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Valdes G, Souza ASD. Use of electronic health records and primary health care accessibility according to data from the third cycle of the PMAQ-AB. CIENCIA & SAUDE COLETIVA 2024; 29:e04492023. [PMID: 38198323 DOI: 10.1590/1413-81232024291.04492023] [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: 03/29/2023] [Accepted: 06/26/2023] [Indexed: 01/12/2024] Open
Abstract
The use of electronic health records (EHR) in primary healthcare (PHC) aims for better integration of services and care quality. One of most the critical points of Brazilian PHC is access. This article aims to analyze, through data from the third evaluation cycle of the Brazilian Program for Improving Access and Quality of Primary Care (PMAQ-AB), the relationship between the use of electronic health records and the parameters of access of the participant teams. Cross-sectional analytical study with secondary data. Data from 38,865 primary care teams, 30,346 health units and 140,444 interviewed users were evaluated. The use of EHR was associated with greater care for non-programmed demands (OR 1.664; 95%CI 1.485-1.866), risk and vulnerability assessment (OR 1.329; 95%CI 1.122-1.574) and use of protocols for clinical conducts (OR 1.656; 95%CI 1.530-1.793), in addition to a greater possibility of scheduling consultation by telephone (OR 3.179; 95%CI 3.030-3.335). Services using EHR are more likely to be the patients first contact (OR 1.226; 95%CI 1.171-1.283) and to be sought when facing urgent health problem (OR 1.198; 95%CI 1.161-1.236). The results point to a concrete possibility of improving access through computerization.
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Affiliation(s)
- Gabriel Valdes
- Núcleo de Evidências da Prefeitura Municipal de Campo Grande. R. Juliete 3, Bosque de Avilan. 79012-512 Campo Grande MS Brasil.
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Berge GT, Granmo OC, Tveit TO, Munkvold BE, Ruthjersen AL, Sharma J. Machine learning-driven clinical decision support system for concept-based searching: a field trial in a Norwegian hospital. BMC Med Inform Decis Mak 2023; 23:5. [PMID: 36627624 PMCID: PMC9832658 DOI: 10.1186/s12911-023-02101-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Natural language processing (NLP) based clinical decision support systems (CDSSs) have demonstrated the ability to extract vital information from patient electronic health records (EHRs) to facilitate important decision support tasks. While obtaining accurate, medical domain interpretable results is crucial, it is demanding because real-world EHRs contain many inconsistencies and inaccuracies. Further, testing of such machine learning-based systems in clinical practice has received limited attention and are yet to be accepted by clinicians for regular use. METHODS We present our results from the evaluation of an NLP-driven CDSS developed and implemented in a Norwegian Hospital. The system incorporates unsupervised and supervised machine learning combined with rule-based algorithms for clinical concept-based searching to identify and classify allergies of concern for anesthesia and intensive care. The system also implements a semi-supervised machine learning approach to automatically annotate medical concepts in the narrative. RESULTS Evaluation of system adoption was performed by a mixed methods approach applying The Unified Theory of Acceptance and Use of Technology (UTAUT) as a theoretical lens. Most of the respondents demonstrated a high degree of system acceptance and expressed a positive attitude towards the system in general and intention to use the system in the future. Increased detection of patient allergies, and thus improved quality of practice and patient safety during surgery or ICU stays, was perceived as the most important advantage of the system. CONCLUSIONS Our combined machine learning and rule-based approach benefits system performance, efficiency, and interpretability. The results demonstrate that the proposed CDSS increases detection of patient allergies, and that the system received high-level acceptance by the clinicians using it. Useful recommendations for further system improvements and implementation initiatives are reducing the quantity of alarms, expansion of the system to include more clinical concepts, closer EHR system integration, and more workstations available at point of care.
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Affiliation(s)
- G. T. Berge
- grid.23048.3d0000 0004 0417 6230Department of Information Systems, University of Agder, Kristiansand, Norway ,grid.417290.90000 0004 0627 3712Department of Technology and eHealth, Sørlandet Hospital Trust, Kristiansand, Norway
| | - O. C. Granmo
- grid.23048.3d0000 0004 0417 6230Department of ICT, University of Agder, Grimstad, Norway
| | - T. O. Tveit
- grid.417290.90000 0004 0627 3712Department of Technology and eHealth, Sørlandet Hospital Trust, Kristiansand, Norway ,grid.417290.90000 0004 0627 3712Department of Anaesthesia and Intensive Care, Sørlandet Hospital Trust, Kristiansand, Norway ,grid.417290.90000 0004 0627 3712Research Department, Sørlandet Hospital Trust, Kristiansand, Norway
| | - B. E. Munkvold
- grid.23048.3d0000 0004 0417 6230Department of Information Systems, University of Agder, Kristiansand, Norway
| | - A. L. Ruthjersen
- grid.417290.90000 0004 0627 3712Department of Technology and eHealth, Sørlandet Hospital Trust, Kristiansand, Norway
| | - J. Sharma
- grid.417290.90000 0004 0627 3712Department of Technology and eHealth, Sørlandet Hospital Trust, Kristiansand, Norway ,grid.23048.3d0000 0004 0417 6230Department of ICT, University of Agder, Grimstad, Norway
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Bowden TC, Lyell D, Coiera E. Emergency department and urgent care clinician perspectives on digital access to past medical histories. BMJ Health Care Inform 2022; 29:bmjhci-2022-100567. [PMID: 35618316 PMCID: PMC9137332 DOI: 10.1136/bmjhci-2022-100567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/13/2022] [Indexed: 11/04/2022] Open
Abstract
ObjectiveTo explore emergency department (ED) and urgent care (UC) clinicians’ perceptions of digital access to patients’ past medical history (PMH).MethodsAn online survey compared anticipated and actual value of access to digital PMH. UTAUT2 (Unified Theory of Acceptance and Use of Technology 2) was used to assess technology acceptance. Quantitative data were analysed using Mann-Whitney U tests and qualitative data were analysed using a general inductive approach.Results33 responses were received. 94% (16/17) of respondents with PMH access said they valued their PMH system and all respondents with no digital PMH access (100%; 16/16) said they believed access would be valuable. Both groups indicated a high level of technology acceptance across all UTAUT2 dimensions. Free-text responses suggested improvements such as increasing the number of patient records available, standardisation of information presentation, increased system reliability, expanded access to information and validation by authoritative/trusted sources.DiscussionNon-PMH respondents’ expectations were closely matched with the benefits obtained by PMH respondents. High levels of technology acceptance indicated a strong willingness to adopt. Clinicians appeared clear about the improvements they would like for PMH content and access. Policy implications include the need to focus on higher levels of patient participation, and increasing the breadth and depth of information and processes to ensure patient record curation and stewardship.ConclusionThere appears to be strong clinician support for digital access to PMH in ED and UC; however, current systems appear to have many shortcomings.
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Affiliation(s)
- Thomas Campbell Bowden
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - David Lyell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Enrico Coiera
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Mullins AK, Morris H, Bailey C, Ben-Meir M, Rankin D, Mousa M, Skouteris H. Physicians' and pharmacists' use of My Health Record in the emergency department: results from a mixed-methods study. Health Inf Sci Syst 2021; 9:19. [PMID: 33898021 PMCID: PMC8051833 DOI: 10.1007/s13755-021-00148-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/02/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose This study aimed to explore pharmacists' and physicians' perceptions of use, barriers to use and the healthcare outcomes associated with use of Australia's national personally controlled electronic health record-known as My Health Record-in the emergency department. Methods A mixed methods approach was deployed, including surveys and individual semi-structured interviews. All physicians and pharmacists who work in the emergency department at Cabrini Health (a non-for-profit healthcare provider in Victoria, Australia) were invited to participate. Due to the timing of elective blocks, physician trainees were excluded from interviews. Results A total of 40 emergency medicine clinicians responded to the survey. Over 50% (n = 22) of all respondents had used My Health Record in the emergency department at least once. A total of 18 clinicians participated in the semi-structured interviews, which led to the identification of three themes with multiple sub-themes regarding My Health Record: (1) benefits; (2) effectiveness; and; (3) barriers. Conclusion Participants reported My Health Record use in the emergency department delivers efficiencies for clinicians and has a heightened utility for complex patients, consistent with previous research conducted outside of the Australian setting. Barriers to use were revealed: outdated content, a lack of trust, a low perception of value, no patient record and multiple medical record systems. The participants in this study highlighted that training and awareness raising is needed in order to improve My Health Record use in the emergency department, a need stressed by physician's. Further observational research is required to explores meaningful MHR use at scale.
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Affiliation(s)
- Alexandra K. Mullins
- Monash Centre for Health Research and Implementation, School Public Health and Preventative Medicine, Monash University, Melbourne, VIC Australia
| | - Heather Morris
- Monash Centre for Health Research and Implementation, School Public Health and Preventative Medicine, Monash University, Melbourne, VIC Australia
| | - Cate Bailey
- Monash Centre for Health Research and Implementation, School Public Health and Preventative Medicine, Monash University, Melbourne, VIC Australia
| | - Michael Ben-Meir
- Monash Centre for Health Research and Implementation, School Public Health and Preventative Medicine, Monash University, Melbourne, VIC Australia
- Cabrini Health, Melbourne, VIC Australia
- Austin Hospital, Austin Health, Melbourne, VIC Australia
| | | | - Mariam Mousa
- Monash Centre for Health Research and Implementation, School Public Health and Preventative Medicine, Monash University, Melbourne, VIC Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School Public Health and Preventative Medicine, Monash University, Melbourne, VIC Australia
- Warwick Business School, University of Warwick, Coventry, UK
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Matthys E, Van Bogaert P, Blommaert S, Verdonck L, Remmen R. Evidence-based early stage type 2 diabetes follow-up in Belgian primary care practices: Impact of multi-professional teams and care protocols. Prim Care Diabetes 2021; 15:249-256. [PMID: 33060036 DOI: 10.1016/j.pcd.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 11/26/2022]
Abstract
AIM The aim of this research is to explore the current early-stage diabetes mellitus type 2 care in Belgian general practices. This, to find out if the care is provided according to the proposed evidence-based national diabetes care guideline. Additionally, this research aims to detect which person and practice characteristics can be associated with a more evidence-based care provision. METHODS People were included in the study if they were recently diagnosed with type 2 diabetes by the participating practice. Practice and person characteristics, and clinical parameter monitoring and lifestyle monitoring data were collected by using a questionnaire and a topic list. RESULTS A total of 27 general practices participated and a total of 249 people were included through their patient records. People monitored in a practice according to a self-developed protocol were 5.5 times more likely to have a better clinical parameter follow-up. Larger practices (>2000 patients), follow-up by general practitioners and practice nurses together and according to self-developed protocols were associated with a significantly better lifestyle follow-up. CONCLUSION Practices providing multidisciplinary diabetes care, in collaboration with practice nurses, and with diabetes care based on self-developed protocols achieved a more comprehensive follow-up.
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Affiliation(s)
- Evi Matthys
- University of Antwerp, Campus Drie Eiken DR334, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | | | | | | | - Roy Remmen
- University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
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Mullins A, O'Donnell R, Mousa M, Rankin D, Ben-Meir M, Boyd-Skinner C, Skouteris H. Health Outcomes and Healthcare Efficiencies Associated with the Use of Electronic Health Records in Hospital Emergency Departments: a Systematic Review. J Med Syst 2020; 44:200. [PMID: 33078276 DOI: 10.1007/s10916-020-01660-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/16/2020] [Indexed: 01/28/2023]
Abstract
Healthcare organisations and governments have invested heavily in electronic health records in anticipation that they will deliver improved health outcomes for consumers and efficiencies across emergency departments. Despite such investment, electronic health records designed to support emergency care have been poorly evaluated. Given the accelerated development and adoption of information technology across healthcare, it is timely that a systematic review of this evidence base is updated in order to drive improvements to design, interoperability and overall clinical utility of electronic health record systems implemented in emergency departments. To assess the impact of electronic health records on healthcare outcomes and efficiencies in the emergency department we carried out a systematic review of published studies on this topic. This is the first review to summarise the cost efficiencies associated with electronic health record use outside of just the United States of America. A systematic search was performed in three scientific databases (MEDLINE, EMcare and EMBASE), of literature published between January 2000 and September 2019. Studies were included in this review if they evaluated electronic health records or health information exchanges (and synonyms for these terms), reported patient outcome and/or healthcare efficiency benefits, were peer-reviewed and published in English. Out of 6635 articles, 23 studies met our inclusion criteria. Wide variation regarding electronic health record access in the emergency department was reported (1.46-56.6%), yet was most frequently reported as less than 20%. Seven different types of health outcomes and three different types of efficiency improvements associated with electronic health record use in the emergency department were identified. The most frequently reported findings were efficiencies, including reductions in diagnostic tests, imaging and costs. This review is the first to report moderate to significant increases in admission rates are associated with electronic health record use in the emergency department, contrasting the findings of previous reviews. Diversity in the methodology employed across the included studies emphasises the need for further research to examine the impact of electronic health record implementation and system design on the findings reported, in order to ensure return on investment for stakeholders and optimised consumer care.
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Affiliation(s)
- Alexandra Mullins
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Renee O'Donnell
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mariam Mousa
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | | | | | - Helen Skouteris
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Warwick Business School, University of Warwick, Coventry, United Kingdom
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Keen J, Abdulwahid MA, King N, Wright JM, Randell R, Gardner P, Waring J, Longo R, Nikolova S, Sloan C, Greenhalgh J. Effects of interorganisational information technology networks on patient safety: a realist synthesis. BMJ Open 2020; 10:e036608. [PMID: 33039991 PMCID: PMC7552839 DOI: 10.1136/bmjopen-2019-036608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Health services in many countries are investing in interorganisational networks, linking patients' records held in different organisations across a city or region. The aim of the systematic review was to establish how, why and in what circumstances these networks improve patient safety, fail to do so, or increase safety risks, for people living at home. DESIGN Realist synthesis, drawing on both quantitative and qualitative evidence, and including consultation with stakeholders in nominal groups and semistructured interviews. ELIGIBILITY CRITERIA The coordination of services for older people living at home, and medicine reconciliation for older patients returning home from hospital. INFORMATION SOURCES 17 sources including Medline, Embase, CINAHL, Cochrane Library, Web of Science, ACM Digital Library, and Applied Social Sciences Index and Abstracts. OUTCOMES Changes in patients' clinical risks. RESULTS We did not find any detailed accounts of the sequences of events that policymakers and others believe will lead from the deployment of interoperable networks to improved patient safety. We were, though, able to identify a substantial number of theory fragments, and these were used to develop programme theories.There is good evidence that there are problems with the coordination of services in general, and the reconciliation of medication lists in particular, and it indicates that most problems are social and organisational in nature. There is also good evidence that doctors and other professionals find interoperable networks difficult to use. There was limited high-quality evidence about safety-related outcomes associated with the deployment of interoperable networks. CONCLUSIONS Empirical evidence does not currently justify claims about the beneficial effects of interoperable networks on patient safety. There appears to be a mismatch between technology-driven assumptions about the effects of networks and the sociotechnical nature of coordination problems. PROSPERO REGISTRATION NUMBER CRD42017073004.
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Affiliation(s)
- Justin Keen
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Natalie King
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Judy M Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire, UK
| | - Peter Gardner
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Roberta Longo
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Silviya Nikolova
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Sloan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Keen J, Abdulwahid M, King N, Wright J, Randell R, Gardner P, Waring J, Longo R, Nikolova S, Sloan C, Greenhalgh J. The effects of interoperable information technology networks on patient safety: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Interoperable networks connect information technology systems of different organisations, allowing professionals in one organisation to access patient data held in another one. Health policy-makers in many countries believe that they will improve the co-ordination of services and, hence, the quality of services and patient safety. To the best of our knowledge, there have not been any previous systematic reviews of the effects of these networks on patient safety.
Objectives
The aim of the study was to establish how, why and in what circumstances interoperable information technology networks improved patient safety, failed to do so or increased safety risks. The objectives of the study were to (1) identify programme theories and prioritise theories to review; (2) search systematically for evidence to test the theories; (3) undertake quality appraisal, and use included texts to support, refine or reject programme theories; (4) synthesise the findings; and (5) disseminate the findings to a range of audiences.
Design
Realist synthesis, including consultation with stakeholders in nominal groups and semistructured interviews.
Settings and participants
Following a stakeholder prioritisation process, several domains were reviewed: older people living at home requiring co-ordinated care, at-risk children living at home and medicines reconciliation services for any patients living at home. The effects of networks on services in health economies were also investigated.
Intervention
An interoperable network that linked at least two organisations, including a maximum of one hospital, in a city or region.
Outcomes
Increase, reduction or no change in patients’ risks, such as a change in the risk of taking an inappropriate medication.
Results
We did not find any detailed accounts of the ways in which interoperable networks are intended to work and improve patient safety. Theory fragments were identified and used to develop programme and mid-range theories. There is good evidence that there are problems with the co-ordination of services in each of the domains studied. The implicit hypothesis about interoperable networks is that they help to solve co-ordination problems, but evidence across the domains showed that professionals found interoperable networks difficult to use. There is insufficient evidence about the effectiveness of interoperable networks to allow us to establish how and why they affect patient safety.
Limitations
The lack of evidence about patient-specific measures of effectiveness meant that we were not able to determine ‘what works’, nor any variations in what works, when interoperable networks are deployed and used by health and social care professionals.
Conclusions
There is a dearth of evidence about the effects of interoperable networks on patient safety. It is not clear if the networks are associated with safer treatment and care, have no effects or increase clinical risks.
Future work
Possible future research includes primary studies of the effectiveness of interoperable networks, of economies of scope and scale and, more generally, on the value of information infrastructures.
Study registration
This study is registered as PROSPERO CRD42017073004.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 40. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Justin Keen
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Natalie King
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Peter Gardner
- School of Psychology, University of Leeds, Leeds, UK
| | - Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Roberta Longo
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Claire Sloan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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Bowden T, Lyell D, Coiera E. Emergency care access to primary care records: an observational study. BMJ Health Care Inform 2020; 27:bmjhci-2020-100153. [PMID: 32830108 PMCID: PMC7445344 DOI: 10.1136/bmjhci-2020-100153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/18/2020] [Accepted: 07/08/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To measure lookup rates of externally held primary care records accessed in emergency care and identify patient characteristics, conditions and potential consequences associated with access. MEASURES Rates of primary care record access and re-presentation to the emergency department (ED) within 30 days and hospital admission. DESIGN A retrospective observational study of 77 181 ED presentations over 4 years and 9 months, analysing 8184 index presentations in which patients' primary care records were accessed from the ED. Data were compared with 17 449 randomly selected index control presentations. Analysis included propensity score matching for age and triage categories. RESULTS 6.3% of overall ED presentations triggered a lookup (rising to 8.3% in year 5); 83.1% of patients were only looked up once and 16.9% of patients looked up on multiple occasions. Lookup patients were on average 25 years older (z=-9.180, p<0.001, r=0.43). Patients with more urgent triage classifications had their records accessed more frequently (z=-36.47, p<0.001, r=0.23). Record access was associated with a significant but negligible increase in hospital admission (χ2 (1, n=13 120)=98.385, p<0.001, phi=0.087) and readmission within 30 days (χ2 (1, n=13 120)=86.288, p<0.001, phi=0.081). DISCUSSION Emergency care clinicians access primary care records more frequently for older patients or those in higher triage categories. Increased levels of inpatient admission and re-presentation within 30 days are likely linked to age and triage categories. CONCLUSION Further studies should focus on the impact of record access on clinical and process outcomes and which record elements have the most utility to shape clinical decisions.
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Affiliation(s)
- Thomas Bowden
- HREC, Macquarie University, Sydney, New South Wales, Australia
| | - David Lyell
- HREC, Macquarie University, Sydney, New South Wales, Australia
| | - Enrico Coiera
- HREC, Macquarie University, Sydney, New South Wales, Australia
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Austin EE, Blakely B, Tufanaru C, Selwood A, Braithwaite J, Clay-Williams R. Strategies to measure and improve emergency department performance: a scoping review. Scand J Trauma Resusc Emerg Med 2020; 28:55. [PMID: 32539739 PMCID: PMC7296671 DOI: 10.1186/s13049-020-00749-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022] Open
Abstract
Background Over the last two decades, Emergency Department (ED) crowding has become an increasingly common occurrence worldwide. Crowding is a complex and challenging issue that affects EDs’ capacity to provide safe, timely and quality care. This review aims to map the research evidence provided by reviews to improve ED performance. Methods and findings We performed a scoping review, searching Cochrane Database of Systematic Reviews, Scopus, EMBASE, CINAHL and PubMed (from inception to July 9, 2019; prospectively registered in Open Science Framework https://osf.io/gkq4t/). Eligibility criteria were: (1) review of primary research studies, published in English; (2) discusses a) how performance is measured in the ED, b) interventions used to improve ED performance and their characteristics, c) the role(s) of patients in improving ED performance, and d) the outcomes attributed to interventions used to improve ED performance; (3) focuses on a hospital ED context in any country or healthcare system. Pairs of reviewers independently screened studies’ titles, abstracts, and full-texts for inclusion according to pre-established criteria. Discrepancies were resolved via discussion. Independent reviewers extracted data using a tool specifically designed for the review. Pairs of independent reviewers explored the quality of included reviews using the Risk of Bias in Systematic Reviews tool. Narrative synthesis was performed on the 77 included reviews. Three reviews identified 202 individual indicators of ED performance. Seventy-four reviews reported 38 different interventions to improve ED performance: 27 interventions describing changes to practice and process (e.g., triage, care transitions, technology), and a further nine interventions describing changes to team composition (e.g., advanced nursing roles, scribes, pharmacy). Two reviews reported on two interventions addressing the role of patients in ED performance, supporting patients’ decisions and providing education. The outcomes attributed to interventions used to improve ED performance were categorised into five key domains: time, proportion, process, cost, and clinical outcomes. Few interventions reported outcomes across all five outcome domains. Conclusions ED performance measurement is complex, involving automated information technology mechanisms and manual data collection, reflecting the multifaceted nature of ED care. Interventions to improve ED performance address a broad range of ED processes and disciplines.
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Affiliation(s)
- Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Brette Blakely
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Catalin Tufanaru
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Amanda Selwood
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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11
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Wang J, Huang J, Cheung CSK, Wong WN, Cheung NT, Wong MC. Adoption of an Electronic Patient Record Sharing Pilot Project: Cross-Sectional Survey. J Med Internet Res 2020; 22:e13761. [PMID: 32250279 PMCID: PMC7171565 DOI: 10.2196/13761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 11/26/2019] [Accepted: 02/09/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The Public Private Interface-Electronic Patient Record (PPI-ePR) system was implemented as a new electronic platform to facilitate collaboration between the public and private sectors in Hong Kong. However, its barriers to participate and benefits have not been comprehensively assessed. OBJECTIVE This study aimed to evaluate the awareness, acceptance, perceived benefits, and obstacles to participation among private doctors and the general public. METHODS From December 2012 to January 2013, 2435 telephone interviews were performed by trained interviewers to survey randomly selected patients who were enrolled or not enrolled in the PPI-ePR system. In addition, self-administered surveys were sent by postal mail to 4229 registered doctors in Hong Kong. The questionnaires for both patients and doctors contained questions on subjects' awareness, acceptance, and perceptions of the PPI-ePR, perceived benefits and obstacles of participating in the program, reasons for not using the system after enrolling, and perceived areas for service improvement of the system. RESULTS More than 53.1% (266/501) of enrolled patients believed that the PPI-ePR system would improve health care quality by reducing duplicate tests and treatments, while more than 76.8% (314/409) of enrolled doctors emphasized timely access to patients' medical records as the biggest benefit of their enrollment. Among nonenrolled patients, unawareness of the project was the most popular obstacle to enrolling in the PPI-ePR system (483/1200, 40.3%). Regarding nonenrolled doctors, the complicated registration process hindered them from participating in the program the most (95/198, 48.0%). Television, newspaper, and magazine advertisements and medical profession newsletters or journals were suggested as the most effective means to encourage participation in the program among surveyed patients (1297/1701, 76.2%) and doctors (428/610, 70.2%), respectively. Lack of clinical indication requiring data extraction from other hospitals was the main reason for low level of PPI-ePR use. CONCLUSIONS This study comprehensively assessed the popularity, perceived benefits, and hindering factors of enrolling in the PPI-ePR system in Hong Kong. Low levels of awareness, few privacy concerns, and inactive use of the PPI-ePR system were among the key features for patients and physicians. Public promotions, simplified logistics, and a user-friendly online interface were suggested to improve the coverage and effectiveness of health information exchange between private and public health care sectors.
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Affiliation(s)
- Jingxuan Wang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, New Territories, Hong Kong
| | - Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, New Territories, Hong Kong
| | - Clement Shek Kei Cheung
- Information Technology and Health Informatics Division, Hospital Authority, Hong Kong, China
| | - Wing Nam Wong
- Information Technology and Health Informatics Division, Hospital Authority, Hong Kong, China
| | - Ngai Tseung Cheung
- Information Technology and Health Informatics Division, Hospital Authority, Hong Kong, China
| | - Martin Cs Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, New Territories, Hong Kong
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12
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Miles P, Hugman A, Ryan A, Landgren F, Liong G. Towards routine use of national electronic health records in Australian emergency departments. Med J Aust 2020; 210 Suppl 6:S7-S9. [PMID: 30927465 DOI: 10.5694/mja2.50033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Paul Miles
- eHealth and Medication Safety, Australian Commission on Safety and Quality in Health Care, Sydney, NSW
| | - Andrew Hugman
- eHealth and Medication Safety, Australian Commission on Safety and Quality in Health Care, Sydney, NSW
| | - Angela Ryan
- Australian Digital Health Agency, Sydney, NSW
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13
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Baharudin A, Abdul Latiff AH, Woo K, Yap FBB, Tang IP, Leong KF, Chin WS, Wang DY. Using Patient Profiles To Guide The Choice Of Antihistamines In The Primary Care Setting In Malaysia: Expert Consensus And Recommendations. Ther Clin Risk Manag 2019; 15:1267-1275. [PMID: 31802877 PMCID: PMC6828722 DOI: 10.2147/tcrm.s221059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/14/2019] [Indexed: 01/05/2023] Open
Abstract
H1-antihistamines are recognized to be effective for conditions such as allergic rhinitis and chronic spontaneous urticaria. However, management of such conditions in the real-world primary care setting may be challenging due to diverse patient-specific considerations, the wide range of antihistamines available, choice of other treatment modalities, and the complexity of interpreting specialist treatment algorithms. Despite regular updates to international guidelines, regional/national surveys of healthcare professionals show a clear gap between guidelines and real-world practice, particularly at the primary care level. This article thus presents the consensus opinion of experts from relevant specialties in Malaysia - allergology, pediatrics, otorhinolaryngology, and dermtology - on harmonizing the use and choice of antihistamines in primary care. Patient profiling is recommended as a tool to guide primary care practitioners in prescribing the appropriate antihistamine for each patient. Patient profiling is a three-step approach that involves 1) identifying the individual's needs; 2) reviewing patient-specific considerations; and 3) monitoring treatment response and referral to specialists in more severe or difficult-to-treat cases. Concurrently, guidelct 3ines should be reviewed and updated periodically to include recommendations that are easily actionable for primary care practitioners.
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Affiliation(s)
- Abdullah Baharudin
- Department of Otorhinolaryngology - Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | | | - Kent Woo
- Allergy and Immunology Clinic, Gleneagles Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Felix Boon-Bin Yap
- Department of Dermatology, Sunway Medical Centre, Bandar Sunway, Selangor, Malaysia
| | - Ing Ping Tang
- Department of Otorhinolaryngology - Head and Neck Surgery, Faculty of Medicine & Health Sciences, University Malaysia Sarawak, Kuching, Sarawak, Malaysia
| | - Kin Fon Leong
- Department of Dermatology, Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Wai Seong Chin
- Pediatric Clinic, Dr Chin's Child Specialist Clinic, Kuala Lumpur, Malaysia
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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14
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Pérez T, Moriarty F, Wallace E, McDowell R, Redmond P, Fahey T. Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: longitudinal study. BMJ 2018; 363:k4524. [PMID: 30429122 PMCID: PMC6233705 DOI: 10.1136/bmj.k4524] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine whether hospital admission is associated with potentially inappropriate prescribing among older primary care patients (aged ≥65 years) and whether such prescribing was more likely after hospital admission than before. DESIGN Longitudinal study of retrospectively extracted data from general practice records. SETTING 44 general practices in Ireland in 2012-15. PARTICIPANTS Adults aged 65 years or over attending participating practices. EXPOSURE Admission to hospital (any hospital admission versus none, and post-admission versus pre-admission). MAIN OUTCOME MEASURES Prevalence of potentially inappropriate prescribing assessed using 45 criteria from the Screening Tool for Older Persons' Prescription (STOPP) version 2, analysed both as rate of distinct potentially inappropriate prescribing criteria met (stratified Cox regression) and binary presence of potentially inappropriate prescribing (logistic regression) and adjusted for patients' characteristics. A sensitivity analysis used matching with propensity scores based on patients' characteristics and diagnoses. RESULTS Overall 38 229 patients were included, and during 2012 the mean age was 76.8 (SD 8.2) years and 43% (13 212) were male. Each year, 10.4-15.0% (3015/29 077 in 2015 to 4537/30 231 in 2014) of patients had at least one hospital admission. The overall prevalence of potentially inappropriate prescribing ranged from 45.3% (13 940/30 789) of patients in 2012 to 51.0% (14 823/29 077) in 2015. Independently of age, sex, number of prescription items, comorbidity, and health cover, hospital admission was associated with a higher rate of distinct potentially inappropriate prescribing criteria met; the adjusted hazard ratio for hospital admission was 1.24 (95% confidence interval 1.20 to 1.28). Among participants who were admitted to hospital, the likelihood of potentially inappropriate prescribing after admission was higher than before admission, independent of patients' characteristics; the adjusted odds ratio for after hospital admission was 1.72 (1.63 to 1.84). Analysis of propensity score matched pairs showed a slight reduction in the hazard ratio for hospital admission to 1.22 (1.18 to 1.25). CONCLUSION Hospital admission was independently associated with potentially inappropriate prescribing. It is important to determine how hospital admission may affect appropriateness of prescribing for older people and how potential adverse consequences of admission can be minimised.
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Affiliation(s)
- Teresa Pérez
- Department of Statistics and Data Science, Complutense University of Madrid, Madrid, Spain
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Moriarty
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emma Wallace
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ronald McDowell
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
- Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Patrick Redmond
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Tom Fahey
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
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15
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Mold F, Raleigh M, Alharbi NS, de Lusignan S. The Impact of Patient Online Access to Computerized Medical Records and Services on Type 2 Diabetes: Systematic Review. J Med Internet Res 2018; 20:e235. [PMID: 29980499 PMCID: PMC6054706 DOI: 10.2196/jmir.7858] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 11/28/2017] [Accepted: 05/15/2018] [Indexed: 12/05/2022] Open
Abstract
Background Online access to computerized medical records has the potential to improve convenience, satisfaction, and care for patients, and to facilitate more efficient organization and delivery of care. Objective The objective of this review is to explore the use and impact of having online access to computerized medical records and services for patients with type 2 diabetes mellitus in primary care. Methods Multiple international databases including Medline, Embase, CINAHL, PsycINFO and the Cochrane Library were searched between 2004 and 2016. No limitations were placed on study design, though we applied detailed inclusion and exclusion criteria to each study. Thematic analysis was used to synthesize the evidence. The Mixed Methods Appraisal Toolkit was used to appraise study quality. Results A search identified 917 studies, of which 28 were included. Five themes were identified: (1) disparities in uptake by age, gender, ethnicity, educational attainment, and number of comorbidities, with young men in full-time employment using these services most; (2) improved health outcomes: glycemic control was improved, but blood pressure results were mixed; (3) self-management support from improved self-care and shared management occurred especially soon after diagnosis and when complications emerged. There was a generally positive effect on physician-patient relationships; (4) accessibility: patients valued more convenient access when online access to computerized medical records and services work; and (5) technical challenges, barriers to use, and system features that impacted patient and physician use. The Mixed Methods Appraisal Toolkit rated 3 studies as 100%, 19 studies as 75%, 4 studies as 50%, and 1 study scored only 25%. Conclusions Patients valued online access to computerized medical records and services, although in its current state of development it may increase disparities. Online access to computerized medical records appears to be safe and is associated with improved glycemic control, but there was a lack of rigorous evidence in terms of positive health outcomes for other complications, such as blood pressure. Patients remain concerned about how these systems work, the rules, and timeliness of using these systems.
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Affiliation(s)
- Freda Mold
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Mary Raleigh
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Nouf Sahal Alharbi
- Department of Health Sciences, College of Applied Studies & Community Service, King Saud University, Riyadh, Saudi Arabia
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
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Liyanage H, Liaw ST, Konstantara E, Mold F, Schreiber R, Kuziemsky C, Terry AL, de Lusignan S. Benefit-risk of Patients' Online Access to their Medical Records: Consensus Exercise of an International Expert Group. Yearb Med Inform 2018; 27:156-162. [PMID: 29681044 PMCID: PMC6115222 DOI: 10.1055/s-0038-1641202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background:
Patients' access to their computerised medical records (CMRs) is a legal right in many countries. However, little is reported about the benefit-risk associated with patients' online access to their CMRs.
Objective:
To conduct a consensus exercise to assess the impact of patients' online access to their CMRs on the quality of care as defined in six domains by the Institute of Medicine (IoM), now the National Academy of Medicine (NAM).
Method:
A five-round Delphi study was conducted. Round One explored experts' (n = 37) viewpoints on providing patients with access to their CMRs. Round Two rated the appropriateness of statements arising from Round One (n = 16). The third round was an online panel discussion of findings (n = 13) with the members of both the International Medical Informatics Association and the European Federation of Medical Informatics Primary Health Care Informatics Working Groups. Two additional rounds, a survey of the revised consensus statements and an online workshop, were carried out to further refine consensus statements.
Results:
Thirty-seven responses from Round One were used as a basis to initially develop 15 statements which were categorised using IoM's domains of care quality. The experts agreed that providing patients online access to their CMRs for bookings, results, and prescriptions increased efficiency and improved the quality of medical records. Experts also anticipated that patients would proactively use their online access to share data with different health care providers, including emergencies. However, experts differed on whether access to limited or summary data was more useful to patients than accessing their complete records. They thought online access would change recording practice, but they were unclear about the benefit-risk of high and onerous levels of security. The 5-round process, finally, produced 16 consensus statements.
Conclusion:
Patients' online access to their CMRs should be part of all CMR systems. It improves the process of health care, but further evidence is required about outcomes. Online access improves efficiency of bookings and other services. However, there is scope to improve many of the processes of care it purports to support, particularly the provision of a more effective interface and the protection of the vulnerable.
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Affiliation(s)
- Harshana Liyanage
- Department of Clinical & Experimental Medicine, University of Surrey, GUILDFORD, Surrey, UK
| | - Siaw-Teng Liaw
- School of Public Health & Community Medicine, UNSW Medicine Australia, Ingham Institute of Applied Medical Research, NSW, Australia
| | - Emmanouela Konstantara
- Department of Clinical & Experimental Medicine, University of Surrey, GUILDFORD, Surrey, UK
| | - Freda Mold
- Department of Health and Medical Sciences, University of Surrey, GUILDFORD, Surrey GU2 7TE, UK
| | | | - Craig Kuziemsky
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada, K1N 6N5
| | - Amanda L Terry
- Centre for Studies in Family Medicine, Department of Family Medicine, Interfaculty Program in Public Health, Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Simon de Lusignan
- Department of Clinical & Experimental Medicine, University of Surrey, GUILDFORD, Surrey, UK
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