Informatics in Primary Care最新文献

{"title":"Effectiveness of local support for the adoption of a national programme--a descriptive study.","authors":"Christopher Pearce,&nbsp;Jenny Bartlett,&nbsp;Adam Mcleod,&nbsp;Paula Eustace,&nbsp;Rod Amos,&nbsp;Marianne Shearer","doi":"10.14236/jhi.v21i4.70","DOIUrl":"https://doi.org/10.14236/jhi.v21i4.70","url":null,"abstract":"<p><strong>Background: </strong>Change management in health care is a complex and time-consuming endeavour, and no less so in implementing technological systems. In deploying a nationwide programme, the personally controlled electronic health record (PCEHR), the Australian Government employed a number of national and local change management programmes.</p><p><strong>Objective: </strong>This article describes the processes undertaken and the experiences of introducing the PCEHR into 74 general practices across a specific area of metropolitan Melbourne.</p><p><strong>Method: </strong>An online survey was developed by an independent evaluator and offered to all participating practices. The response rate was 82%.</p><p><strong>Results: </strong>The deployment and testing of the eHealth infrastructure and the roll-out of the PCEHR were deeply supported through face-to-face, locally contextualised support processes. The area Medicare Local (ML), an organisation that provides support services to general practice and allied health in the community, provided support and programme coordination. This support occurred in the environment of a number of other initiatives to improve adoption.</p><p><strong>Conclusion: </strong>The impact and value of this support in the registration and adoption process was explored in an online survey and found to be the key factor in practice engagement and success. ML support was seen as instrumental in improving adoption and was more effective than other activities. This article highlights the role of local support, in this case, MLs, in the effective implementation of eHealth programmes across a range of stakeholder groups, in particular, general practice, and the potential for the lessons learned from the engagement model of such an entity to be more generally applied.</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"21 4","pages":"171-8"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32883140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coding errors in an analysis of the impact of pay-for-performance on the care for long-term cardiovascular disease: a case study.","authors":"Simon de Lusignan,&nbsp;Benjamin Sun,&nbsp;Christopher Pearce,&nbsp;Christopher Farmer,&nbsp;Paul Steven,&nbsp;Simon Jones","doi":"10.14236/jhi.v21i2.62","DOIUrl":"https://doi.org/10.14236/jhi.v21i2.62","url":null,"abstract":"<p><strong>Objective: </strong>There is no standard method of publishing the code ranges in research using routine data. We report how code selection affects the reported prevalence and precision of results.</p><p><strong>Design: </strong>We compared code ranges used to report the impact of pay-for-performance (P4P), with those specified in the P4P scheme, and those used by our informatics team to identify cases. We estimated the positive predictive values (PPV) of people with chronic conditions who were included in the study population, and compared the prevalence and blood pressure (BP) of people with hypertension (HT).</p><p><strong>Setting: </strong>Routinely collected primary care data from the quality improvement in chronic kidney disease (QICKD-ISRCTN56023731) trial.</p><p><strong>Main outcome measures: </strong>The case study population represented roughly 85% of those in the HT P4P group (PPV = 0.842; 95%CI = 0.840-0.844; p < 0.001). We also found differences in the prevalence of stroke (PPV = 0.694; 95%CI = 0.687- 0.700) and coronary heart disease (PPV = 0.166; 95%CI = 0.162-0.170), where the paper restricted itself to myocardial infarction codes.</p><p><strong>Results: </strong>We found that the long-term cardiovascular conditions and codes selected for these conditions were inconsistent with those in P4P or the QICKD trial. The prevalence of HT based on the case study codes was 10.3%, compared with 11.8% using the P4P codes; the mean BP was 138.3 mmHg (standard deviation (SD) 15.84 mmHg)/79.4 mmHg (SD 10.3 mmHg) and 137.3 mmHg (SD 15.31)/79.1 mmHg (SD 9.93 mmHg) for the case study and P4P populations, respectively (p < 0.001).</p><p><strong>Conclusion: </strong>The case study lacked precision, and excluded cases had a lower BP. Publishing code ranges made this comparison possible and should be mandated for publications based on routine data.</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"21 2","pages":"92-101"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32352036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accelerating the development of an information ecosystem in health care, by stimulating the growth of safe intermediate processing of health information (IPHI).","authors":"H. Liyanage, S. Liaw, S. de Lusignan","doi":"10.14236/JHI.V20I2.28","DOIUrl":"https://doi.org/10.14236/JHI.V20I2.28","url":null,"abstract":"Health care, in common with many other industries, is generating large amounts of routine data, data that are challenging to process, analyse or curate, so-called 'big data'. A challenge for health informatics is to make sense of these data. Part of the answer will come from the development of ontologies that support the use of heterogeneous data sources and the development of intermediate processors of health information (IPHI). IPHI will sit between the generators of health data and information, often the providers of health care, and the managers, commissioners, policy makers, researchers, and the pharmaceutical and other healthcare industries. They will create a health ecosystem by processing data in a way that stimulates improved data quality and potentially healthcare delivery by providers of health care, and by providing greater insights to legitimate users of data. Exemplars are provided of how a health ecosystem might be encouraged and developed to promote patient safety and more efficient health care. These are in the areas of how to integrate data around the unsafe use of alcohol and to explore vaccine safety. A challenge for IPHI is how to ensure that their processing of data is valid, safe and maintains privacy. Development of the healthcare ecosystem and IPHI should be actively encouraged internationally. Governments, regulators and providers of health care should facilitate access to health data and the use of national and international comparisons to monitor standards. However, most importantly, they should pilot new methods of improving quality and safety through the intermediate processing of health data.","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"29 1","pages":"81-6"},"PeriodicalIF":0.0,"publicationDate":"2013-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89836863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General practitioners' views on using a prescribing substitution application (ScriptSwitch(®)).","authors":"Carly Hire,&nbsp;Bruno Rushforth","doi":"10.14236/jhi.v21i1.6","DOIUrl":"https://doi.org/10.14236/jhi.v21i1.6","url":null,"abstract":"<p><strong>Background: </strong>General practitioners (GPs) are increasingly pressured to prescribe cost-effectively, due to rising prescribing expenditure and limited budgets. A computerised prescribing substitution application (ScriptSwitch(®)) provides 'pop-ups' of cost-saving drug switches at the point of prescribing. It has been used by some United Kingdom local health commissioning organisations as part of a medicines management strategy.</p><p><strong>Objective: </strong>To explore GPs' views on using this prescribing substitution application in their day-to-day clinical practice.</p><p><strong>Methods: </strong>Qualitative study employing face-to-face semi-structured interviews, undertaken with a convenience sample of eight GPs across five practices within one local health commissioning area in the North of England. Interviews were audio-recorded, transcribed verbatim and thematically analysed.</p><p><strong>Results: </strong>Six themes were identified including: (1) GPs' acceptance, (2) the application's impact, (3) external control, (4) disruption to workflow, (5) GP willingness to switch and (6) patient willingness to switch.</p><p><strong>Conclusions: </strong>Clinician, patient and organisational factors were identified which were assumed by GPs to affect the engagement with the application. Despite general acceptance of the application to enhance cost-effective prescribing, its impact was perceived to be limited within the context of existing cost-effective prescribing initiatives. The application's perceived lack of 'learning'-e.g. offering the same switch despite the prescriber repeatedly declining this-devalued users' confidence in it. With patients varying in amenability and acceptance to drug switches, GPs appear to experience tension between considering individual patient choice and wider practice population prescribing priorities. Giving GPs more control in adapting the application to their own local prescribing priorities may enhance its success.</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"21 1","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32177867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of interoperability of electronic health records on ambulatory physician practices: a discrete-event simulation study.","authors":"Yuan Zhou,&nbsp;Jessica S Ancker,&nbsp;Mandar Upadhye,&nbsp;Nicolette M McGeorge,&nbsp;Theresa K Guarrera,&nbsp;Sudeep Hegde,&nbsp;Peter W Crane,&nbsp;Rollin J Fairbanks,&nbsp;Ann M Bisantz,&nbsp;Rainu Kaushal,&nbsp;Li Lin","doi":"10.14236/jhi.v21i1.36","DOIUrl":"https://doi.org/10.14236/jhi.v21i1.36","url":null,"abstract":"<p><strong>Background: </strong>The effect of health information technology (HIT) on efficiency and workload among clinical and nonclinical staff has been debated, with conflicting evidence about whether electronic health records (EHRs) increase or decrease effort. None of this paper to date, however, examines the effect of interoperability quantitatively using discrete event simulation techniques.</p><p><strong>Objective: </strong>To estimate the impact of EHR systems with various levels of interoperability on day-to-day tasks and operations of ambulatory physician offices.</p><p><strong>Methods: </strong>Interviews and observations were used to collect workflow data from 12 adult primary and specialty practices. A discrete event simulation model was constructed to represent patient flows and clinical and administrative tasks of physicians and staff members.</p><p><strong>Results: </strong>High levels of EHR interoperability were associated with reduced time spent by providers on four tasks: preparing lab reports, requesting lab orders, prescribing medications, and writing referrals. The implementation of an EHR was associated with less time spent by administrators but more time spent by physicians, compared with time spent at paper-based practices. In addition, the presence of EHRs and of interoperability did not significantly affect the time usage of registered nurses or the total visit time and waiting time of patients.</p><p><strong>Conclusion: </strong>This paper suggests that the impact of using HIT on clinical and nonclinical staff work efficiency varies, however, overall it appears to improve time efficiency more for administrators than for physicians and nurses.</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"21 1","pages":"21-9"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32177871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Effects of exam room EHR use on doctor-patient communication: a systematic literature review\" - triadic and other key terms may have identified additional literature.","authors":"Christopher Martin Pearce, Pushpa Kumarapeli, Simon de Lusignan","doi":"10.14236/jhi.v21i1.39","DOIUrl":"10.14236/jhi.v21i1.39","url":null,"abstract":"","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"21 1","pages":"40-2"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32177873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a web-based pharmaceutical care plan to facilitate collaboration between healthcare providers and patients.","authors":"Marlies M E Geurts,&nbsp;Martijn Ivens,&nbsp;Egbert van Gelder,&nbsp;Johan J de Gier","doi":"10.14236/jhi.v21i1.40","DOIUrl":"https://doi.org/10.14236/jhi.v21i1.40","url":null,"abstract":"<p><strong>Background: </strong>In medication therapy management there is a need for a tool to document medication reviews and pharmaceutical care plans (PCPs) as well as facilitate collaboration and sharing of patient data between different healthcare providers. Currently, pharmacists and general practitioners (GPs) have their own computer systems and patient files. To facilitate collaboration between different healthcare providers and to exchange patient data we developed a paper-based tool. As a result the structured collection of all relevant information for a clinical medication review was more protocol driven. The tool also enabled to plan interventions and follow-up activities: the PCP. The PCP was piloted among three GPs and six community pharmacists. Interviews with all healthcare providers concluded the PCP was found a very useful tool to collect and share patient data. A disadvantage was the time spent to collect all information. We therefore developed our PCP into a web-based tool: the web-based PCP (W-PCP).</p><p><strong>Objectives: </strong>Development of a W-PCP to (1) provide healthcare providers with information from pharmacist- and GP computer systems and (2) facilitate collaboration between healthcare providers and patients. Development and Application: W-PCP facilitates uploading and sharing of patient data among health care professionals and collaboration between professionals and patients on performing treatment plans. The W-PCP is a stand-alone application developed by cocreation using a generic software platform that provides developmental speed and flexibility.</p><p><strong>Method: </strong>The W-PCP was used in three research lines, two in primary care and one in a hospital setting. Outcomes measures were defined as satisfaction about efficiency and effectiveness during data sharing and documentation in providing care and conducting medication reviews using the W-PCP. First experiences concerning the use of W-PCP in a primary care setting were collected by a questionnaire and interviews with pharmacists and GPs using the W-PCP.</p><p><strong>Results: </strong>A questionnaire about first experiences with the W-PCP was sent to 38 healthcare providers. 17 healthcare providers returned the questionnaire (response 44.7%). The use of W-PCP resulted in positive experiences from participating healthcare providers. One of the needs expressed is to have the W-PCP application integrated in the current pharmacy and GP computer systems. All experiences, needs, and ideas for improvement of the current application were collected. On the basis of experiences and requirements collected, the application will be further developed.</p><p><strong>Conclusions: </strong>The W-PCP application can potentially support successful collaboration between different healthcare providers and patients, which is important for medication therapy management. With this application, a successful collaboration between different healthcare providers and patien","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"21 1","pages":"53-9"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32177352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of howRU and EQ-5D measures of health-related quality of life in an outpatient clinic.","authors":"Tim Benson,&nbsp;Henry W W Potts,&nbsp;Justin M Whatling,&nbsp;David Patterson","doi":"10.14236/jhi.v21i1.9","DOIUrl":"https://doi.org/10.14236/jhi.v21i1.9","url":null,"abstract":"<p><p>This paper reports on a head-to-head study of howRU and EQ-5D on patients with cardiovascular disease. howRU is a short generic measure of health-related quality of life comprising 39 words, designed for routine use, which we compare with EQ-5D (230 words). Patients attending a clinic completed both instruments. Completed data were available for 116 patients, 51% female, mean age 56 and SD 20. howRU is shorter, has better readability statistics, a higher completion rate, a wider range of states used and a smaller ceiling effect than EQ-5D. The correlations of howRU with EQ-5D are similar to those of EQ-5D with other validated instruments. </p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"21 1","pages":"12-7"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32177869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Getting on with your computer is associated with job satisfaction in primary care: entrants to primary care should be assessed for their competency with electronic patient record systems.","authors":"Simon de Lusignan,&nbsp;Christopher Pearce,&nbsp;Neil Munro","doi":"10.14236/jhi.v21i1.61","DOIUrl":"https://doi.org/10.14236/jhi.v21i1.61","url":null,"abstract":"<p><p>Job satisfaction in primary care is associated with getting on with your computer. Many primary care professionals spend longer interacting with their computer than anything else in their day. However, the computer often makes demands rather than be an aid or supporter that has learned its user's preferences. The use of electronic patient record (EPR) systems is underrepresented in the assessment of entrants to primary care, and in definitions of the core competencies of a family physician/general practitioner. We call for this to be put right: for the use of the EPR to support direct patient care and clinical governance to be given greater prominence in training and assessment. In parallel, policy makers should ensure that the EPR system use is orientated to ensuring patients receive evidence-based care, and EPR system suppliers should explore how their systems might better support their clinician users, in particular learning their preferences. </p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"21 1","pages":"i-iii"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32177868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Satisfaction with electronic health records is associated with job satisfaction among primary care physicians.","authors":"Christine D Jones,&nbsp;George M Holmes,&nbsp;Sarah E Lewis,&nbsp;Kristie W Thompson,&nbsp;Samuel Cykert,&nbsp;Darren A DeWalt","doi":"10.14236/jhi.v21i1.27","DOIUrl":"https://doi.org/10.14236/jhi.v21i1.27","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between electronic health record (EHR) satisfaction and job satisfaction in primary care physicians (PCPs).</p><p><strong>Method: </strong>Cross-sectional survey of PCPs at 825 primary care practices in North Carolina.</p><p><strong>Results: </strong>Surveys were returned from 283 individuals across 214 practices (26% response rate for practices), of whom 122 were physicians with EHRs and no missing information. We found that for each point increase in EHR satisfaction, job satisfaction increased by ∼0.36 points both in an unadjusted and an adjusted model (β 0.359 unadjusted, 0.361 adjusted; p < 0.001 for both models).</p><p><strong>Conclusion: </strong>We found that EHR satisfaction was associated with job satisfaction in a cross-sectional survey of PCPs. Our conclusions are limited by suboptimum survey response rate, but if confirmed may have substantial implications for how EHR vendors develop their product to support the needs of PCPs.</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"21 1","pages":"18-20"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32177870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}