National primary care research & development centre




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INFORMATION AND COMMUNICATION TECHNOLOGIES




de Lusignan S, Chan T. The development of primary care information technology in the United Kingdom. Journal of Ambulatory Care Management 2008 31 (3) 201-10.

http://dx.doi.org/10.1097/01.JAC.0000324664.88131.d2

http://pmid.us/18574377

Background: UK primary care is highly computerized; initially led by enthusiastic general practitioners who developed their own systems. This preceded the development of a National Health Service information strategy and an ambitious National Programme for IT., Model: A 4-element model is proposed to explain the development of information technology: (1) individual clinician choice; (2) integration into the clinical task--usually an office visit; (3) technological developments; and (4) organizational factors., Conclusion: All 4 elements of this model have been tilted in favor of the utilization of information technology; lessons from the United Kingdom may help other health systems looking to implement information technology systems in primary care.

Ludwick DA, Doucette J. Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries. International Journal of Medical Informatics. 21st July 2008.


http://dx.doi.org/10.1016/j.ijmedinf.2008.06.005

http://pmid.us/18644745

Abstract: The adoption of health information systems is seen world wide as one method to mitigate the widening health care demand and supply gap. The purpose of this review was to identify the current state of knowledge about health information systems adoption in primary care. The goal was to understand factors and influencers affecting implementation outcomes from previous health information systems implementations experiences. A comprehensive systematic literature review of peer reviewed and grey literature was undertaken to identify the current state of knowledge regarding the implementation of health information systems. A total of 6 databases, 27 journal websites, 20 websites from grey sources, 9 websites from medical colleges and professional associations as well as 22 government/commission websites were searched. The searches returned almost 3700 article titles. Eighty-six articles met our inclusion and exclusion criteria. Articles show that systems' graphical user interface design quality, feature functionality, project management, procurement and users' previous experience affect implementation outcomes. Implementers had concerns about factors such as privacy, patient safety, provider/patient relations, staff anxiety, time factors, quality of care, finances, efficiency, and liability. The review showed that implementers can insulate the project from such concerns by establishing strong leadership, using project management techniques, establishing standards and training their staff to ensure such risks do not compromise implementation success. The review revealed the concept of socio-technical factors, or "fit" factors, that complicate health information systems deployment. The socio-technical perspective considers how the technical features of a health information system interact with the social features of a health care work environment. The review showed that quality of care, patient safety and provider/patient relations were not, positively or negatively, affected by systems implementation. The fact that no articles were found reviewing the benefits or drawbacks of health information systems accruing to patients should be concern to adopters, payers and jurisdictions. No studies were found that compared how provider-patient interactions in interviews are effected when providers used electronic health information systems as opposed to the paper equivalent. Very little information was available about privacy and liability

Nemeth LS, et al Implementing change in primary care practices using electronic medical records: a conceptual framework. Implementation Science 2008 3:3.

http://dx.doi.org/10.1186/1748-5908-3-3

http://www.implementationscience.com/content/3/1/3

http://pmid.us/18199330

Background: Implementing change in primary care is difficult, and little practical guidance is available to assist small primary care practices. Methods to structure care and develop new roles are often needed to implement an evidence-based practice that improves care. This study explored the process of change used to implement clinical guidelines for primary and secondary prevention of cardiovascular disease in primary care practices that used a common electronic medical record (EMR). Methods: Multiple conceptual frameworks informed the design of this study designed to explain the complex phenomena of implementing change in primary care practice. Qualitative methods were used to examine the processes of change that practice members used to implement the guidelines. Purposive sampling in eight primary care practices within the Practice Partner Research Network-Translating Researching into Practice (PPRNet-TRIP II) clinical trial yielded 28 staff members and clinicians who were interviewed regarding how change in practice occurred while implementing clinical guidelines for primary and secondary prevention of cardiovascular disease and strokes. Results: A conceptual framework for implementing clinical guidelines into primary care practice was developed through this research. Seven concepts and their relationships were modelled within this framework: leaders setting a vision with clear goals for staff to embrace; involving the team to enable the goals and vision for the practice to be achieved; enhancing communication systems to reinforce goals for patient care; developing the team to enable the staff to contribute toward practice improvement; taking small steps, encouraging practices' tests of small changes in practice; assimilating the electronic medical record to maximize clinical effectiveness, enhancing practices' use of the electronic tool they have invested in for patient care improvement; and providing feedback within a culture of improvement, leading to an iterative cycle of goal setting by leaders. Conclusion: This conceptual framework provides a mental model which can serve as a guide for practice leaders implementing clinical guidelines in primary care practice using electronic medical records. Using the concepts as implementation and evaluation criteria, program developers and teams can stimulate improvements in their practice settings. Investing in collaborative team development of clinicians and staff may enable the practice environment to be more adaptive to change and improvement

Pearce C, et al Computers in the new consultation: within the first minute. Family Practice 2008 25 (3) 202-8.

http://dx.doi.org/10.1093/fampra/cmn018


Background. Computers are now commonplace in the general practice consultation in many countries and literature is beginning to appear that describes the effects of this presence on the doctor-patient relationship. Concepts such as patient centredness emphasize the importance of this relationship to patient outcomes, yet the presence of the computer has introduced another partner to that relationship. Objective. To describe the patient-doctor-computer relationship during the opening period of the consultation. Methods. Twenty GPs provided 141 consultations for direct observation, using digital video. Consultations were analysed according to Goffman's dramaturgical methodology. Results. Openings could be described as doctor, patient or computer openings, according to the source of initial influence on the consultation. Specific behaviours can be described within those three categories. Conclusions. The presence of the computer has changed the beginning of the consultation. Where once only two actors needed to perform their roles, now three interact in differing wa ys. Information comes from many sources, and behaviour responds accordingly. Future studies of the consultation need to take into account the impact of the computer in shaping how the consultation flows and the information needs of all participants

Varonen H, Kortteisto T, Kaila M, for the EBMeDS Study Group. What may help or hinder the implementation of computerized decision support systems (CDSSs): a focus group study with physicians. Family Practice 2008 25 (3) 162-7.

http://dx.doi.org/10.1093/fampra/cmn020

http://pmid.us/18504253


Objectives. To identify potential barriers and facilitators to implementing computerized decision support systems (CDSSs) in health care as perceived by clinicians. Methods. We carried out a qualitative focus group study with primary and secondary health care settings in six areas of Finland. A total of 39 interviewed physicians, of whom 22 practised in primary care and 17 in secondary care. The main outcome measures physicians' expectations, preconceived barriers and facilitators were explicitly identified by the participants during the interviews. Results. Identified barriers were earlier experience of dysfunctional computer systems in health care, potential harm to doctor-patient relationship, obscured responsibilities, threats to clinician's autonomy and potential extra workload due to excessive reminders. Identified facilitators were self-control of frequency and contents of CDSS and noticeable help of CDSS in clinical practice. It was easy for the physicians to think of applications and clinical topics for CDSS that could help them to avoid mistakes and improve work processes. Conclusions. Physicians had relatively positive attitudes towards the idea of CDSS. They expected flexibility, individuality and reliability of the CDSS. The rather high level of computerized practices and wide use of electronic guidelines probably have paved the way for the CDSS in Finland

Wild C, Langer T. Emerging health technologies: Informing and supporting health policy early. Health Policy 2008 87 (2) 160-71.

http://dx.doi.org/10.1016/j.healthpol.2008.01.002

http://pmid.us/18295925


Objectives All western healthcare systems are confronted with a rising number of new health technologies. To support decision-making processes with sound information about new health technologies, some countries have established "Horizon Scanning Systems (HSS)". This paper gives an overview of processes and practices of HSS. Method The paper is based on a literature review (Medline and Embase) and on unpublished information gathered from HSS-agencies. Results The 13 current HSS have been collaborating in the EuroScan network since 1999. EuroScan has agreed on a common terminology, classification and understanding of their activities. All their activities consist of 5 sequenced main components: identification and filtering, prioritization, early assessment, dissemination and monitoring the assessed technologies. Although there is a common understanding with regard to function and processes there are some differences in the scope of the national/regional HSS. Conclusion EuroScan has played an important role in the harmonization process so that effective collaboration, reduction of duplication and the further development of procedures have become possible. Because of the common understanding there is a certain stability and integration across the functions of HSS. Nonetheless there are some obvious "blank spots" susceptible to subjectivity, such as an implicit prioritization process

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