Potential impact of advanced clinical information technology on cancer care in 2015

Piloting electronic screening forms in primary care: findings from a mixed methods study to identify patients eligible for low dose CT lung cancer screening

Background

Recent evidence suggests that screening with low dose computed tomography (LDCT) scans significantly reduces mortality from lung cancer. However, optimal methods to identify potentially eligible patients in primary care are not known. Using brief electronic screening forms administered prior to a primary care visit is a strategy to identify high risk, asymptomatic patients eligible for LDCT screening. The objective of this study was to compare the acceptability and feasibility of using brief electronic versus paper screening forms to identify eligible patients at high risk of developing lung cancer in primary care.

Methods

A mixed method pilot comparative study was conducted in primary care. Practices were allocated to an electronic form (e-form) group or a paper-based form (p-form) group. Allocation was randomly assigned for the first practice then by alternation. Patients in the e-form practices completed forms at home via the web or in the waiting room on a tablet. Patients in p-form practices completed forms in waiting rooms. Interviews were conducted with patients, administrators, and primary care physicians (PCPs) about their experiences.

Results

Six of 30 (20%) eligible practices agreed to participate. Over the 16-week study period, a total of 831 of an expected 1442 patients (58%) aged 55–74 years were enrolled; 573/690 (83%) patients in the e-form group and 258/752 (34%) in the p-form group. Of the 573 participants in the e-form group, 335 (58%) completed forms via the web; 238 (29%) did so via tablet. Twenty-four interviews were conducted with 15 patients, 5 administrative staff and 4 PCPs. Patients were willing to discuss lung cancer screening eligibility with their PCP. Staff members expressed low administrative burden except for an extra step to link appointment information to patient demographics to identify eligible patients. PCPs indicated that forms were reminders to discuss smoking cessation. PCPs in the e-form group reported that patients asked questions about screening.

Conclusion

There was fairly low uptake by primary care practices. For e-forms to be feasible in practice workflow, electronic medical record software needs to link appointment information with patient eligibility requirements. The use of brief pre-consultation electronic screening forms for LDCT eligibility encouraged PCPs to discuss smoking cessation with patients.

Future Research in Health Information Technology: A Review

INTRODUCTION

Currently, information technology is considered an important tool to improve healthcare services. To adopt the right technologies, policy makers should have adequate information about present and future advances. This study aimed to review and compare studies with a focus on the future of health information technology.

METHOD

This review study was completed in 2015. The databases used were Scopus, Web of Science, ProQuest, Ovid Medline, and PubMed. Keyword searches were used to identify papers and materials published between 2000 and 2015. Initially, 407 papers were obtained, and they were reduced to 11 papers at the final stage. The selected papers were described and compared in terms of the country of origin, objective, methodology, and time horizon.

RESULTS

The papers were divided into two groups: those forecasting the future of health information technology (seven papers) and those providing health information technology foresight (four papers). The results showed that papers related to forecasting the future of health information technology were mostly a literature review, and the time horizon was up to 10 years in most of these studies. In the health information technology foresight group, most of the studies used a combination of techniques, such as scenario building and Delphi methods, and had long-term objectives.

CONCLUSION

To make the most of an investment and to improve planning and successful implementation of health information technology, a strategic plan for the future needs to be set. To achieve this aim, methods such as forecasting the future of health information technology and offering health information technology foresight can be applied. The forecasting method is used when the objectives are not very large, and the foresight approach is recommended when large-scale objectives are set to be achieved. In the field of health information technology, the results of foresight studies can help to establish realistic long-term expectations of the future of health information technology.

Models for the Study of Whole Systems

This article summarizes a network and complex systems science model for research on whole systems of complementary and alternative medicine (CAM) such as homeopathy and traditional Chinese medicine. The holistic concepts of networks and nonlinear dynamical complex systems are well matched to the global and interactive perspectives of whole systems of CAM, whereas the reductionistic science model is well matched to the isolated local organ, cell, and molecular mechanistic perspectives of pharmaceutically based biomedicine. Whole systems of CAM are not drugs with specific actions. The diagnostic and therapeutic approaches of whole systems of CAM produce effects that involve global and patterned shifts across multiple subsystems of the person as a whole. For homeopathy, several characteristics of complex systems, including the probabilistic nature of attractor patterns, variable sensitivity of complex systems to initial conditions, and emergent behaviors in the evolution of a system in its full environmental context over time, could help account for the mixed basic science and controlled clinical trial research findings, in contrast with the consistently positive outcomes of observational studies in the literature. Application of theories and methods from complex systems and network science can open a new era of advances in understanding factors that lead to good versus poor individual global outcome patterns and to rational triage of patients to one type of care over another. The growing reliance on complex systems thinking and systems biology for cancer research affords a unique opportunity to bridge between the CAM and conventional medical worlds with some common language and conceptual models.

Citation analysis of the prognosis of Haux et al. for the year 2013

In 2002, Haux, Ammenwerth, Herzog, and Knaup published a prognosis about health care in the information society. In contrast to other prognoses, they underpinned their 30 theses with 71 quantitative statements that could be easily checked. A citation analysis was performed to assess the perception of this work in the medical informatics community. The ISI Web of Science was used for the citation search. From 55 hits, 38 articles were finally included in the metadata analysis, 33 articles in the qualitative analysis. The most prominent statement citing the paper of Haux et al. was identified in each article, divided into statements about the present and those about the future. Each statement was tagged with one keyword out of a convenient list. One article provided a statement about the present and the future. Most of the references were published in English as journal articles between 2006 and 2009. The majority of the first authors were from Europe. Twenty-two articles offered a statement about the present, 12 about the future. There was a shift from the present emphasis on electronic medical records and information and communication technologies to challenges in the future because of an aging population and the advent of personalized medicine. The citing papers seemed to be representative of medical informatics in terms of journals and the authors' countries of origin. The statements relating the citing literature with the paper of Haux et al. corresponded well with current notions about medical informatics. However, there was no debate about the concrete theses and prognoses offered in the cited paper. Therefore, the medical informatics community needs to rethink its own citation strategy.

Improving modern cancer care through information technology

The cancer care system is increasingly complex, marked by multiple hand-offs between primary care and specialty providers, inadequate communication among providers, and lack of clarity about a "medical home" (the ideal accountable care provider) for cancer patients. Patients and families often cite such difficulties as information deficits, uncoordinated care, and insufficient psychosocial support. This article presents a review of the challenges of delivering well coordinated, patient-centered cancer care in a complex modern healthcare system. An examination is made of the potential role of information technology (IT) advances to help both providers and patients. Using the published literature as background, a review is provided of selected work that is underway to improve communication, coordination, and quality of care. Also discussed are additional challenges and opportunities to advancing understanding of how patient data, provider and patient involvement, and informatics innovations can support high-quality cancer care.

The Future of Cancer Surveillance

Cancer surveillance is entering an exciting era where the scope of its activities will be expanded and the amount, quality, and depth of information on cancer will be richer and more readily available to practitioners, decision makers and the public. This future is being built on a solid history of accomplishment that has placed cancer foremost among all chronic diseases in the organization and implementation of a systematic and integrated monitoring enterprise that is of essential value in both clinical medicine and public health. The future of cancer surveillance will be driven not only by innovations in methods of cancer surveillance itself, but also by developments in information technology and communication and by revolutionary new tools used in the delivery of medical care. At the same time, it will be a challenge to ensure levels of privacy and confidentiality needed to maintain the public trust. In the Cancer Surveillance and Information Summit, a 2004 conference sponsored by C-Change, experts from the field and from allied and related disciplines in both the public and private sectors met to consider the future of the cancer surveillance enterprise. Seven recommendations, detailed in this article, emerged from the conference to guide future growth and development. Steps that can and should be taken by all individuals and groups involved in cancer surveillance were included. The shared view is that cancer surveillance and information is essential to fulfill a vision for a future where cancer is prevented, detected early, and either cured or managed successfully as a chronic illness.