A study of general practitioners' perspectives on electronic medical records systems in NHS Scotland

<b>Background</b> Primary care doctors in NHSScotland have been using electronic medical records within their practices routinely for many years. The Scottish Health Executive eHealth strategy (2008-2011) has recently brought radical changes to the primary care computing landscape in Scotland: an information system (GPASS) which was provided free-of-charge by NHSScotland to a majority of GP practices has now been replaced by systems provided by two approved commercial providers. The transition to new electronic medical records had to be completed nationally across all health-boards by March 2012. <p></p><b> Methods</b> We carried out 25 in-depth semi-structured interviews with primary care doctors to elucidate GPs' perspectives on their practice information systems and collect more general information on management processes in the patient surgical pathway in NHSScotland. We undertook a thematic analysis of interviewees' responses, using Normalisation Process Theory as the underpinning conceptual framework. <p></p> <b>Results</b> The majority of GPs' interviewed considered that electronic medical records are an integral and essential element of their work during the consultation, playing a key role in facilitating integrated and continuity of care for patients and making clinical information more accessible. However, GPs expressed a number of reservations about various system functionalities - for example: in relation to usability, system navigation and information visualisation. <b>Conclusion </b>Our study highlights that while electronic information systems are perceived as having important benefits, there remains substantial scope to improve GPs' interaction and overall satisfaction with these systems. Iterative user-centred improvements combined with additional training in the use of technology would promote an increased understanding, familiarity and command of the range of functionalities of electronic medical records among primary care doctors

Building a national Infection Intelligence Platform to improve antimicrobial stewardship and drive better patient outcomes:the Scottish experience

Background: The better use of new and emerging data streams to understand the epidemiology of infectious disease and to inform and evaluate antimicrobial stewardship improvement programmes is paramount in the global fight against antimicrobial resistance. Objectives: To create a national informatics platform that synergises the wealth of disjointed, infection-related health data, building intelligence capability that allows rapid enquiry, generation of new knowledge and feedback to clinicians and policy makers. Methods: A multi-stakeholder community, led by the Scottish Antimicrobial Prescribing Group, secured government funding to deliver a national program of work centred on three key aspects: technical platform development with record linkage capability across multiple datasets; a proportionate governance approach to enhance responsiveness; generation of new evidence to guide clinical practice. Results: The National Health Service Scotland Infection Intelligence Platform (IIP) is now hosted within the national health data repository to assure resilience and sustainability. New technical solutions include simplified “data views” of complex, linked datasets and embedded statistical programmes to enhance capability. These developments have enabled responsiveness, flexibility and robustness in conducting population-based studies including a focus on intended and unintended effects of antimicrobial stewardship interventions and quantification of infection risk factors and clinical outcomes. Conclusion: We have completed the build and test phase of IIP, overcoming the technical and governance challenges and produced new capability in infection informatics, generating new evidence for improved clinical practice. This provides a foundation for expansion and opportunity for global collaborations

Managing interoperability and complexity in health systems

In recent years, we have witnessed substantial progress in the use of clinical informatics systems to support clinicians during episodes of care, manage specialised domain knowledge, perform complex clinical data analysis and improve the management of health organisations’ resources. However, the vision of fully integrated health information eco-systems, which provide relevant information and useful knowledge at the point-of-care, remains elusive. This journal Focus Theme reviews some of the enduring challenges of interoperability and complexity in clinical informatics systems. Furthermore, a range of approaches are proposed in order to address, harness and resolve some of the many remaining issues towards a greater integration of health information systems and extraction of useful or new knowledge from heterogeneous electronic data repositories

A study of clinical and information management processes in the surgical pre-assessment clinic

Establishing day-case surgery as the preferred hospital admission route for all eligible patients requires adequate preoperative assessment of patients in order to quickly distinguish those who will require minimum assessment and are suitable for day-case admission from those who will require more extensive management and will need to be admitted as inpatients. As part of a study to elucidate clinical and information management processes within the patient surgical pathway in NHS Scotland, we conducted a total of 10 in-depth semi-structured interviews during 4 visits to the Dumfries & Galloway Royal Infirmary surgical pre-assessment clinic. We modelled clinical processes using process-mapping techniques and analysed interview data using qualitative methods. We used Normalisation Process Theory as a conceptual framework to interpret the factors which were identified as facilitating or hindering information elucidation tasks and communication within the multi-disciplinary team. The pre-assessment clinic of Dumfries & Galloway Royal Infirmary was opened in 2008 in response to clinical and workflow issues which had been identified with former patient management practices in the surgical pathway. The preoperative clinic now operates under well established processes and protocols. The use of a computerised system for managing preoperative documentation substantially transformed clinical practices and facilitates communication and information-sharing among the multi-disciplinary team.ConclusionSuccessful deployment and normalisation of innovative clinical and information management processes was possible because both local and national strategic priorities were synergistic and the system was developed collaboratively by the POA staff and the health-board IT team, resulting in a highly contextualised operationalisation of clinical and information management processes. Further concerted efforts from a range of stakeholders are required to fully integrate preoperative assessment within the health-board surgical care pathway. A substantial – yet unfulfilled – potential benefit in embedding information technology in routine use within the preoperative clinic would be to improve the reporting of surgical outcomes

Modelling the Shift in the Balance of Care in the NHS

The concept of Shifting the Balance of Care was first introduced to NHS Scotland in 2005 through the Kerr Report. The key messages from the report were to: ensure sustainable and safe local services, which are supported by the right skills, change the emphasis of care into the community, provide preventative reactive care, and fully integrate the system to tackle the changes, use technology more effectively, and involve the public in finding solutions to change. Following the report, a framework was developed which highlighted and prioritised eight areas of improvement. These areas for improvement are the focus by which this research examines if Operational Research (OR), specifically OR models, can have a positive impact in Shifting the Balance of Care. The research utilises underlying OR methodologies and methods and provides evidence from the literature of the ability of nine selected models to facilitate the Shift in the Balance of Care. A contributing factor to the research is the barriers to implementation of OR models into the NHS. With reference to the literature, the common barriers to implementation of OR models are categorised and used to provide direction to modellers where implementation barriers are more prevalent in some models than in others. The research also provides empirical evidence of three selected models’ (the Lean Methodology, Process Mapping and Simulation, developed over two Case Studies) ability to address and influence the prioritised Improvement Areas, with the addition of a newly developed model: SoApt. The development of SoApt follows the Principles of Model Development derived as a guide to modellers who wish to develop a new model. SoApt is also empirically explored in a Case Study and provides some evidence of the models ability to aid Decision-makers, faced with limited budgets, to choose between options which will Shift the Balance of Care. OR methods and methodologies are examined to ascertain the Roles of Models for each model explored in the Case Studies. Examination of the Roles of Models against the Improvement Areas provided evidence of a models’ ability to address more than one of the priority areas and that models can be used together or sequentially. In addition, with reference to OR methods and methodologies, a theoretical Evaluation Framework is proposed which suggests the User and User Satisfaction is key to the evaluation of a model’s success; positive experiences of the User and Use of the model may help to eliminate some of the barriers to implementation

Haemodialysis Electronic Patient Portal: A Design Requirements Analysis and Feasibility Study with Domain Experts

In 2013, the UK national renal registry established 57,000 adults in the UK were treated for advanced kidney failure, 23,683 (42%) receiving haemodialysis. Haemodialysis patients face some of the highest treatment burden in the National Health Service (NHS) and are among the most 'expensive' to treat. In addition, patients endure complex treatment trajectories. In this study, we have sought to gather and synthesise the opinion of clinical and Human Computer Interaction (HCI) domain experts (n=9) to establish a set of initial design requirements in order to test the feasibility of developing a digital aid (i.e. electronic haemodialysis patient portal) to support patients in the course of their treatment. Expert feedback was gathered by means of interviews and focus groups in order to instruct design requirements for a haemodialysis patient portal