Informatics in Primary Care最新文献

Background: Although the collection of patient ethnicity data is a requirement of publicly funded healthcare providers in the UK, recording of ethnicity is sub-optimal for reasons that remain poorly understood.

Aims and objectives: We sought to understand enablers and barriers to the collection and utilisation of ethnicity data within electronic health records, how these practices have developed and what benefit this information provides to different stakeholder groups.

Methods: We undertook an in-depth, qualitative case study drawing on interviews and documents obtained from participants working as academics, managers and administrators within the UK.

Results: Information regarding patient ethnicity was collected and coded as administrative patient data, and/or in narrative form within clinical records. We identified disparities in the classification of ethnicity, approaches to coding and levels of completeness due to differing local, regional and national policies and processes. Most participants could not identify any clinical value of ethnicity information and many did not know if and when data were shared between services or used to support quality of care and research.

Conclusions: Findings highlighted substantial variations in data classification, and practical challenges in data collection and usage that undermine the integrity of data collected. Future work needs to focus on explaining the uses of these data to frontline clinicians, identifying resources that can support busy professionals to collect standardised data and then, once collected, maximising the utility of these data.

Dr. John Bryden was the executive officer of European Federation for Medical Informatics for a decade between 1998 and 2008. When he retired from active work within the federation, he was awarded an honorary fellowship. In one of his early papers from the 1960s, he described how some relatively novel machines called computers might replace the punched cards that were being used at the time. He saw, before many others, that computers could be used for the care of individual patients and even more so for groups of patients. He implemented a unique patient identifier (community health index) which has enabled Scotland to link electronic medical record data for clinical management of chronic disease deterministically. An example was the development of the Glasgow Coma Scale. One benefit of demonstrating significant value in projects such as this at an early stage of record linkage was that the governance framework for the use of data became relatively permissive. Another major success was diabetes care; it became possible to apply insights from the aggregate data to improve services and make them more efficient. Scotland has developed safe havens for data where not only the physical environment but also the people, mechanisms and projects are all subject to control to ensure safety and confidentiality. Similar moves are under way in Europe. TRANSFoRm (www.transformproject.eu) led by King's college in London is mainly focused on primary care data. Excellence in medical informatics is possible as a result of the work of its pioneers, including John Bryden's first paper suggesting that computers might be useful.

Background: This study compares general practitioners (GPs) and general practice trainees (GPTs) on the adaptation to the electronic health records (EHRs) and how they perceive its impact on medical consultations.

Methods: Cross-sectional, descriptive study. The link for an online questionnaire was sent to mainland Portuguese health care centre groups.

Results: A total of 147 physicians (100 females and 47 males). GPs had more learning difficulties in using the EHR (P < 0.05), greater difficulty in keeping regular updated records (P < 0.001) and a more noticeable fear of the possibility of occurring prescription errors (P < 0.05), when compared with GPTs. Most GPs (75%) and GPTs (80.4%) are satisfied with how they use the EHR.

Conclusions: Most participants have adhered to the EHR, and are satisfied with its use. A negative impact on medical consultations was not observed. However, it is the group of GPs that is less adapted to the electronic system.

Introduction: Increasing investment in eHealth aims to improve cost effectiveness and safety of care. Data extraction and aggregation can create new data products to improve professional practice and provide feedback to improve the quality of source data. A previous systematic review concluded that locally relevant clinical indicators and use of clinical record systems could support clinical governance. We aimed to extend and update the review with a theoretical framework.

Methods: We searched PubMed, Medline, Web of Science, ABI Inform (Proquest) and Business Source Premier (EBSCO) using the terms curation, information ecosystem, data quality management (DQM), data governance, information governance (IG) and data stewardship. We focused on and analysed the scope of DQM and IG processes, theoretical frameworks, and determinants of the processing, quality assurance, presentation and sharing of data across the enterprise.

Findings: There are good theoretical reasons for integrated governance, but there is variable alignment of DQM, IG and health system objectives across the health enterprise. Ethical constraints exist that require health information ecosystems to process data in ways that are aligned with improving health and system efficiency and ensuring patient safety. Despite an increasingly 'big-data' environment, DQM and IG in health services are still fragmented across the data production cycle. We extend current work on DQM and IG with a theoretical framework for integrated IG across the data cycle.

Conclusions: The dimensions of this theory-based framework would require testing with qualitative and quantitative studies to examine the applicability and utility, along with an evaluation of its impact on data quality across the health enterprise.

There is an increasing international recognition that the evaluation of health information technologies should involve assessments of both the technology and the social/organisational contexts into which it is deployed. There is, however, a lack of agreement on definitions, published guidance on how such 'sociotechnical evaluations' should be undertaken, and how they distinguish themselves from other approaches. We explain what sociotechnical evaluations are, consider the contexts in which these are most usefully undertaken, explain what they entail, reflect on the potential pitfalls associated with such research, and suggest possible ways to avoid these.

Aims: To compare the quality of data collection via electronic data capture (EDC) with voiced questionnaire (QNN) and data image capture features using a tablet versus standard paper-based QNN, to assess the user's perception of using the EDC tool, and to compare user satisfaction with the two methods.

Study design: Randomised cross-over study. Study sites: This study was conducted in two villages along the Thailand-Myanmar border.

Methodology: This study included 30 community health volunteers (CHVs) and 120 Karen hill tribe villagers. Employing a cross-over study design, the CHVs were allocated randomly to two groups, in which they performed interviews in different sequences using EDC and QNN.

Results: Data discrepancies were found between the two data-collection methods, when data from the paper-based and image-capture methods were compared, and when conducting skip pattern questions. More than 90% of the CHVs perceived the EDC to be useful and easy to use. Both interviewers and interviewees were more satisfied with the EDC compared with QNN in terms of format, ease of use, and system speed.

Conclusion: The EDC can effectively be used as an alternative method to paper-based QNNs for data collection. It produces more accurate data that can be considered evidence-based.

Background: Although the presence of an electronic health record (EHR) alone does not ensure high quality, efficient care, few studies have focused on the work of those charged with optimising use of existing EHR functionality.

Objective: To examine the approaches used and challenges perceived by analysts supporting the optimisation of primary care teams' EHR use at a large U.S. academic health care system.

Methods: A qualitative study was conducted. Optimisation analysts and their supervisor were interviewed and data were analysed for themes.

Results: Analysts needed to reconcile the tension created by organisational mandates focused on the standardisation of EHR processes with the primary care teams' demand for EHR customisation. They gained an understanding of health information technology (HIT) leadership's and primary care team's goals through attending meetings, reading meeting minutes and visiting with clinical teams. Within what was organisationally possible, EHR education could then be tailored to fit team needs. Major challenges were related to organisational attempts to standardise EHR use despite varied clinic contexts, personnel readiness and technical issues with the EHR platform. Forcing standardisation upon clinical needs that current EHR functionality could not satisfy was difficult.

Conclusions: Dedicated optimisation analysts can add value to health systems through playing a mediating role between HIT leadership and care teams. Our findings imply that EHR optimisation should be performed with an in-depth understanding of the workflow, cognitive and interactional activities in primary care.

Objective: The purpose of this paper is to describe the use of video-based observation research methods in primary care environment and highlight important methodological considerations and provide practical guidance for primary care and human factors researchers conducting video studies to understand patient-clinician interaction in primary care settings.

Methods: We reviewed studies in the literature which used video methods in health care research, and we also used our own experience based on the video studies we conducted in primary care settings.

Results: This paper highlighted the benefits of using video techniques, such as multi-channel recording and video coding, and compared "unmanned" video recording with the traditional observation method in primary care research. We proposed a list that can be followed step by step to conduct an effective video study in a primary care setting for a given problem. This paper also described obstacles, researchers should anticipate when using video recording methods in future studies.

Conclusion: With the new technological improvements, video-based observation research is becoming a promising method in primary care and HFE research. Video recording has been under-utilised as a data collection tool because of confidentiality and privacy issues. However, it has many benefits as opposed to traditional observations, and recent studies using video recording methods have introduced new research areas and approaches.