Informatics in Primary Care最新文献

{"title":"The Scottish Emergency Care Summary--an evaluation of a national shared record system aiming to improve patient care: technology report.","authors":"Libby M M Morris,&nbsp;Colin Brown,&nbsp;Marysia Williamson,&nbsp;Jeremy C Wyatt","doi":"10.14236/jhi.v20i1.46","DOIUrl":"https://doi.org/10.14236/jhi.v20i1.46","url":null,"abstract":"<p><strong>Background: </strong>In Scotland, out-of-hours calls are all triaged by the National Health Service emergency service (NHS24) but the clinicians receiving calls have no direct access to patient records.</p><p><strong>Objective: </strong>To improve the safety of patient care in unscheduled consultations when the usual primary care record is not available.</p><p><strong>Technology: </strong>The Emergency Care Summary (ECS) is a record system offering controlled access to medication and adverse reactions details for nearly every person registered with a general practice in Scotland. It holds a secure central copy of these parts of the general practitioner (GP) practice record and is updated automatically twice daily. It is accessible under specified unplanned clinical circumstances by clinicians working in out-of-hours organisations, NHS24 and accident and emergency departments if they have consent from the patient and a current legitimate relationship for that patient's care.</p><p><strong>Application: </strong>We describe the design of the security model, management of data quality, deployment, costs and clinical benefits of the ECS over four years nationwide in Scotland, to inform the debate on the safe and effective sharing of health data in other nations.</p><p><strong>Evaluation: </strong>Forms were emailed to 300 NHS24 clinicians and 81% of the 113 respondents said that the ECS was helpful or very helpful and felt that it changed their clinical management in 20% of cases.</p><p><strong>Conclusion: </strong>The ECS is acceptable to patients and helpful for clinicians and is used routinely for unscheduled care when normal medical records are unavailable. Benefits include more efficient assessment and reduced drug interaction, adverse reaction and duplicate prescribing.</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"20 1","pages":"41-9"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31176850","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":"Implementation of a web-based tool for patient medication self-management: the Medication Self-titration Evaluation Programme (Med-STEP) for blood pressure control.","authors":"Richard W Grant,&nbsp;Jennifer C Pandiscio,&nbsp;Hannah Pajolek,&nbsp;Alyssa Woulfe,&nbsp;Alexandra Pelletier,&nbsp;Joseph Kvedar,&nbsp;Elyse R Park","doi":"10.14236/jhi.v20i1.48","DOIUrl":"https://doi.org/10.14236/jhi.v20i1.48","url":null,"abstract":"<p><strong>Background: </strong>Informatics tools may help support hypertension management.</p><p><strong>Objective: </strong>To design, implement and evaluate a web-based system for patient anti-hypertensive medication self-titration.</p><p><strong>Methods: </strong>Study stages included: six focus groups (50 patients) to identify barriers/facilitators to patient medication self-titration, software design informed by qualitative analysis of focus group responses and a six-month single-arm pilot study (20 patients) to assess implementation feasibility.</p><p><strong>Results: </strong>Focus groups emphasised patient need to feel confident that their own primary care providers were directly involved and approved of the titration protocol. Physicians required 3.3 ± 2.8 minutes/patient to create individualised six-step medication pathways for once-monthly blood pressure evaluations. Pilot participants (mean age of 51.5 ± 11 years, 45% women, mean baseline blood pressure 139/84 ± 12.2/7.5 mmHg) had five medication increases, two non-adherence self-reports, 52 months not requiring medication changes, 24 skipped months and 17 months with no evaluations due to technical issues. Four pilot patients dropped out before study completion. From baseline to study completion, blood pressure decreased among the 16 patients remaining in the study (8.0/4.7 mmHg, p = 0.03 for both systolic and diastolic pressures).</p><p><strong>Conclusions: </strong>Lessons learned included the benefit of qualitative patient analysis prior to system development and the feasibility of physicians designing individual treatment pathways. Any potential clinical benefits were offset by technical problems, the tendency for patients to skip their monthly self-evaluations and drop outs. To be more widely adopted such systems must effectively generalise to a wider range of patients and be integrated into clinical workflow.</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"20 1","pages":"57-67"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3829638/pdf/nihms500155.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31176852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International informatics research, communication, episodes of care, evaluation and measuring outcomes.","authors":"Simon de Lusignan","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"20 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31177448","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 health information ecosystem, technology to support more effective hospital discharge, data quality enables prediction of outcomes, and supporting better decision making.","authors":"Simon de Lusignan","doi":"10.14236/jhi.v20i2.35","DOIUrl":"https://doi.org/10.14236/jhi.v20i2.35","url":null,"abstract":"","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"20 2","pages":"77-9"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31460672","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":"Clinicians were oblivious to incorrect logging of test dates and the associated risks in an online pathology application: a case study.","authors":"Amber Appleton,&nbsp;Khaled Sadek,&nbsp;Ian G J Dawson,&nbsp;Simon de Lusignan","doi":"10.14236/jhi.v20i4.13","DOIUrl":"https://doi.org/10.14236/jhi.v20i4.13","url":null,"abstract":"<p><strong>Background: </strong>UK primary care physicians receive their laboratory test results electronically. This study reports a computerised physician order entry (CPOE) system error in the pathology test request date that went unnoticed in family practices.</p><p><strong>Method: </strong>We conducted a case study using a causation of risk theoretical framework; comprising interviews with clinicians and the manufacturer to explore the identification of and reaction to the error. The primary outcome was the evolution and recognition of and response to the problem. The secondary outcome was to identify other issues with this system noted by users.</p><p><strong>Results: </strong>The problem was defined as the incorrect logging of test dates ordered through a CPOE system. The system assigned the test request date to the results, hence a blood test taken after a therapeutic intervention (e.g. an increase in cholesterol-lowering therapy) would appear in the computerised medical record as though it had been tested prior to the increase in treatment. This case demonstrates that: the manufacturers failed to understand family physician workflow; regulation of medical software did not prevent the error; and inherent user trust in technology exacerbated this problem. It took three months before users in two practices independently noted the date errors.</p><p><strong>Conclusion: </strong>This case illustrates how users take software on trust and suppliers fail to make provision for risks associated with new software. Resulting errors led to inappropriate prescribing, follow-up, costs and risk. The evaluation of such devices should include utilising risk management processes (RMP) to minimise and manage potential risk.</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"20 4","pages":"241-7"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31611295","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":"Time for research networks to be trained in informatics and based within informatics centres.","authors":"Simon de Lusignan","doi":"10.14236/jhi.v20i1.42","DOIUrl":"https://doi.org/10.14236/jhi.v20i1.42","url":null,"abstract":"","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"20 1","pages":"3-5"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31177449","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":"Making the most of the personal health data asset and the online patient.","authors":"Simon de Lusignan","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"20 4","pages":"217-9"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31611291","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":"Notifications of hospital events to outpatient clinicians using health information exchange: a post-implementation survey.","authors":"Richard Altman,&nbsp;Jason S Shapiro,&nbsp;Thomas Moore,&nbsp;Gilad J Kuperman","doi":"10.14236/jhi.v20i4.14","DOIUrl":"https://doi.org/10.14236/jhi.v20i4.14","url":null,"abstract":"<p><strong>Background: </strong>The trend towards hospitalist medicine can lead to disjointed patient care. Outpatient clinicians may be unaware of patients' encounters with a disparate healthcare system. Electronic notifications to outpatient clinicians of patients' emergency department (ED) visits and inpatient admissions and discharges using health information exchange can inform outpatient clinicians of patients' hospital-based events.</p><p><strong>Objective: </strong>Assess outpatient clinicians' impressions of a new, secure messaging-based, patient event notification system.</p><p><strong>Methods: </strong>Twenty outpatient clinicians receiving notifications of hospital-based events were recruited and 14 agreed to participate. Using a semi-structured interview, clinicians were asked about their use of notifications and the impact on their practices.</p><p><strong>Results: </strong>Nine of 14 interviewed clinicians (64%) thought that without notifications, they would have heard about fewer than 10% of ED visits before the patient's next visit. Nine clinicians (64%) thought that without notifications, they would have heard about fewer than 25% of inpatient admissions and discharges before the patient's next visit. Six clinicians (43%) reported that they call the inpatient team more often because of notifications. Eight users (57%) thought that notifications improved patient safety by increasing their awareness of the patients' clinical events and their medication changes. Key themes identified were the importance of workflow integration and a desire for more clinical information in notifications.</p><p><strong>Conclusions: </strong>The notification system is perceived by clinicians to be of value. These findings should instigate further message-oriented use of health information exchange and point to refinements that can lead to even greater benefits.</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"20 4","pages":"249-55"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31611296","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":"Pharmacist-generated electronic consults to improve hypertension management in a multisite health centre: pilot study.","authors":"Marissa Salvo,&nbsp;Stefanie C Nigro,&nbsp;Deborah Ward","doi":"10.14236/jhi.v20i3.23","DOIUrl":"https://doi.org/10.14236/jhi.v20i3.23","url":null,"abstract":"<p><strong>Background: </strong>Utilisation of the electronic medical record (EMR) is believed to facilitate timely access to patient information, enhance communication between care team members and further promote clinical decision support.</p><p><strong>Objective: </strong>To determine if pharmacist-generated electronic consults (e-consults) improve blood pressure control among patients with uncontrolled hypertension in a multisite health centre.</p><p><strong>Methods: </strong>Pharmacists generated hypertension medication e-consults with review by primary care provider (PCP) during the patient appointment. We conducted a retrospective review of consults to determine types of pharmacist recommendations, PCP acceptance rates, and blood pressure changes.</p><p><strong>Results: </strong>Pharmacists generated a total of 60 e-consults, 41 patients with a systolic blood pressure above their respective goal; e-consults were accepted 46% ( n = 19) of the time.</p><p><strong>Conclusion: </strong>This pilot project demonstrates a unique way for pharmacists to proactively utilise the EMR when delivering coordinated care within a multisite health centre. In addition, pharmacists were successfully integrated into the planned care approach.</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"20 3","pages":"181-4"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31460683","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":"Harshana Liyanage,&nbsp;Siaw-Teng Liaw,&nbsp;Simon de Lusignan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"20 2","pages":"81-6"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31460673","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}