Informatics in Primary Care最新文献

Background: Falls in older Australians are an increasingly costly public health issue, driving the development of novel modes of intervention, especially those that rely on computer-driven technologies.

Objective: The aim of this paper was to gain an understanding of the state of the art of research on smart homes and computer-based monitoring technologies to prevent and detect falls in the community-dwelling elderly.

Method: Cochrane, Medline, Embase and Google databases were searched for articles on fall prevention in the elderly using pre-specified search terms. Additional papers were searched for in the reference lists of relevant reviews and by the process of 'snowballing'. Only studies that investigated outcomes related to falling such as fall prevention and detection, change in participants' fear of falling and attitudes towards monitoring technology were included.

Results: Nine papers fulfilled the inclusion criteria. The following outcomes were observed: (1) older adults' attitudes towards fall detectors and smart home technology are generally positive; (2) privacy concerns and intrusiveness of technology were perceived as less important to participants than their perception of health needs and (3) unfriendly and age-inappropriate design of the interface may be one of the deciding factors in not using the technology.

Conclusion: So far, there is little evidence that using smart home technology may assist in fall prevention or detection, but there are some indications that it may increase older adults' confidence and sense of security, thus possibly enabling aging in place.

Background: Many young people with chronic ill health use technology for self-care activities, but little is known about the use of telehealth amongst those with spina bifida. The limited availability of specialist continence nurses in primary care settings, for this client group in the UK, exacerbates their reliance on parents or carers.

Objectives: 1. Exploring the way in which home-based and technology-enabled clinical interventions affect young people's engagement in continence self-care. 2. Articulating the way in which telehealth impacts on nursing practice and the conduct of remote clinical encounters.

Methods: A virtual nurse-led clinic was established to support a small cohort of service users and their parents from home. Data from participants were collected and analysed alongside a narrative record of a reflective diary, used by the continence specialist nurse.

Results: Participants reported increased level of self-confidence, which was attributed to interacting remotely with the specialist nurse. The virtual clinic assisted users to attain some self-care goals as well as assert their role as partners in care planning. The specialist nurse gained new valuable skills in mastering telehealth technology and managing remote clinical provision.

Conclusions: Using Skype™ to support young people with complex needs is an effective intervention to support continence care at home. Dedicated technical support during the initial set-up phase and on-going clinical mentorship are needed to ensure that telehealth is successfully embedded within health care practice.

This journal strongly supports the sharing of data to support research and quality improvement. However, this needs to be done in a way that ensures the benefits vastly outweigh the risks, and vitally using methods which are inspire both public and professional confidences--robust pseudonymisation is needed to achieve this. The case for using routine data for research has already been well made and probably also for quality improvement; however, clearer mechanisms are needed of how we test that the public interest is served. Ensuring that the public interest is served is essential if we are to maintain patients' and public's trust, especially in the English National Health Service where the realpolitik is that patients can opt out of data sharing.

Background: The protection of personal information privacy has become one of the most pressing security concerns for record keepers: this will become more onerous with the introduction of the European General Data Protection Regulation (GDPR) in mid-2014. Many institutions, both large and small, have yet to implement the essential infrastructure for data privacy protection and patient consent and control when accessing and sharing data; even more have failed to instil a privacy and security awareness mindset and culture amongst their staff. Increased regulation, together with better compliance monitoring, has led to the imposition of increasingly significant monetary penalties for failure to protect privacy: these too are set to become more onerous under the GDPR, increasing to a maximum of 2% of annual turnover.

Objective: There is growing pressure in clinical environments to deliver shared patient care and to support this with integrated information. This demands that more information passes between institutions and care providers without breaching patient privacy or autonomy. This can be achieved with relatively minor enhancements of existing infrastructures and does not require extensive investment in inter-operating electronic records: indeed such investments to date have been shown not to materially improve data sharing. REQUIREMENTS FOR PRIVACY: There is an ethical duty as well as a legal obligation on the part of care providers (and record keepers) to keep patient information confidential and to share it only with the authorisation of the patient. To achieve this information storage and retrieval, communication systems must be appropriately configured. There are many components of this, which are discussed in this paper. Patients may consult clinicians anywhere and at any time: therefore, their data must be available for recipient-driven retrieval (i.e. like the World Wide Web) under patient control and kept private: a method for delivering this is outlined.

Introduction: With growing sophistication of eHealth platforms, medical information is increasingly shared across patients, health care providers, institutions and across borders. This implies more stringent demands on the quality of data entry at the point-of-care. Non-native English-speaking general practitioners (GPs) experience difficulties in interacting with international classification systems and nomenclatures to facilitate the secondary use of their data and to ensure semantic interoperability.

Aim: To identify words and phrases pertaining to the heart failure domain and to explore the difficulties in mapping to corresponding concepts in ICPC-2, ICD-10, SNOMED-CT and UMLS.

Methods: The medical concepts in a Belgian guideline for GPs in its French version were extracted manually and coded first in ICPC-2, then ICD-10 by a physician, an expert in classification systems. In addition, mappings were sought with SNOMED-CT and UMLS concepts, using the UMLS SNOMED-CT browser.

Results: We identified 143 words and phrases, of which 128 referred to a single concept (1-to-1 mapping), while 15 referred to two or more concepts (1-to-n mapping to ICPC rubrics or to the other nomenclatures). In the guideline, words or phrases were often too general for specific mapping to a code or term. Marked discrepancy between semantic tags and types was found.

Conclusion: This article shows the variability of the various international classifications and nomenclatures, the need for structured guidelines with more attention to precise wording and the need for classification expertise embedded in sophisticated terminological resources. End users need support to perform their clinical work in their own language, while still assuring standardised and semantic interoperable medical registration. Collaboration between computational linguists, knowledge engineers, health informaticians and domain experts is needed.

Background: Non-attendance at paediatric urology outpatient appointments results in the patient's failure to receive medical care and wastes health care resources.

Objective: To determine the utility of using routinely collected electronic health record (EHR) data for multi-centre analysis of variables predictive of patient noshows (NS) to identify areas for future intervention.

Methods: Data were obtained from Children's Hospital Colorado, Rady Children's Hospital San Diego and University of Virginia Hospital paediatric urology practices, which use the Epic® EHR system. Data were extracted for all urology outpatient appointments scheduled from 1 October 2010 to 30 September 2011 using automated electronic data extraction techniques. Data included appointment type; date; provider type and days from scheduling to appointment. All data were de-identified prior to analysis. Predictor variables identified using χ(2) and analysis of variance were modelled using multivariate logistic regression.

Results: A total of 2994 NS patients were identified within a population of 28,715, with a mean NS rate of 10.4%. Multivariate logistic regression determined that an appointment with mid-level provider (odds ratio (OR) 1.70 95% CI (1.56, 1.85)) and an increased number of days between scheduling and appointment (15-28 days OR 1.24 (1.09, 1.41); 29+ days OR 1.70 (1.53, 1.89)) were significantly associated with NS appointments.

Conclusion: We demonstrated sufficient interoperability among institutions to obtain data rapidly and efficiently for use in 1) interventions; 2) further study and 3) more complex analysis. Demographic and potentially modifiable clinic characteristics were associated with NS to the outpatient clinic. The analysis also demonstrated that available data are dependent on the clinical data collection systems and practices.

Even though informatics is a term used commonly in healthcare, it can be a confusing and disengaging one. Many definitions exist in the literature, and attempts have been made to develop a clear taxonomy. Despite this, informatics is still a term that lacks clarity in both its scope and the classification of sub-terms that it encompasses. This paper reviews the importance of an agreed taxonomy and explores the challenges of establishing exactly what is meant by health informatics (HI). It reviews what a taxonomy should do, summarises previous attempts at categorising and organising HI and suggests the elements to consider when seeking to develop a system of classification. The paper does not provide all the answers, but it does clarify the questions. By plotting a path towards a taxonomy of HI, it will be possible to enhance understanding and optimise the benefits of embracing technology in clinical practice.

Background: Sensor technologies are designed to assist independent living of older adults. However, it is often difficult for older adults to make an informed decision about adopting sensor technologies.

Objective: To explore Bruce's framework of informed decision making (IDM) for in-home use of sensor technologies in community-dwelling elders.

Method: The IDM framework guided development of a semi-structured interview. A theory-driven coding approach was used for analysis.

Results: Participants supported most of the elements of the framework, but not all aspects of each element were addressed. Perceived usefulness of technologies was identified as an area for framework extension.

Conclusion: This paper provides useful information for health care professionals to consider how to enhance IDM of older adults regarding the use of sensor technologies. The results also illuminate elements of the IDM framework that may be critical to facilitating independent living for older adults.