Informatics in Primary Care最新文献

{"title":"Use of email in communication between the Finnish primary healthcare system and general practitioners.","authors":"Tuula Karhula,&nbsp;Timo Kauppila,&nbsp;Outi Elonheimo,&nbsp;Mats Brommels","doi":"10.14236/jhi.v19i1.790","DOIUrl":"https://doi.org/10.14236/jhi.v19i1.790","url":null,"abstract":"<p><strong>Background: </strong>The volume of emails is rising rapidly everywhere. However, there is no data available concerning how primary healthcare physicians feel about the use of email communication between themselves, with their managers and with other people contacting them.</p><p><strong>Objective: </strong>The objective of this study was to find out what the attitudes of primary care physicians are towards email at work.</p><p><strong>Methods: </strong>The use of email was studied among a convenience sample of primary healthcare physicians.</p><p><strong>Results: </strong>Physicians thought that email was a good instrument for delivering information but not as an instrument for leadership. Physicians in lead positions thought more often than ordinary general practitioners (GPs) that email is good for information. The leaders used email more actively than other GPs. The contents of the emails received by the GPs differed depending on the site of work. The total number of emails was higher in urban areas than in rural areas. Emails relating to administration, educational information and meeting materials were more often sent in rural than in urban primary healthcare settings. Information about daily work arrangements and about social events were more frequently emailed in urban than in rural surroundings. Email was considered important for information inside the system but a somewhat difficult tool for discussing complicated subjects. Generally, it was agreed that there was some unimportant information filtering through this medium to the target GPs. GPs were uncertain whether important data reached everybody who needed it or not. Still, almost everybody used the email system regularly and the use of it was considered relatively easy. GPs were generally prone to adopt advice and instructions given via email and implemented those in their working routines. The use of the email system was related to technical ability to use the system. The easier the GP thought that the email system was the more he used it. Rural GPs were more critical in applying advice shared via email than their counterparts in urban areas. In general, physicians thought that email was a good method for reaching many people at the same time. However, the main points of the messages may be missed and the whole email may sometimes not be read.</p><p><strong>Conclusion: </strong>Especially during periods of change in the workplace, it is very important that management is conducted personally. Care must be taken so that disinformation does not spoil the informative value of email in the administration of primary health care. The needed technical assistance should be given to everyone in order to get the best advantage from the use of the email system.</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"19 1","pages":"25-32"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30282534","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":"Primary care provider perceptions and use of a novel medication reconciliation technology.","authors":"Blake J Lesselroth,&nbsp;Patricia J Holahan,&nbsp;Kathleen Adams,&nbsp;Zhen Z Sullivan,&nbsp;Victoria L Church,&nbsp;Susan Woods,&nbsp;Robert Felder,&nbsp;Shawn Adams,&nbsp;David A Dorr","doi":"10.14236/jhi.v19i2.802","DOIUrl":"https://doi.org/10.14236/jhi.v19i2.802","url":null,"abstract":"<p><strong>Background: </strong>Although medication reconciliation (MR) can reduce medication discrepancies, it is challenging to operationalise. Consequently, we developed a health information technology (HIT) to collect a patient medication history and make it available to the primary care (PC) provider. We deployed a self-service kiosk in a PC clinic that permits patients to indicate a medication adherence history. Patient responses are immediately viewable in the legacy electronic health record. This paper describes a survey developed to assess PC provider perceptions of our HIT and HIT implementation effectiveness.</p><p><strong>Methods: </strong>We developed and administered a survey to all PC providers to assess technology implementation effectiveness. The survey included scales measuring (1) user attitudes towards MR, (2) perceptions of our HIT and (3) the local organisational climate for implementation. We also assessed the consistency and quality of tool use.</p><p><strong>Results: </strong>Nearly 90% of PC providers responded to the survey and 58% indicated that they were familiar with the technology and had seen the tool output. Most providers believed that MR represented an important safety intervention, although 43% did not believe that they had the necessary resources to manage discrepancies. Composite scale scores for the 58% of respondents familiar with the HIT indicate that the majority favoured our tool over usual care. However, composite scale scores suggest that the climate for implementation at our facility was suboptimal. Overall, the quality and consistency of tool use among providers was very heterogeneous.</p><p><strong>Conclusions: </strong>A patient self-service kiosk offers an efficient mechanism to collect a medication adherence history; provider survey responses indicate that they appreciated and used the MR kiosk output. Nonetheless, opportunities exist to improve data displays and embed decision support to facilitate discrepancy management.</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"19 2","pages":"105-18"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40165294","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":"Informatics research, practice, theory and history.","authors":"Simon de Lusignan","doi":"10.14236/jhi.v19i3.804","DOIUrl":"https://doi.org/10.14236/jhi.v19i3.804","url":null,"abstract":"","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"19 3","pages":"125-6"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30681823","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":"Informatics in primary care: 20 years on--editor's report 2011.","authors":"Simon de Lusignan","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"19 3","pages":"183-6"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30734758","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":"Anything but engaged: user involvement in the context of a national electronic health record implementation.","authors":"Kathrin Cresswell,&nbsp;Zoe Morrison,&nbsp;Sarah Crowe,&nbsp;Ann Robertson,&nbsp;Aziz Sheikh","doi":"10.14236/jhi.v19i4.814","DOIUrl":"https://doi.org/10.14236/jhi.v19i4.814","url":null,"abstract":"<p><strong>Background: </strong>The absence of meaningful end user engagement has repeatedly been highlighted as a key factor contributing to 'failed' implementations of electronic health records (EHRs), but achieving this is particularly challenging in the context of national scale initiatives. In 2002, the National Health Service (NHS) embarked on a so-called 'top-down' national implementation strategy aimed at introducing commercial, centrally procured, EHRs into hospitals throughout England.</p><p><strong>Objective: </strong>We aimed to examine approaches to, and experiences of, user engagement in the context of a large-scale EHR implementation across purposefully selected hospital care providers implementing early versions of nationally procured software.</p><p><strong>Methods: </strong>We conducted a qualitative, case-study based, socio-technically informed, longitudinal investigation, purposefully sampling and collecting data from four hospitals. Our data comprised a total of 123 semi-structured interviews with users and managers, 15 interviews with additional stakeholders, 43 hours of non-participant observations of meetings and system use, and relevant organisation-specific documents from each case study site. Analysis was thematic, building on an existing model of user engagement that was originally developed in the context of studying the implementation of relatively simple technologies in commercial settings. NVivo8 software was used to facilitate coding.</p><p><strong>Results: </strong>Despite an enduring commitment to the vision of shared EHRs and an appreciation of their potential benefits, meaningful end user engagement was never achieved. Hospital staff were not consulted in systems choice, leading to frustration; they were then further alienated by the implementation of systems that they perceived as inadequately customised. Various efforts to achieve local engagement were attempted, but these were in effect risk mitigation strategies. We found the role of clinical champions to be important in these engagement efforts, but progress was hampered by the hierarchical structures within healthcare teams. As a result, engagement efforts focused mainly on clinical staff with inadequate consideration of management and administrative staff.</p><p><strong>Conclusions: </strong>This work has allowed us to further develop an existing model of user engagement from the commercial sector and adapt it to inform user engagement in the context of large-scale eHealth implementations. By identifying key points of possible engagement, disengagement and re-engagement, this model will we hope both help those planning similar large-scale EHR implementation efforts and act as a much needed catalyst to further research in this neglected field of enquiry.</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"19 4","pages":"191-206"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30786233","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":"Generalisability of The Health Improvement Network (THIN) database: demographics, chronic disease prevalence and mortality rates.","authors":"Betina T Blak,&nbsp;Mary Thompson,&nbsp;Hassy Dattani,&nbsp;Alison Bourke","doi":"10.14236/jhi.v19i4.820","DOIUrl":"https://doi.org/10.14236/jhi.v19i4.820","url":null,"abstract":"INTRODUCTION\u0000The degree of generalisability of patient databases to the general population is important for interpreting database research. This report describes the representativeness of The Health Improvement Network (THIN), a UK primary care database, of the UK population.\u0000\u0000\u0000METHODS\u0000Demographics, deprivation (Townsend), Quality and Outcomes Framework (QOF) condition prevalence and deaths from THIN were compared with national statistical and QOF 2006/2007 data.\u0000\u0000\u0000RESULTS\u0000Demographics were similar although THIN contained fewer people aged under 25 years. Condition prevalence was comparable, e.g. 3.5% diabetes prevalence in THIN, 3.7% nationally. More THIN patients lived in the most affluent areas (23.5% in THIN, 20% nationally). Between 1990 and 2009, standardised mortality ratio ranged from 0.81 (95% CI: 0.39-1.49; 1990) to 0.93 (95% CI: 0.48-1.64; 1995). Adjusting for demographics/deprivation, the 2006 THIN death rate was 9.08/1000 population close to the national death rate of 9.4/1000 population.\u0000\u0000\u0000CONCLUSION\u0000THIN is generalisable to the UK for demographics, major condition prevalence and death rates adjusted for demographics and deprivation.","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"19 4","pages":"251-5"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30786163","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":"Towards a terminologies support system in primary care.","authors":"Joseph Roumier,&nbsp;Marc Jamoulle,&nbsp;Robert Vander Stichele,&nbsp;Laurent Romary,&nbsp;Elena Cardillo","doi":"10.14236/jhi.v19i4.821","DOIUrl":"https://doi.org/10.14236/jhi.v19i4.821","url":null,"abstract":"We read with great interest your paper about SNOMED-CT in the November 2011 issue of Informatics in Primary Care. We appreciate your comments were triggered by the adoption of SNOMEDCT as the central nomenclature for the NHS, aimed to be a comprehensive coding system, able to code any concept. However, we additionally need a broad terminology support system. SNOMED-CT is an international collaborative effort, grown out of the clinical need for classification of the American pathologists since 1965, first known as SNOP. In 2001, a historical merge was accomplished with the UK Read Codes, ensuring the introduction of missing clinical concepts. There are now more than 300 000 concepts represented in SNOMED-CT, with a fully specified identifier, located into an ontology, using since 2002 Description Logics as a formal representation framework but without textual definition. This ontology bares the marks of the hybrid composition and the historical changes in classification approach, both in SNOMED and in the Read Codes. As pointed out in your paper there is a risk that this system becomes the only dominant tool for the registration of clinical terms. Other valuable approaches to medical registrations maybe more suited for use in primary care, such as the International Classification of Primary Care (ICPC) available in 30 languages. If the e-Health system of a country only supports SNOMED-CT, functionalities in other classification may be lost: This situation would be reminiscent of Maslow0s law of the instrument: ‘If you only have a hammer, everything looks like a nail’. Such an approach may also limit the scope for international collaboration with countries not using SNOMED and with knowledge bases that might be indexed differently. Fortunately, there is cooperation between the parent organisations of SNOMED-CT (IHTSDO – International Health Terminology Standards Organisation) and ICPC (WONCA – World Organisation of Family Doctors) after the mapping project between ICPC Plus and SNOMED-CT. There have also been mapping projects between SNOMED-CT and ICD (WHO) and other health care terminologies and between ICD and ICPC. However, these mapping projects may not be a sufficient guarantee that the specific functionalities of ICPC will be maintained in future e-Health projects fostering semantic interoperability. ICPC is widely used and categorises medical encounters and events into a relatively limited number of concepts. This limited set is sufficient to represent most, if not nearly all, clinical activity in primary care. We are not sure whether ICPC with its bi-axial functionality will be exploitable in SNOMED-CT. As pointed out in de Lusignan et al’s leading article, SNOMED-CT offers more coding choice but it may be harder to find the right granularity of concept (and the corresponding code), to represent the sometimes fuzzy reality of primary care. What is really needed is a terminology support system. This terminology support system would allow:","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"19 4","pages":"257-8"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30786164","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":"Defining datasets and creating data dictionaries for quality improvement and research in chronic disease using routinely collected data: an ontology-driven approach.","authors":"Simon de Lusignan,&nbsp;Siaw-Teng Liaw,&nbsp;Georgios Michalakidis,&nbsp;Simon Jones","doi":"10.14236/jhi.v19i3.805","DOIUrl":"https://doi.org/10.14236/jhi.v19i3.805","url":null,"abstract":"<p><strong>Background: </strong>The burden of chronic disease is increasing, and research and quality improvement will be less effective if case finding strategies are suboptimal.</p><p><strong>Objective: </strong>To describe an ontology-driven approach to case finding in chronic disease and how this approach can be used to create a data dictionary and make the codes used in case finding transparent.</p><p><strong>Method: </strong>A five-step process: (1) identifying a reference coding system or terminology; (2) using an ontology-driven approach to identify cases; (3) developing metadata that can be used to identify the extracted data; (4) mapping the extracted data to the reference terminology; and (5) creating the data dictionary.</p><p><strong>Results: </strong>Hypertension is presented as an exemplar. A patient with hypertension can be represented by a range of codes including diagnostic, history and administrative. Metadata can link the coding system and data extraction queries to the correct data mapping and translation tool, which then maps it to the equivalent code in the reference terminology. The code extracted, the term, its domain and subdomain, and the name of the data extraction query can then be automatically grouped and published online as a readily searchable data dictionary. An exemplar online is: www.clininf.eu/qickd-data-dictionary.html</p><p><strong>Conclusion: </strong>Adopting an ontology-driven approach to case finding could improve the quality of disease registers and of research based on routine data. It would offer considerable advantages over using limited datasets to define cases. This approach should be considered by those involved in research and quality improvement projects which utilise routine data.</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"19 3","pages":"127-34"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30681824","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":"Mismatch between the prevalence of overweight and obese children and adolescents and recording in electronic health records: a cross-sectional study.","authors":"Paula Otero,&nbsp;Pablo Durán,&nbsp;Débora Setton,&nbsp;Alfredo Eymann,&nbsp;Julio Busaniche,&nbsp;Julián Llera","doi":"10.14236/jhi.v19i2.798","DOIUrl":"https://doi.org/10.14236/jhi.v19i2.798","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of obesity has increased dramatically in recent years. An electronic health record (EHR) can be used to identify and manage overweight and obesity by providing timely information.</p><p><strong>Objective: </strong>To estimate the prevalence of overweight and obesity using anthropometric data from an EHR and to compare it with the frequency of diagnoses of 'overweight' and 'obesity' registered by pediatricians.</p><p><strong>Methods: </strong>Cross-sectional, descriptive analytical study from a sample of records from children aged between 2 and 19 years who had at least one well-child visit registered in the EHR over the 24-month period between 2007 and 2008. The record of a diagnosis of overweight or obesity by physicians was compared with estimations based on body mass index (BMI; World Health Organization Growth Reference Data).</p><p><strong>Results: </strong>Of 14 743 patients aged 2-19 years, 22.1% were overweight and 9.8% were obese. By contrast, a diagnosis of overweight was registered in the EHR for 3.3% of patients, with a figure of 1.1% for obesity. The prevalence of overweight/obesity was lower in adolescents than in children and preschoolers. Based on BMI cut-off points, we found that only 11.5% of the overweight or obese patients had these diagnoses registered in the EHR. Referral to a nutritionist or endocrinolist, and the frequency of selected laboratory tests based on BMI categories vary between 11.8 and 52.5%.</p><p><strong>Conclusion: </strong>An EHR can contribute to the identification of a population at risk when there is a sub-registry of these diagnoses by primary care physicians.</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"19 2","pages":"75-82"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40165290","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":"Emergency medicine residents' beliefs about contributing to a Google Docs presentation: a survey protocol.","authors":"Patrick M Archambault,&nbsp;Danielle Blouin,&nbsp;Julien Poitras,&nbsp;Renée-Marie Fountain,&nbsp;Richard Fleet,&nbsp;Andrea Bilodeau,&nbsp;France Légaré","doi":"10.14236/jhi.v19i4.815","DOIUrl":"https://doi.org/10.14236/jhi.v19i4.815","url":null,"abstract":"<p><strong>Background: </strong>Web 2.0 collaborative writing technologies have shown positive effects on medical education. One such technology, Google Docs(™), offers collaborative writing applications that improve healthcare students' sharing of information. Since 2008, all graduating residents in emergency medicine in Canada have had access to an online Google Docs(™) slideshow designed to help them share summaries of landmark articles in preparation for their Royal College of Physicians and Surgeons of Canada certification exam. A recent evaluation showed that contributions to the presentation were low.</p><p><strong>Objective: </strong>This study will identify the factors that influence residents' decision to contribute or not to contribute to this online collaborative project.</p><p><strong>Methods: </strong>Using the Theory of Planned Behaviour, semistructured interviews will be conducted with 25 graduating emergency medicine residents in Canada. Content from the interviews will be analysed to determine the most important beliefs in relation to the defined behaviour.</p><p><strong>Conclusion: </strong>To our knowledge, this study will be the first to use a theory based framework to identify healthcare trainees' salient beliefs concerning their decision whether to contribute to an online collaborative writing project using Google Docs(™).</p>","PeriodicalId":30591,"journal":{"name":"Informatics in Primary Care","volume":"19 4","pages":"207-16"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30786234","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}