows and shared information with a team of developers who built the EHR-based tools.Results: Four steps to the insurance assistance workflow were common among CHCs: 1) Identifying patients for public health insurance application assistance; 2) Completing and submitting the public health insurance application when clinic staff met with patients to collect requisite information and helped them apply for benefits; 3) Tracking public health insurance approval to monitor for decisions; and 4) assisting with annual health insurance reapplication. We developed EHR-based tools to support clinical staff with each of these steps.Conclusion: CHCs are uniquely positioned to help patients and families with public health insurance applications. CHCs have invested in staff to assist patients with insurance applications and help prevent coverage gaps. To best assist patients and to foster efficiency, EHR based insurance tools need comprehensive, timely, and accurate health insurance information
Outputs and Growth of Primary Care Databases in the United Kingdom: Bibliometric Analysis
Full text linkBackground: Electronic health database (EHD) data is increasingly used by researchers. The major United Kingdom EHDs are the ‘Clinical Practice Research Datalink’ (CPRD), ‘The Health Improvement Network’ (THIN) and ‘QResearch’. Over time, outputs from these databases have increased, but have not been evaluated.Objective: This study compares research outputs from CPRD, THIN and QResearch assessing growth and publication outputs over a 10-year period (2004-2013). CPRD was also reviewed separately over 20 years as a case study.Methods: Publications from CPRD and QResearch were extracted using the Science Citation Index (SCI) of the Thomson Scientific Institute for Scientific Information (Web of Science). THIN data was obtained from University College London and validated in Web of Science. All databases were analysed for growth in publications, the speciality areas and the journals in which their data have been published.Results: These databases collectively produced 1,296 publications over a ten-year period, with CPRD representing 63.6% (n=825 papers), THIN 30.4% (n=394) and QResearch 5.9% (n=77). Pharmacoepidemiology and General Medicine were the most common specialities featured. Over the 9-year period (2004-2013), publications for THIN and QResearch have slowly increased over time, whereas CPRD publications have increased substantially in last 4 years with almost 75% of CPRD publications published in the past 9 years.Conclusion: These databases are enhancing scientific research and are growing yearly, however display variability in their growth. They could become more powerful research tools if the National Health Service and general practitioners can provide accurate and comprehensive data for inclusion in these databases
Integrating third-party telehealth records with the general practice electronic medical record system: a solution.
Full text linkBackground: The implementation of telemonitoring at scale has been less successful than anticipated, often hindered by clinicians’ perceived increase in workload. One important factor has been the lack of integration of patient generated data (PGD) with the electronic medical record (EMR). Clinicians have had problems accessing PGD on telehealth systems especially in patient consultations in primary care.Objective: To design a method to produce a report of PGD that is available to clinicians through their routine EMR system.Method: We modelled a system with a use case approach using Unified Modelling Language to enable us to design a method of producing the required report. Anonymised PGD are downloaded from a third-party telehealth system to National Health Service (NHS) systems and linked to the patient record available in the hospital recording system using the patient NHS ID through an interface accessed by healthcare professionals. The telehealth data are then processed into a report using the patient record. This report summarises the readings in graphical and tabular form with an average calculated and with a recommended follow-up suggested if required. The report is then disseminated to general practitioner practices through routine document distribution pathways.Results: This addition to the telehealth system is viewed positively by clinicians. It has helped to greatly increase the number of general practices using telemonitoring to manage blood pressure in NHS Lothian
