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Coleman JJ, Atia J, Evison F, Wilson L, Gallier S, Sames R, Capewell A, Copley R, Gyves H, Ball S, Pankhurst T. Adoption by clinicians of electronic order communications in NHS secondary care: a descriptive account. BMJ Health Care Inform 2024; 31:e100850. [PMID: 38729772 PMCID: PMC11097811 DOI: 10.1136/bmjhci-2023-100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/24/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Due to the rapid advancement in information technology, changes to communication modalities are increasingly implemented in healthcare. One such modality is Computerised Provider Order Entry (CPOE) systems which replace paper, verbal or telephone orders with electronic booking of requests. We aimed to understand the uptake, and user acceptability, of CPOE in a large National Health Service hospital system. METHODS This retrospective single-centre study investigates the longitudinal uptake of communications through the Prescribing, Information and Communication System (PICS). The development and configuration of PICS are led by the doctors, nurses and allied health professionals that use it and requests for CPOE driven by clinical need have been described.Records of every request (imaging, specialty review, procedure, laboratory) made through PICS were collected between October 2008 and July 2019 and resulting counts were presented. An estimate of the proportion of completed requests made through the system has been provided for three example requests. User surveys were completed. RESULTS In the first 6 months of implementation, a total of 832 new request types (imaging types and specialty referrals) were added to the system. Subsequently, an average of 6.6 new request types were added monthly. In total, 8 035 132 orders were requested through PICS. In three example request types (imaging, endoscopy and full blood count), increases in the proportion of requests being made via PICS were seen. User feedback at 6 months reported improved communications using the electronic system. CONCLUSION CPOE was popular, rapidly adopted and diversified across specialties encompassing wide-ranging requests.
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Affiliation(s)
- Jamie J Coleman
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Jolene Atia
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Felicity Evison
- Data Science Team, Research Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Suzy Gallier
- PIONEER Health Data Research Hub, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Sames
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrew Capewell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Copley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Gyves
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simon Ball
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tanya Pankhurst
- Digital Healthcare and Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Price C, Suhomlinova O, Green W. Researching big IT in the UK National Health Service: A systematic review of theory-based studies. Int J Med Inform 2024; 185:105395. [PMID: 38442664 DOI: 10.1016/j.ijmedinf.2024.105395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To identify and discuss theory-based studies of large-scale health information technology programs in the UK National Health Service. MATERIALS AND METHODS Using the PRISMA systematic review framework, we searched Scopus, PubMed and CINAHL databases from inception to March 2022 for theory-based studies of large-scale health IT implementations. We undertook detailed full-text analyses of papers meeting our inclusion criteria. RESULTS Forty-six studies were included after assessment for eligibility, of which twenty-five applied theories from the information systems arena (socio-technical approaches, normalization process theory, user acceptance theories, diffusion of innovation), twelve from sociology (structuration theory, actor-network theory, institutional theory), while nine adopted other theories. Most investigated England's National Program for IT (2002-2011), exploring various technologies among which electronic records predominated. Research themes were categorized into user factors, program factors, process outcomes, clinical impact, technology, and organizational factors. Most research was qualitative, often using a case study strategy with a longitudinal or cross-sectional approach. Data were typically collected through interviews, observation, and document analysis; sampling was generally purposive; and most studies used thematic or related analyses. Theories were generally applied in a superficial or fragmentary manner; and articles frequently lacked detail on how theoretical constructs and relationships aided organization, analysis, and interpretation of data. CONCLUSION Theory-based studies of large NHS IT programs are relatively uncommon. As large healthcare programs evolve over a long timeframe in complex and dynamic environments, wider adoption of theory-based methods could strengthen the explanatory and predictive utility of research findings across multiple evaluation studies. Our review has confirmed earlier suggestions for theory selection, and we suggest there is scope for more explicit use of such theoretical constructs to strengthen the conceptual foundations of health informatics research. Additionally, the challenges of large national health informatics programs afford wide-ranging opportunities to test, refine, and adapt sociological and information systems theories.
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Affiliation(s)
- Colin Price
- University of Leicester, School of Business, 266 London Road, Leicester LE2 1RQ, United Kingdom.
| | - Olga Suhomlinova
- University of Leicester, School of Business, 266 London Road, Leicester LE2 1RQ, United Kingdom
| | - William Green
- University of Leicester, School of Business, 266 London Road, Leicester LE2 1RQ, United Kingdom
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3
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Asgari E, Kaur J, Nuredini G, Balloch J, Taylor AM, Sebire N, Robinson R, Peters C, Sridharan S, Pimenta D. Impact of Electronic Health Record Use on Cognitive Load and Burnout Among Clinicians: Narrative Review. JMIR Med Inform 2024; 12:e55499. [PMID: 38607672 PMCID: PMC11053390 DOI: 10.2196/55499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
The cognitive load theory suggests that completing a task relies on the interplay between sensory input, working memory, and long-term memory. Cognitive overload occurs when the working memory's limited capacity is exceeded due to excessive information processing. In health care, clinicians face increasing cognitive load as the complexity of patient care has risen, leading to potential burnout. Electronic health records (EHRs) have become a common feature in modern health care, offering improved access to data and the ability to provide better patient care. They have been added to the electronic ecosystem alongside emails and other resources, such as guidelines and literature searches. Concerns have arisen in recent years that despite many benefits, the use of EHRs may lead to cognitive overload, which can impact the performance and well-being of clinicians. We aimed to review the impact of EHR use on cognitive load and how it correlates with physician burnout. Additionally, we wanted to identify potential strategies recommended in the literature that could be implemented to decrease the cognitive burden associated with the use of EHRs, with the goal of reducing clinician burnout. Using a comprehensive literature review on the topic, we have explored the link between EHR use, cognitive load, and burnout among health care professionals. We have also noted key factors that can help reduce EHR-related cognitive load, which may help reduce clinician burnout. The research findings suggest that inadequate efforts to present large amounts of clinical data to users in a manner that allows the user to control the cognitive burden in the EHR and the complexity of the user interfaces, thus adding more "work" to tasks, can lead to cognitive overload and burnout; this calls for strategies to mitigate these effects. Several factors, such as the presentation of information in the EHR, the specialty, the health care setting, and the time spent completing documentation and navigating systems, can contribute to this excess cognitive load and result in burnout. Potential strategies to mitigate this might include improving user interfaces, streamlining information, and reducing documentation burden requirements for clinicians. New technologies may facilitate these strategies. The review highlights the importance of addressing cognitive overload as one of the unintended consequences of EHR adoption and potential strategies for mitigation, identifying gaps in the current literature that require further exploration.
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Affiliation(s)
- Elham Asgari
- Guy's and St Thomas' NHS Trust, London, United Kingdom
- Tortus AI, London, United Kingdom
| | - Japsimar Kaur
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | - Neil Sebire
- Great Ormond Street Hospital, London, United Kingdom
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Morley J, Zhang J. A controversial new federated data platform for the NHS in England. BMJ 2023; 383:2776. [PMID: 38030152 DOI: 10.1136/bmj.p2776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Affiliation(s)
- Jessica Morley
- Oxford Internet Institute, University of Oxford, Oxford UK
| | - Joe Zhang
- Institute of Global Health Innovation, Imperial College London, London UK
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Mackenzie A, Lewis E, Loveland J. Successes and challenges in extracting information from DICOM image databases for audit and research. Br J Radiol 2023; 96:20230104. [PMID: 37698251 PMCID: PMC10607388 DOI: 10.1259/bjr.20230104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 09/13/2023] Open
Abstract
In radiography, much valuable associated data (metadata) is generated during image acquisition. The current setup of picture archive and communication systems (PACS) can make extraction of this metadata difficult, especially as it is typically stored with the image. The aim of this work is to examine the current challenges in extracting image metadata and to discuss the potential benefits of using this rich information. This work focuses on breast screening, though the conclusions are applicable to other modalities.The data stored in PACS contain information, currently underutilised, and is of great benefit for auditing and improving imaging and radiographic practice. From the literature, we present examples of the potential clinical benefit such as audits of dose, and radiographic practice, as well as more advanced research highlighting the effects of radiographic practice, e.g. cancer detection rates affected by imaging technology.This review considers the challenges in extracting data, namely,• The search tools for data on most PACS are inadequate being both time-consuming and limited in elements that can be searched.• Security and information governance considerations• Anonymisation of data if required• Data curationThe review describes some solutions that have been successfully implemented.• Retrospective extraction: direct query on PACS• Extracting data prospectively• Use of structured reports• Use of trusted research environmentsUltimately, the data access process will be made easier by inclusion during PACS procurement. Auditing data from PACS can be used to improve quality of imaging and workflow, all of which will be a clinical benefit to patients.
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Affiliation(s)
| | | | - John Loveland
- NCCPM, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
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Zhang J, Morley J, Gallifant J, Oddy C, Teo JT, Ashrafian H, Delaney B, Darzi A. Mapping and evaluating national data flows: transparency, privacy, and guiding infrastructural transformation. Lancet Digit Health 2023; 5:e737-e748. [PMID: 37775190 DOI: 10.1016/s2589-7500(23)00157-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/07/2023] [Accepted: 08/02/2023] [Indexed: 10/01/2023]
Abstract
The importance of big health data is recognised worldwide. Most UK National Health Service (NHS) care interactions are recorded in electronic health records, resulting in an unmatched potential for population-level datasets. However, policy reviews have highlighted challenges from a complex data-sharing landscape relating to transparency, privacy, and analysis capabilities. In response, we used public information sources to map all electronic patient data flows across England, from providers to more than 460 subsequent academic, commercial, and public data consumers. Although NHS data support a global research ecosystem, we found that multistage data flow chains limit transparency and risk public trust, most data interactions do not fulfil recommended best practices for safe data access, and existing infrastructure produces aggregation of duplicate data assets, thus limiting diversity of data and added value to end users. We provide recommendations to support data infrastructure transformation and have produced a website (https://DataInsights.uk) to promote transparency and showcase NHS data assets.
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Affiliation(s)
- Joe Zhang
- Institute of Global Health Innovation, Imperial College London, London, UK; Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Jess Morley
- Oxford Internet Institute, University of Oxford, Oxford, UK
| | - Jack Gallifant
- Department of Intensive Care, Imperial College Healthcare NHS Trust, London, UK; Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Chris Oddy
- Department of Anaesthesia, Critical Care and Pain, St George's Healthcare NHS Trust, London, UK
| | - James T Teo
- London Medical Imaging and AI Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London, UK; Leeds University Business School, Leeds, UK
| | - Brendan Delaney
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK
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Brown MRD, Knight M, Peters CJ, Maleki S, Motavalli A, Nedjat-Shokouhi B. Digital outpatient health solutions as a vehicle to improve healthcare sustainability-a United Kingdom focused policy and practice perspective. Front Digit Health 2023; 5:1242896. [PMID: 37829594 PMCID: PMC10566364 DOI: 10.3389/fdgth.2023.1242896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction In the midst of a global climate emergency and with health care systems across the world facing extreme pressure, interest in digital approaches as a potential part-solution to these challenges has increased rapidly. The evidence base to support the role that digitalization can play in moving towards more sustainable models of healthcare is growing, as is the awareness of this key area of healthcare reform amongst policy makers, clinicians and the public. Method and Results In this policy and practice review we explore four domains of healthcare sustainability-environmental, economic, and patient and clinician, delineating the potential impact that digitally enabled healthcare can have on each area. Real-world examples are provided to illustrate the impact individual digital interventions can have on each pillar of sustainability and demonstrate the scale of the potential benefits which can be achieved. Discussion Digitally enabled healthcare solutions present an approach which offer numerous benefits, including environmental sustainability, economic benefits, and improved patient experience. There are also potential drawbacks such as the risk of digital exclusion and the need for integration with existing technology platforms. Overall, it is essential to strike a balance between the benefits and potential drawbacks of digital healthcare solutions to ensure that they are equitable, effective, and sustainable.
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Affiliation(s)
- Matthew R. D. Brown
- Medefer, London, United Kingdom
- The Royal Marsden Hospital NHS Trust, London, United Kingdom
| | - Matthew Knight
- Medefer, London, United Kingdom
- West Hertfordshire Teaching Hospitals NHS Trust, Watford, Hertfordshire, United Kingdom
| | - Christopher J. Peters
- Medefer, London, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Li E, Lounsbury O, Clarke J, Ashrafian H, Darzi A, Neves AL. Perceptions of chief clinical information officers on the state of electronic health records systems interoperability in NHS England: a qualitative interview study. BMC Med Inform Decis Mak 2023; 23:158. [PMID: 37573388 PMCID: PMC10423420 DOI: 10.1186/s12911-023-02255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 08/02/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND In the era of electronic health records (EHR), the ability to share clinical data is a key facilitator of healthcare delivery. Since the introduction of EHRs, this aspect has been extensively studied from the perspective of healthcare providers. Less often explored are the day-to-day challenges surrounding the procurement, deployment, maintenance, and use of interoperable EHR systems, from the perspective of healthcare administrators, such as chief clinical information officers (CCIOs). OBJECTIVE Our study aims to capture the perceptions of CCIOs on the current state of EHR interoperability in the NHS, its impact on patient safety, the perceived facilitators and barriers to improving EHR interoperability, and what the future of EHR development in the NHS may entail. METHODS Semi-structured interviews were conducted between November 2020 - October 2021. Convenience sampling was employed to recruit NHS England CCIOs. Interviews were digitally recorded and transcribed verbatim. A thematic analysis was performed by two independent researchers to identify emerging themes. RESULTS Fifteen CCIOs participated in the study. Participants reported that limited EHR interoperability contributed to the inability to easily access and transfer data into a unified source, thus resulting in data fragmentation. The resulting lack of clarity on patients' health status negatively impacts patient safety through suboptimal care coordination, duplication of efforts, and more defensive practice. Facilitators to improving interoperability included the recognition of the need by clinicians, patient expectations, and the inherent centralised nature of the NHS. Barriers included systems usability difficulties, and institutional, data management, and financial-related challenges. Looking ahead, participants acknowledged that realising that vision across the NHS would require a renewed focus on mandating data standards, user-centred design, greater patient involvement, and encouraging inter-organisational collaboration. CONCLUSION Tackling poor interoperability will require solutions both at the technical level and in the wider policy context. This will involve demanding interoperability functionalities from the outset in procurement contracts, fostering greater inter-organisation cooperation on implementation strategies, and encouraging systems vendors to prioritise interoperability in their products. Only by comprehensively addressing these challenges would the full potential promised by the use of fully interoperable EHRs be realised.
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Affiliation(s)
- Edmond Li
- Institute of Global Health Innovation, National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK.
| | | | - Jonathan Clarke
- Institute of Global Health Innovation, National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
- Centre for Mathematics of Precision Healthcare, Department of Mathematics, Imperial College London, London, UK
| | - Hutan Ashrafian
- Institute of Global Health Innovation, National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Ara Darzi
- Institute of Global Health Innovation, National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Ana Luisa Neves
- Institute of Global Health Innovation, National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Department of Community Medicine, Health Information and Decision, Center for Health Technology and Services Research, University of Porto, Porto, Portugal
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9
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Salisbury H. Helen Salisbury: Continuing disquiet on the data front. BMJ 2023; 382:1761. [PMID: 37527868 DOI: 10.1136/bmj.p1761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
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Persson J, Larsson R, Erlingsdottir G, Rydenfält C. How Digital Systems Are Used in Swedish Home Care Nursing Practice: A Qualitative Interview Study to Identify Challenges and Opportunities. Comput Inform Nurs 2023; 41:586-594. [PMID: 36649078 PMCID: PMC10437456 DOI: 10.1097/cin.0000000000001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This study investigates how digital technology is used (or not used) in home care nursing, to identify challenges and opportunities that can move the digitalization of home care nursing forward. The use of digital technology in daily practices of home care nursing was analyzed based on semistructured interviews in four Swedish home care organizations. The results correspond to the two initial stages of a design thinking process: (1) knowledge about users and the use context , presented as an up-to-date description of how digital technology has affected home care nursing practice, and (2) definition of areas for improvement , presented as challenges and opportunities. We identified the following areas to proceed with in the subsequent stages of designing home care nursing digitalization: (1) nurses' ability to access information and conduct documentation in the field, particularly how new digital systems are integrated with existing routines and systems; (2) the multitude of communication processes that nurses must manage, including communication channels that are used and the level of synchronicity; (3) an increasingly complex digital working environment, where evaluating existing systems and routines is one way to learn where improvements can be most efficient.
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Dowding D, Skyrme S, Randell R, Newbould L, Faisal M, Hardiker N. Researching nurses' use of digital technology during the COVID-19 pandemic. Nurs Stand 2023; 38:63-68. [PMID: 37157913 DOI: 10.7748/ns.2023.e12013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 05/10/2023]
Abstract
The adoption of digital technology by nurses accelerated during the coronavirus disease 2019 (COVID-19) pandemic. However, not all nurses were familiar with the various digital systems used in their organisations and there were reports of digital technology not being fit for purpose. This article describes a service evaluation that used an online survey to obtain nurses' feedback on the digital systems used to support patient care during the pandemic. Fifty-five respondents provided details about 85 separate digital systems. The usability of these systems varied significantly across technology types, while barriers to their use included nurses' lack of digital literacy and inadequate access to IT infrastructure. However, most of the nurse respondents felt that digital technology had supported effective patient care during the COVID-19 pandemic.
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Affiliation(s)
- Dawn Dowding
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England
| | - Sarah Skyrme
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England
| | - Rebecca Randell
- faculty of health studies, University of Bradford, Bradford, England
| | - Louise Newbould
- Department For Social Policy And Social Work, University of York, York, England
| | - Muhammad Faisal
- Faculty of Health Studies, University of Bradford, Bradford, England
| | - Nick Hardiker
- School of Human And Health Sciences, University of Huddersfield, Huddersfield, England
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See TC, Uberoi R, Ramsden W. Navigating an effective imaging results notification in our healthcare system. Clin Radiol 2023; 78:159-163. [PMID: 36411090 DOI: 10.1016/j.crad.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/19/2022]
Affiliation(s)
- T C See
- Box 219, Radiology Department, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
| | - R Uberoi
- Radiology Department, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | - W Ramsden
- Radiology Department, Leeds teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
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Shackshaft T, Junaid F, Badrinath P. Making every contact count: Can healthcare professionals do more to avoid preventable child deaths? CHILD ABUSE & NEGLECT 2022; 132:105825. [PMID: 35932657 DOI: 10.1016/j.chiabu.2022.105825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/20/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Healthcare professionals (HCPs) have a responsibility and unique opportunities to identify and act on safeguarding concerns. Child Safeguarding Practice Reviews (CSPRs) are produced in the United Kingdom when a child has died or been seriously harmed, and abuse or neglect is suspected or confirmed. To our knowledge there is no recent systematic analysis of CSPRs from an HCP perspective. OBJECTIVE To establish if HCPs are acting in an appropriate and safe manner when confronted with cases of potential child abuse and neglect and recommend areas for further improvement. PARTICIPANTS AND SETTINGS CSPR abstracts published on a specialist UK database between 2018 and 2021 involving the death of a child. METHODS After applying the exclusion criteria we used stratified random sampling to select one third of eligible reports. Using a systematic framework, common qualitative themes were extracted and analyzed. RESULTS 42 of 125 eligible CSPRs were analyzed. Child deaths were more common in male children and those aged under one. We identified areas where communication could be further improved including better understanding of the referral process, coordination at discharge, and communication between primary and secondary care. We found that HCPs were not well equipped to identify risk factors for child abuse such as poor parental health and complex family structures. CONCLUSIONS There is significant scope for improvement in strengthening the knowledge and skill base of HCPs in identifying and acting on signs of child abuse. We propose improvements in terms of staff training, resources and better systems to ensure HCPs respond to safeguarding concerns safely and appropriately.
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Affiliation(s)
- Thomas Shackshaft
- Public Health Suffolk, Suffolk County Council, Endeavour House, 8 Russell Road, Ipswich IP1 2BX, United Kingdom
| | - Fatima Junaid
- Russells Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, United Kingdom.
| | - Padmanabhan Badrinath
- Public Health Suffolk, Suffolk County Council, Endeavour House, 8 Russell Road, Ipswich IP1 2BX, United Kingdom.
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Yang MH, Liu CY, Wang TJ, Lee YH, Ko SH, Chao SC, Lin HR. A Comparison of Two Cross-Sectional Studies on Successful Model of Introducing Nursing Information System in a Regional Teaching Hospital in Taiwan. Comput Inform Nurs 2022; 40:571-579. [PMID: 34740222 DOI: 10.1097/cin.0000000000000818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nursing information system introduction is an important measure for hospital nursing departments to promote the clinical practice of nursing with both efficiency and quality. A comparison of two cross-sectional study designs was adopted, and the information systems success model, as proposed by DeLone and McLean (2003), was used to explore the effectiveness of the six dimensions of system quality, information quality, service quality, use, user satisfaction, and net benefits at 6 and 12 months after the introduction launch of the nursing information system in hospitals. Multiple regression analysis was used across the two cross-sectional studies. The research results found that the nursing information system conformed to the information systems success model, and half a year to 1 year after the introduction of the nursing information system, use affected the nursing information system net benefits via the mediator variable of user satisfaction; however, the effect of full mediation changed to partial mediation effect with time. The research results can be used as a reference for hospitals and nursing administrators for the newly developed nursing information system.
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Affiliation(s)
- Meei-Horng Yang
- Author Affiliations: PhD Program, School of Nursing, National Taipei University of Nursing and Health Sciences (Mrs Yang), Taipei; Department of External Affairs, Wei Gong Memorial Hospital (Mrs Yang), Miaoli; Biostatistical Consultant Lab and Department of Speech Language Pathology and Audiology (Dr Liu) and School of Nursing (Dr Lin and Dr Wang), National Taipei University of Nursing and Health Sciences, Taipei; Department of Nursing, China Medical University Hsinchu Hospital (Mrs Lee), HsinChu; Department of Nursing, Wei Gong Memorial Hospital (Ms Chao), Miaoli; and Department of Nursing, Chong Ren Hospital (Mrs Ko), Miaoli, Taiwan
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Litchfield I, Turner AM, Ferreira Filho JB, Lee M, Weber P. Automated conflict resolution for patients with multiple morbidity being treated using more than one set of single condition clinical guidance: A case study. Comput Biol Med 2022; 144:105381. [DOI: 10.1016/j.compbiomed.2022.105381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/14/2022] [Accepted: 03/02/2022] [Indexed: 11/15/2022]
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Acharya A, Black RC, Smithies A, Darzi A. Evaluating the impact of a digital leadership programme on national digital priorities: a mixed methods study. BMJ Open 2022; 12:e056369. [PMID: 35487747 PMCID: PMC9058758 DOI: 10.1136/bmjopen-2021-056369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This study aimed to determine the impact of the United Kingdom's National Health Service Digital Academy (NHSDA) Digital Health Leadership course on high-level recommendations in digital preparedness and the development of a proficient leadership to oversee digital transformation, which has been a longstanding priority within the NHS. DESIGN A mixed methods study incorporating an online questionnaire, in-depth interviews and focus groups that were then analysed through a thematic analysis, underpinned by a constructivist approach. SETTINGS An online mixed methods study of a defined cohort of participants who had completed the NHSDA course. PARTICIPANTS 26 participants were recruited to the study, of whom 50% were clinicians, 26.9% in management and 19.2% in data science. All had completed the 2-year NHSDA programme in Digital Health Leadership more than 6 months prior. RESULTS Interviews and focus groups elicited two key areas of impact of the course: loco-regional digitisation and the development of a network of change agents. The dissertation project had direct effects on local digital transformation efforts. Most of these projects focused on clinician (11.7%) or service user (10.3%) engagement, as oppose to de novo digital processes (9.4%). The development of a network of digital leaders has facilitated communication between organisations and improved the efficiency of the national digital infrastructure. CONCLUSIONS A bespoke course incorporating a dissertation of practice model for digital health leaders can have broader impact for the attainment of digital priorities. This includes helping trusts to successfully adopt digital solutions, as well as fostering shared organisational learning. These influences, however, are mediated by resource and cultural barriers, which continue to hinder transformation efforts.
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Affiliation(s)
- Amish Acharya
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ruth Claire Black
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Alisdair Smithies
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK
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TAM-UTAUT and the acceptance of remote healthcare technologies by healthcare professionals: A systematic review. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.101008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Shaw SE, Hughes G, Wherton J, Moore L, Rosen R, Papoutsi C, Rushforth A, Morris J, Wood GW, Faulkner S, Greenhalgh T. Achieving Spread, Scale Up and Sustainability of Video Consulting Services During the COVID-19 Pandemic? Findings From a Comparative Case Study of Policy Implementation in England, Wales, Scotland and Northern Ireland. Front Digit Health 2021; 3:754319. [PMID: 34988546 PMCID: PMC8720935 DOI: 10.3389/fdgth.2021.754319] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Requirements for physical distancing as a result of COVID-19 and the need to reduce the risk of infection prompted policy supporting rapid roll out of video consulting across the four nations of the UK-England, Northern Ireland, Scotland and Wales. Drawing on three studies of the accelerated implementation and uptake of video consulting across the four nations, we present a comparative and interpretive policy analysis of the spread and scale-up of video consulting during the pandemic. Data include interviews with 59 national level stakeholders, 55 health and social care staff and 30 patients, 20 national documents, responses to a UK-wide survey of NHS staff and analysis of routine activity data. Sampling ensured variations in geography, clinical context and adoption progress across the combined dataset. Comparative analysis was guided by theory on policy implementation and crisis management. The pandemic provided a "burning platform" prompting UK-wide policy supporting the use of video consulting in health care as a critical means of managing the risk of infection and a standard mode of provision. This policy push facilitated interest in video consulting across the UK. There was, however, marked variation in how this was put into practice across the four nations. Pre-existing infrastructure, policies and incentives for video consulting in Scotland, combined with a collaborative system-level approach, a program dedicated to developing video-based services and resourcing and supporting staff to deliver them enabled widespread buy-in and rapid spread. In England, Wales and Northern Ireland, pre-existing support for digital health (e.g., hardware, incentives) and virtual care, combined with reduced regulation and "light touch" procurement managed to override some (but by no means all) cultural barriers and professional resistance to implementing digital change. In Northern Ireland and Wales, limited infrastructure muted spread. In all three countries, significant effort at system level to develop, review and run video consulting programs enabled a substantial number of providers to change their practice, albeit variably across settings. Across all four nations ongoing uncertainty, potential restructuring and tightening of regulations, along with difficulties inherent in addressing inequalities in digital access, raise questions about the longer-term sustainability of changes to-date.
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Affiliation(s)
- Sara E. Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Lucy Moore
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Alex Rushforth
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Joanne Morris
- Joint Research Management Office, Barts Health NHS Trust, London, United Kingdom
| | - Gary W. Wood
- Independent Research Consultant, Birmingham, United Kingdom
| | - Stuart Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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19
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Martin PM. NHS blood tube shortage reminds us of our waste. BMJ 2021; 375:n2401. [PMID: 34625449 DOI: 10.1136/bmj.n2401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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20
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Dendere R, Janda M, Sullivan C. Are we doing it right? We need to evaluate the current approaches for implementation of digital health systems. AUST HEALTH REV 2021; 45:778-781. [PMID: 34488938 DOI: 10.1071/ah20289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/28/2021] [Indexed: 11/23/2022]
Abstract
Successful implementation of digital health programs is imperative as it is becoming increasingly clear that digital solutions will underpin modern health care. These projects are often supported by large budgets and if not implemented successfully, the quality, safety, and efficiency of patient care may be compromised. Failure rates for the implementation of large, complex healthcare software platforms in digital health programs have been persistently high. Although several factors may contribute to the failure of such projects, the majority have been reported to fail largely due to poor project management. Nevertheless, little is known about the optimal project management approaches for digital health projects, with many health services reliant on external advisory companies and contractors for advice. Although publication bias makes it difficult to reliably study and understand global trends for the failure of digital health projects, examination of media reports and published literature indicates that this is a global phenomenon affecting digital health projects in North America, Europe and Australasia. In this article, our aim is to examine the literature for evidence underpinning current project management approaches used when implementing commercial, off-the-shelf healthcare information technology solutions, including complex healthcare software in large digital health programs in hospitals or across health systems, and evaluate the suitability of current project management approaches to deliver these projects. This starts to build an important evidence base for hospitals and health services considering digital transformation projects.
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Affiliation(s)
- Ronald Dendere
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Qld 4102, Australia. ; and Corresponding author.
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Qld 4102, Australia.
| | - Clair Sullivan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Qld 4102, Australia. ; and Digital Metro North, Metro North Hospital and Health Service, Department of Health, Queensland Government, Qld 4029, Australia.
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21
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Digital health's impact on integrated care, carer empowerment and patient-centeredness for persons living with dementia. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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22
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Mukherjee M, Cresswell K, Sheikh A. Identifying strategies to overcome roadblocks to utilising near real-time healthcare and administrative data to create a Scotland-wide learning health system. Health Informatics J 2021; 27:1460458220977579. [PMID: 33446033 DOI: 10.1177/1460458220977579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Creating a learning health system could help reduce variations in quality of care. Success is dependent on timely access to health data. To explore the barriers and facilitators to timely access to patients' data, we conducted in-depth semi-structured interviews with 37 purposively sampled participants from government, the NHS and academia across Scotland. Interviews were analysed using the framework approach. Participants were of the view that Scotland could play a leading role in the exploitation of routine data to drive forward service improvements, but highlighted major impediments: (i) persistence of paper-based records and a variety of information systems; (ii) the need for a proportionate approach to managing information governance; and (iii) the need for support structures to facilitate accrual, processing, linking, analysis and timely use and reuse of data for patient benefit. There is a pressing need to digitise and integrate existing health information infrastructures, guided by a nationwide proportionate information governance approach and the need to enhance technological and human capabilities to support these efforts.
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Affiliation(s)
- Mome Mukherjee
- The University of Edinburgh, UK.,Health Data Research, UK
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Li E, Clarke J, Neves AL, Ashrafian H, Darzi A. Electronic Health Records, Interoperability and Patient Safety in Health Systems of High-income Countries: A Systematic Review Protocol. BMJ Open 2021; 11:e044941. [PMID: 34261679 PMCID: PMC8280868 DOI: 10.1136/bmjopen-2020-044941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION The availability and routine use of electronic health records (EHRs) have become commonplace in healthcare systems of many high-income countries. While there is an ever-growing body of literature pertaining to their use, evidence surrounding the importance of EHR interoperability and its impact on patient safety remains less clear. There is, therefore, a need and opportunity to evaluate the evidence available regarding this relationship so as to better inform health informatics development and policies in the years to come. This systematic review aims to evaluate the impact of EHR interoperability on patient safety in health systems of high-income countries. METHODS AND ANALYSIS A systematic literature review will be conducted via a computerised search through four databases: PubMed, Embase, Health Management Information Consortium and PsycInfo for relevant articles published between 2010 and 2020. Outcomes of interest will include impact on patient safety and the broader effects on health systems. Quality of the randomised quantitative studies will be assessed using Cochrane Risk of Bias Tool. Non-randomised papers will be evaluated with the Risk of Bias In Non-Randomised Studies-of Interventions tool. Drummond's Checklist will be used for publications pertaining to economic evaluation. The National Institute for Health and Care Excellence quality appraisal checklist will be used to assess qualitative studies. A narrative synthesis will be conducted for included studies, and the body of evidence will be summarised in a summary of findings table. ETHICS AND DISSEMINATION This review will summarise published studies with non-identifiable data and, thus, does not require ethical approval. Findings will be disseminated through preprints, open access peer-reviewed publications, and conference presentations. PROSPERO REGISTRATION NUMBER CRD42020209285.
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Affiliation(s)
- Edmond Li
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Jonathan Clarke
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Department of Surgery & Cancer, Imperial College London, London, UK
- Centre for Mathematics of Precision Healthcare, Department of Mathematics, Imperial College London, London, UK
| | - Ana Luisa Neves
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Department of Surgery & Cancer, Imperial College London, London, UK
- Center for Health Technology and Services Research, Department of Community Medicine, Health Information and Decision, University of Porto, Porto, Portugal
| | - Hutan Ashrafian
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Ara Darzi
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Department of Surgery & Cancer, Imperial College London, London, UK
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24
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Scheibner J, Sleigh J, Ienca M, Vayena E. Benefits, challenges, and contributors to success for national eHealth systems implementation: a scoping review. J Am Med Inform Assoc 2021; 28:2039-2049. [PMID: 34151990 DOI: 10.1093/jamia/ocab096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/27/2021] [Accepted: 05/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Our scoping review aims to assess what legal, ethical, and socio-technical factors contribute to or inhibit the success of national eHealth system implementations. In addition, our review seeks to describe the characteristics and benefits of eHealth systems. MATERIALS AND METHODS We conducted a scoping review of literature published in English between January 2000 and 2020 using a keyword search on 5 databases: PubMed, Scopus, Web of Science, IEEEXplore, and ProQuest. After removal of duplicates, abstract screening, and full-text filtering, 86 articles were included from 8276 search results. RESULTS We identified 17 stakeholder groups, 6 eHealth Systems areas, and 15 types of legal regimes and standards. In-depth textual analysis revealed challenges mainly in implementation, followed by ethico-legal and data-related aspects. Key factors influencing success include promoting trust of the system, ensuring wider acceptance among users, reconciling the system with legal requirements, and ensuring an adaptable technical platform. DISCUSSION Results revealed support for decentralized implementations because they carry less implementation and engagement challenges than centralized ones. Simultaneously, due to decentralized systems' interoperability issues, federated implementations (with a set of national standards) might be preferable. CONCLUSION This study identifies the primary socio-technical, legal, and ethical factors that challenge and contribute to the success of eHealth system implementations. This study also describes the complexities and characteristics of existing eHealth implementation programs, and suggests guidance for resolving the identified challenges.
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Affiliation(s)
- James Scheibner
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland.,College of Business, Government and Law, Flinders University, Adelaide, Australia
| | - Joanna Sleigh
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
| | - Marcello Ienca
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
| | - Effy Vayena
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
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25
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McBride N, Liyala S. Memoirs from Bukhalalire: a poetic inquiry into the lived experience of M-PESA mobile money usage in rural Kenya. EUR J INFORM SYST 2021. [DOI: 10.1080/0960085x.2021.1924088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Neil McBride
- Centre for Computing and Social Responsibility, De Montfort University, Leicester, United Kingdom
| | - Samuel Liyala
- School of Informatics and Innovative Systems, Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
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26
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Broadbent DM, Wang A, Cheyne CP, James M, Lathe J, Stratton IM, Roberts J, Moitt T, Vora JP, Gabbay M, García-Fiñana M, Harding SP. Safety and cost-effectiveness of individualised screening for diabetic retinopathy: the ISDR open-label, equivalence RCT. Diabetologia 2021; 64:56-69. [PMID: 33146763 PMCID: PMC7716929 DOI: 10.1007/s00125-020-05313-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/08/2020] [Indexed: 12/12/2022]
Abstract
AIMS/HYPOTHESIS Using variable diabetic retinopathy screening intervals, informed by personal risk levels, offers improved engagement of people with diabetes and reallocation of resources to high-risk groups, while addressing the increasing prevalence of diabetes. However, safety data on extending screening intervals are minimal. The aim of this study was to evaluate the safety and cost-effectiveness of individualised, variable-interval, risk-based population screening compared with usual care, with wide-ranging input from individuals with diabetes. METHODS This was a two-arm, parallel-assignment, equivalence RCT (minimum 2 year follow-up) in individuals with diabetes aged 12 years or older registered with a single English screening programme. Participants were randomly allocated 1:1 at baseline to individualised screening at 6, 12 or 24 months for those at high, medium and low risk, respectively, as determined at each screening episode by a risk-calculation engine using local demographic, screening and clinical data, or to annual screening (control group). Screening staff and investigators were observer-masked to allocation and interval. Data were collected within the screening programme. The primary outcome was attendance (safety). A secondary safety outcome was the development of sight-threatening diabetic retinopathy. Cost-effectiveness was evaluated within a 2 year time horizon from National Health Service and societal perspectives. RESULTS A total of 4534 participants were randomised. After withdrawals, there were 2097 participants in the individualised screening arm and 2224 in the control arm. Attendance rates at first follow-up were equivalent between the two arms (individualised screening 83.6%; control arm 84.7%; difference -1.0 [95% CI -3.2, 1.2]), while sight-threatening diabetic retinopathy detection rates were non-inferior in the individualised screening arm (individualised screening 1.4%, control arm 1.7%; difference -0.3 [95% CI -1.1, 0.5]). Sensitivity analyses confirmed these findings. No important adverse events were observed. Mean differences in complete case quality-adjusted life-years (EuroQol Five-Dimension Questionnaire, Health Utilities Index Mark 3) did not significantly differ from zero; multiple imputation supported the dominance of individualised screening. Incremental cost savings per person with individualised screening were £17.34 (95% CI 17.02, 17.67) from the National Health Service perspective and £23.11 (95% CI 22.73, 23.53) from the societal perspective, representing a 21% reduction in overall programme costs. Overall, 43.2% fewer screening appointments were required in the individualised arm. CONCLUSIONS/INTERPRETATION Stakeholders involved in diabetes care can be reassured by this study, which is the largest ophthalmic RCT in diabetic retinopathy screening to date, that extended and individualised, variable-interval, risk-based screening is feasible and can be safely and cost-effectively introduced in established systematic programmes. Because of the 2 year time horizon of the trial and the long time frame of the disease, robust monitoring of attendance and retinopathy rates should be included in any future implementation. TRIAL REGISTRATION ISRCTN 87561257 FUNDING: The study was funded by the UK National Institute for Health Research. Graphical abstract.
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Affiliation(s)
- Deborah M Broadbent
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK.
- St Paul's Eye Unit, Liverpool University Hospitals Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK.
| | - Amu Wang
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
- St Paul's Eye Unit, Liverpool University Hospitals Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK
| | - Christopher P Cheyne
- Department of Biostatistics, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
- Clinical Trials Research Centre, Liverpool, UK
| | - Marilyn James
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
| | - James Lathe
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Irene M Stratton
- Gloucestershire Retinal Research Group, Cheltenham General Hospital, Cheltenham, UK
| | | | - Tracy Moitt
- Clinical Trials Research Centre, Liverpool, UK
| | - Jiten P Vora
- Department of Diabetes and Endocrinology, Royal Liverpool University Hospital, Liverpool, UK
| | - Mark Gabbay
- Department of Health Services Research, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
- Brownlow Health Centre, Member of Liverpool Health Partners, Liverpool, UK
| | - Marta García-Fiñana
- Department of Biostatistics, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
- Clinical Trials Research Centre, Liverpool, UK
| | - Simon P Harding
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK
- St Paul's Eye Unit, Liverpool University Hospitals Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK
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Mauco KL, Scott RE, Mars M. Validation of an e-health readiness assessment framework for developing countries. BMC Health Serv Res 2020; 20:575. [PMID: 32576174 PMCID: PMC7313186 DOI: 10.1186/s12913-020-05448-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background Studies document e-health as having potential to improve quality of healthcare services, resulting in both developed and developing countries demonstrating continued interest in e-health uptake and use. e-Health implementations are not always successful as high failure rates have been reported in both developed and developing countries. These failures are often a result of lack of e-health readiness. e-Health readiness has been defined as the preparedness of healthcare institutions or communities for the anticipated change brought by programs related to information and communication technologies. As such it is critical to conduct an e-health readiness assessment prior to implementation of e-health innovations so as to reduce chances of project failure. Noting the absence of an adequate e-health readiness assessment framework (eHRAF) suitable for use in developing countries, the authors conceptualised, designed, and created a developing country specific eHRAF to aid in e-health policy planning. The aim of this study was to validate the developed eHRAF and to determine if it required further refinement before empirical testing. Methods Published options for a framework validation process were adopted, and fifteen globally located e-health experts engaged. Botswana experts were engaged using saturation sampling, while international experts were purposively selected. Responses were collated in an Excel spreadsheet, and NVivo 11 software used to aid thematic analysis of the open ended questions. Results Analysis of responses showed overall support for the content and format of the proposed eHRAF. Equivocal responses to some open ended questions were recorded, most of which suggested modifications to terms within the framework. One expert from the developed world had alternate views. Conclusions The proposed eHRAF provides guidance for e-health policy development and planning by identifying, in an evidence based manner, the major areas to be considered when preparing for an e-health readiness assessment in the context of developing countries.
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Affiliation(s)
- Kabelo Leonard Mauco
- Department of TeleHealth, University of KwaZulu-Natal, Durban, South Africa. .,Botho University, P O BOX 501564, Gaborone, Botswana.
| | - Richard E Scott
- Department of TeleHealth, University of KwaZulu-Natal, Durban, South Africa.,NT Consulting - Global e-Health Inc, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Maurice Mars
- Department of TeleHealth, University of KwaZulu-Natal, Durban, South Africa.,Flinders University, Adelaide, South Australia, Australia
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Muinga N, Magare S, Monda J, English M, Fraser H, Powell J, Paton C. Digital health Systems in Kenyan Public Hospitals: a mixed-methods survey. BMC Med Inform Decis Mak 2020; 20:2. [PMID: 31906932 PMCID: PMC6945428 DOI: 10.1186/s12911-019-1005-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 12/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background As healthcare facilities in Low- and Middle-Income Countries adopt digital health systems to improve hospital administration and patient care, it is important to understand the adoption process and assess the systems’ capabilities. This survey aimed to provide decision-makers with information on the digital health systems landscape and to support the rapidly developing digital health community in Kenya and the region by sharing knowledge. Methods We conducted a survey of County Health Records Information Officers (CHRIOs) to determine the extent to which digital health systems in public hospitals that serve as internship training centres in Kenya are adopted. We conducted site visits and interviewed hospital administrators and end users who were at the facility on the day of the visit. We also interviewed digital health system vendors to understand the adoption process from their perspective. Semi-structured interview guides adapted from the literature were used. We identified emergent themes using a thematic analysis from the data. Results We obtained information from 39 CHRIOs, 58 hospital managers and system users, and 9 digital health system vendors through semi-structured interviews and completed questionnaires. From the survey, all facilities mentioned purchased a digital health system primarily for administrative purposes. Radiology and laboratory management systems were commonly standalone systems and there were varying levels of interoperability within facilities that had multiple systems. We only saw one in-patient clinical module in use. Users reported on issues such as system usability, inadequate training, infrastructure and system support. Vendors reported the availability of a wide range of modules, but implementation was constrained by funding, prioritisation of services, users’ lack of confidence in new technologies and lack of appropriate data sharing policies. Conclusion Public hospitals in Kenya are increasingly purchasing systems to support administrative functions and this study highlights challenges faced by hospital users and vendors. Significant work is required to ensure interoperability of systems within hospitals and with other government services. Additional studies on clinical usability and the workflow fit of digital health systems are required to ensure efficient system implementation. However, this requires support from key stakeholders including the government, international donors and regional health informatics organisations.
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Affiliation(s)
- Naomi Muinga
- Health services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi, 00100, Kenya.
| | | | - Jonathan Monda
- Health services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi, 00100, Kenya
| | - Mike English
- Health services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi, 00100, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Hamish Fraser
- Brown Center for Biomedical Informatics, Brown University, Providence, RI, USA
| | - John Powell
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Paton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Asthana S, Jones R, Sheaff R. Why does the NHS struggle to adopt eHealth innovations? A review of macro, meso and micro factors. BMC Health Serv Res 2019; 19:984. [PMID: 31864370 PMCID: PMC6925468 DOI: 10.1186/s12913-019-4790-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 11/29/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Having a tax-funded and supposedly 'National' Health Service (NHS), one might assume that the UK is well-positioned to roll out eHealth innovations at scale. Yet, despite a strong policy push, the English NHS has been limited in the extent to which it has exploited the potential of eHealth. MAIN BODY This paper considers a range of macro, meso and micro factors influencing eHealth innovation in the English NHS. CONCLUSIONS While barriers to eHealth innovation exist at all scales, the fragmentation of the NHS is the most significant factor limiting adoption and diffusion. Rather than addressing problems of fragmentation, national policy seems to have intensified the digital divide. As the recently published NHS Long Term Plan places great emphasis on the role of digital transformation in helping health and care professionals communicate better and enabling people to access the care they need quickly and easily, the implications for the digital divide are likely to be significant for effectiveness, efficiency and equity.
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Affiliation(s)
- Sheena Asthana
- School of Law, Criminology and Government, University of Plymouth, Plymouth, UK.
| | - Ray Jones
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
| | - Rod Sheaff
- School of Law, Criminology and Government, University of Plymouth, Plymouth, UK
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Warren LR, Clarke J, Arora S, Darzi A. Improving data sharing between acute hospitals in England: an overview of health record system distribution and retrospective observational analysis of inter-hospital transitions of care. BMJ Open 2019; 9:e031637. [PMID: 31806611 PMCID: PMC7008454 DOI: 10.1136/bmjopen-2019-031637] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To determine the frequency of use and spatial distribution of health record systems in the English National Health Service (NHS). To quantify transitions of care between acute hospital trusts and health record systems to guide improvements to data sharing and interoperability. DESIGN Retrospective observational study using Hospital Episode Statistics. SETTING Acute hospital trusts in the NHS in England. PARTICIPANTS All adult patients resident in England that had one or more inpatient, outpatient or accident and emergency encounters at acute NHS hospital trusts between April 2017 and April 2018. PRIMARY AND SECONDARY OUTCOME MEASURES Frequency of use and spatial distribution of health record systems. Frequency and spatial distribution of transitions of care between hospital trusts and health record systems. RESULTS 21 286 873 patients were involved in 121 351 837 encounters at 152 included trusts. 117 (77.0%) hospital trusts were using electronic health records (EHR). There was limited regional alignment of EHR systems. On 11 017 767 (9.1%) occasions, patients attended a hospital using a different health record system to their previous hospital attendance. 15 736 863 (73.9%) patients had two or more encounters with the included trusts and 3 931 255 (25.0%) of those attended two or more trusts. Over half (53.6%) of these patients had encounters shared between just 20 pairs of hospitals. Only two of these pairs of trusts used the same EHR system. CONCLUSIONS Each year, millions of patients in England attend two or more different hospital trusts. Most of the pairs of trusts that commonly share patients do not use the same record systems. This research highlights significant barriers to inter-hospital data sharing and interoperability. Findings from this study can be used to improve electronic health record system coordination and develop targeted approaches to improve interoperability. The methods used in this study could be used in other healthcare systems that face the same interoperability challenges.
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Affiliation(s)
- Leigh R Warren
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jonathan Clarke
- Department of Surgery and Cancer, Imperial College London, London, UK
- Centre for Health Policy, Imperial College London, London, UK
- Centre for Mathematics of Precision Healthcare, Imperial College London, London, UK
- Department of Biostatistics, Harvard University, Boston, United States
| | - Sonal Arora
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
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Harris JM, Brierley RC, Pufulete M, Bucciarelli-Ducci C, Stokes EA, Greenwood JP, Dorman SH, Anderson RA, Rogers CA, Wordsworth S, Berry S, Reeves BC. A national registry to assess the value of cardiovascular magnetic resonance imaging after primary percutaneous coronary intervention pathway activation: a feasibility cohort study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Cardiovascular magnetic resonance (CMR) is increasingly used in patients who activate the primary percutaneous coronary intervention (PPCI) pathway to assess heart function. It is uncertain whether having CMR influences patient management or the risk of major adverse cardiovascular events in these patients.
Objective
To determine whether or not it is feasible to set up a national registry, linking routinely collected data from hospital information systems (HISs), to investigate the role of CMR in patients who activate the PPCI pathway.
Design
A feasibility prospective cohort study.
Setting
Four 24/7 PPCI hospitals in England and Wales (two with and two without a dedicated CMR facility).
Participants
Patients who activated the PPCI pathway and underwent an emergency coronary angiogram.
Interventions
CMR either performed or not performed within 10 weeks of the index event.
Main outcome measures
A. Feasibility parameters – (1) patient consent implemented at all hospitals, (2) data extracted from more than one HIS and successfully linked for > 90% of consented patients at all four hospitals, (3) HIS data successfully linked with Hospital Episode Statistics (HES) and Patient Episode Database Wales (PEDW) for > 90% of consented patients at all four hospitals and (4) CMR requested and carried out for ≥ 10% of patients activating the PPCI pathway in CMR hospitals. B. Key drivers of cost-effectiveness for CMR (identified from simple cost-effectiveness models) in patients with (1) multivessel disease and (2) unobstructed coronary arteries. C. A change in clinical management arising from having CMR (defined using formal consensus and identified using HES follow-up data in the 12 months after the index event).
Results
A. (1) Consent was implemented (for all hospitals, consent rates were 59–74%) and 1670 participants were recruited. (2) Data submission was variable – clinical data available for ≥ 82% of patients across all hospitals, biochemistry and echocardiography (ECHO) data available for ≥ 98%, 34% and 87% of patients in three hospitals and medications data available for 97% of patients in one hospital. (3) HIS data were linked with hospital episode data for 99% of all consented patients. (4) At the two CMR hospitals, 14% and 20% of patients received CMR. B. In both (1) multivessel disease and (2) unobstructed coronary arteries, the difference in quality-adjusted life-years (QALYs) between CMR and no CMR [‘current’ comparator, stress ECHO and standard ECHO, respectively] was very small [0.0012, 95% confidence interval (CI) –0.0076 to 0.0093 and 0.0005, 95% CI –0.0050 to 0.0077, respectively]. The diagnostic accuracy of the ischaemia tests was the key driver of cost-effectiveness in sensitivity analyses for both patient subgroups. C. There was consensus that CMR leads to clinically important changes in management in five patient subgroups. Some changes in management were successfully identified in hospital episode data (e.g. new diagnoses/procedures, frequency of outpatient episodes related to cardiac events), others were not (e.g. changes in medications, new diagnostic tests).
Conclusions
A national registry is not currently feasible. Patients were consented successfully but conventional consent could not be implemented nationally. Linking HIS and hospital episode data was feasible but HIS data were not uniformly available. It is feasible to identify some, but not all, changes in management in the five patient subgroups using hospital episode data. The delay in obtaining hospital episode data influenced the relevance of some of our study objectives.
Future work
To test the feasibility of conducting the study using national data sets (e.g. HES, British Cardiovascular Intervention Society audit database, Diagnostic Imaging Dataset, Clinical Practice Research Datalink).
Funding
The National Institute for Health Research (NIHR) Health Services and Delivery Research programme. This study was designed and delivered in collaboration with the Clinical Trials and Evaluation Unit, a UK Clinical Research Collaboration-registered clinical trials unit that, as part of the Bristol Trials Centre, is in receipt of NIHR clinical trials unit support funding.
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Affiliation(s)
- Jessica M Harris
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Rachel C Brierley
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Maria Pufulete
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Chiara Bucciarelli-Ducci
- National Institute for Health Research (NIHR) Bristol Cardiovascular Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Elizabeth A Stokes
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Stephen H Dorman
- National Institute for Health Research (NIHR) Bristol Cardiovascular Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Chris A Rogers
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sunita Berry
- NHS England, South West Clinical Networks and Senate, Bristol, UK
| | - Barnaby C Reeves
- Clinical Trials and Evaluation Unit, Bristol Trials Centre, University of Bristol, Bristol, UK
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Charlesworth M, van Zundert AAJ. Digital dystopias: will the electronic health record ever fulfil its potential? Anaesthesia 2019; 74:1361-1364. [DOI: 10.1111/anae.14683] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2019] [Indexed: 12/17/2022]
Affiliation(s)
- M. Charlesworth
- Department of Cardiothoracic Anaesthesia Wythenshawe Hospital Manchester University Hospitals NHS Foundation Trust ManchesterUK
| | - A. A. J. van Zundert
- Discipline of Anaesthesiology Department of Anaesthesia and Peri‐operative Medicine Royal Brisbane and Women's Hospital The University of Queensland Brisbane QLD Australia
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Clarke JM, Warren LR, Arora S, Barahona M, Darzi AW. Guiding interoperable electronic health records through patient-sharing networks. NPJ Digit Med 2018; 1:65. [PMID: 31304342 PMCID: PMC6550264 DOI: 10.1038/s41746-018-0072-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/09/2018] [Indexed: 01/01/2023] Open
Abstract
Effective sharing of clinical information between care providers is a critical component of a safe, efficient health system. National data-sharing systems may be costly, politically contentious and do not reflect local patterns of care delivery. This study examines hospital attendances in England from 2013 to 2015 to identify instances of patient sharing between hospitals. Of 19.6 million patients receiving care from 155 hospital care providers, 130 million presentations were identified. On 14.7 million occasions (12%), patients attended a different hospital to the one they attended on their previous interaction. A network of hospitals was constructed based on the frequency of patient sharing between hospitals which was partitioned using the Louvain algorithm into ten distinct data-sharing communities, improving the continuity of data sharing in such instances from 0 to 65-95%. Locally implemented data-sharing communities of hospitals may achieve effective accessibility of clinical information without a large-scale national interoperable information system.
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Affiliation(s)
- Jonathan M. Clarke
- NIHR Patient Safety Translational Research Centre, Imperial College London, London, W2 1NY UK
- EPSRC Centre for Mathematics of Precision Healthcare, Imperial College London, London, SW7 2AZ UK
- Centre for Health Policy, Imperial College London, London, W2 1NY UK
| | - Leigh R. Warren
- NIHR Patient Safety Translational Research Centre, Imperial College London, London, W2 1NY UK
| | - Sonal Arora
- NIHR Patient Safety Translational Research Centre, Imperial College London, London, W2 1NY UK
| | - Mauricio Barahona
- EPSRC Centre for Mathematics of Precision Healthcare, Imperial College London, London, SW7 2AZ UK
- Department of Mathematics, Imperial College London, London, SW7 2AZ UK
| | - Ara W. Darzi
- NIHR Patient Safety Translational Research Centre, Imperial College London, London, W2 1NY UK
- Centre for Health Policy, Imperial College London, London, W2 1NY UK
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Wieringa G. Teaching the pony new tricks: competences for specialists in laboratory medicine to meet the challenges of disruptive innovation. ACTA ACUST UNITED AC 2018; 57:398-402. [DOI: 10.1515/cclm-2018-0609] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/14/2018] [Indexed: 11/15/2022]
Abstract
Abstract
The 20th century digital revolution has already seen the introduction of faster, more diverse, easier to use technologies with extended capacity and capability that has enhanced productivity in Laboratory Medicine and allowed more effective use of human resource. With increasing demands for better health and best care the challenge to future healthcare systems is to deploy technology, facilities and human resources more effectively. For the 21st century the digital age heralds opportunities for information-led technology providers to become healthcare providers when algorithm driven care can support patients’ needs at the point of care close to or in their homes. For Specialists in Laboratory Medicine the opportunity arises for working beyond the laboratory in partnership with the emerging providers. The challenge to specialists is to extend their skill and competence to leadership roles that (a) determine clinical need and strategic direction for local environments, (b) ensure technology solutions are cost-effective, safe and reliable, (c) assume the business acumen to market, negotiate and manage change in services, (d) expect understanding of the clinical bioinformatics that underpin genomics, health information science (data mining and health economics) and physical sciences (e) expect knowledge and skills in the provision of direct clinical care in the face of staffing shortfalls experienced by many healthcare systems and (f) enhance their communication and interactive skills. In growing their leadership contribution a partnership approach in education and training across healthcare divides, in conjunction with the diagnostics and/or information technology industries, through integrated professional organisation approaches, joint approaches with academia and policy related healthcare organisations is recommended.
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Affiliation(s)
- Gijsbert Wieringa
- Department of Laboratory Medicine, Bolton NHS Foundation Trust , Minerva Road , Bolton BL4 0JR , UK
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Verheij RA, Curcin V, Delaney BC, McGilchrist MM. Possible Sources of Bias in Primary Care Electronic Health Record Data Use and Reuse. J Med Internet Res 2018; 20:e185. [PMID: 29844010 PMCID: PMC5997930 DOI: 10.2196/jmir.9134] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/11/2018] [Accepted: 03/01/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Enormous amounts of data are recorded routinely in health care as part of the care process, primarily for managing individual patient care. There are significant opportunities to use these data for other purposes, many of which would contribute to establishing a learning health system. This is particularly true for data recorded in primary care settings, as in many countries, these are the first place patients turn to for most health problems. OBJECTIVE In this paper, we discuss whether data that are recorded routinely as part of the health care process in primary care are actually fit to use for other purposes such as research and quality of health care indicators, how the original purpose may affect the extent to which the data are fit for another purpose, and the mechanisms behind these effects. In doing so, we want to identify possible sources of bias that are relevant for the use and reuse of these type of data. METHODS This paper is based on the authors' experience as users of electronic health records data, as general practitioners, health informatics experts, and health services researchers. It is a product of the discussions they had during the Translational Research and Patient Safety in Europe (TRANSFoRm) project, which was funded by the European Commission and sought to develop, pilot, and evaluate a core information architecture for the learning health system in Europe, based on primary care electronic health records. RESULTS We first describe the different stages in the processing of electronic health record data, as well as the different purposes for which these data are used. Given the different data processing steps and purposes, we then discuss the possible mechanisms for each individual data processing step that can generate biased outcomes. We identified 13 possible sources of bias. Four of them are related to the organization of a health care system, whereas some are of a more technical nature. CONCLUSIONS There are a substantial number of possible sources of bias; very little is known about the size and direction of their impact. However, anyone that uses or reuses data that were recorded as part of the health care process (such as researchers and clinicians) should be aware of the associated data collection process and environmental influences that can affect the quality of the data. Our stepwise, actor- and purpose-oriented approach may help to identify these possible sources of bias. Unless data quality issues are better understood and unless adequate controls are embedded throughout the data lifecycle, data-driven health care will not live up to its expectations. We need a data quality research agenda to devise the appropriate instruments needed to assess the magnitude of each of the possible sources of bias, and then start measuring their impact. The possible sources of bias described in this paper serve as a starting point for this research agenda.
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Affiliation(s)
- Robert A Verheij
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Vasa Curcin
- King's College London, London, United Kingdom
| | - Brendan C Delaney
- Imperial College London, Imperial College Business School, London, United Kingdom
| | - Mark M McGilchrist
- University of Dundee, Department of Public Health Sciences, Dundee, United Kingdom
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Brierley RC, Pufulete M, Harris J, Bucciarelli-Ducci C, Greenwood JP, Dorman S, Anderson R, Rogers CA, Reeves BC. Developing a UK registry to investigate the role of cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway: a multicentre, feasibility study linking routinely collected electronic patient data. BMJ Open 2018; 8:e018987. [PMID: 29500206 PMCID: PMC5855336 DOI: 10.1136/bmjopen-2017-018987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To determine whether it is feasible to set up a national registry, linking routinely collected data from hospital information systems (HIS), to investigate the role of cardiovascular magnetic resonance (CMR) in patients who activate the primary percutaneous coronary intervention (PPCI) pathway. DESIGN Feasibility prospective cohort study, to establish whether: (1) consent can be implemented; (2) data linkage and extraction from multiple HIS can be achieved for >90% of consented patients; (3) local data can be successfully linked with hospital episode data (Hospital Episode Statistics, HES; Patient Episode Database for Wales, PEDW) for >90% of consented patients and (4) the proportion of patients activating the PPCI pathway who get a CMR scan is ≥10% in hospitals with dedicated CMR facilities. PARTICIPANTS Patients from four 24/7 PPCI hospitals in England and Wales (two with and two without a dedicated CMR facility) who activated the PPCI pathway and underwent an emergency coronary angiogram. RESULTS Consent was successfully implemented at all hospitals (consent rates ranged from 59% to 74%) and 1670 participants were recruited. Data submission was variable: all hospitals submitted clinical data (for ≥82% of patients); only three hospitals submitted biochemistry data (for ≥98% of patients) and echocardiography data (for 34%-87% of patients); only one hospital submitted medications data (for 97% of patients). At the two CMR centres, 14% and 20% of patients received a CMR scan. Data submitted by hospitals were linked with HES and PEDW for 99% of all consented patients. CONCLUSION We successfully consented patients but obtaining individual, opt-in consent would not be feasible for a national registry. Linkage of data from HIS with hospital episode data was feasible. However, data from HIS are not uniformly available/exportable and, in centres with a dedicated CMR facility, some referrals for CMR were for research rather than clinical purposes.
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Affiliation(s)
- Rachel C Brierley
- Clinical Trials and Evaluation Unit, University of Bristol, Bristol, UK
| | - Maria Pufulete
- Clinical Trials and Evaluation Unit, University of Bristol, Bristol, UK
| | - Jessica Harris
- Clinical Trials and Evaluation Unit, University of Bristol, Bristol, UK
| | - Chiara Bucciarelli-Ducci
- NIHR Bristol Cardiovascular Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Stephen Dorman
- NIHR Bristol Cardiovascular Research Unit, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, University of Bristol, Bristol, UK
| | - Barnaby C Reeves
- Clinical Trials and Evaluation Unit, University of Bristol, Bristol, UK
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