Effects of Electronic Communication in General Practice

There is a continuous growth in the number of different physicians involved in the treatment of an individual patient. This increase is caused by the growing specialization of physicians in particular fields, by the increasing number of physicians that work part time, and by transmuralization. With transmuralization is meant the trend to place expensive hospital care partly outside the hospital, whereby general practitioners and specialised nurses fulfill an essential role. Another important cause for the increasing number of physicians is that the average patient becomes much older than before, with the chance of getting more often confronted with different disorders and therefore also with different specialists. The increase in the number of physicians results in a growing need for good communication to guarantee the quality of care

Shaping the future for primary care education and training project. Best practise in education and training strategies for integrated health and social care: development of a benchmarking tool

Collaboration and partnership working between Higher Education and the NHS is an essential requirement for effective delivery of care (Universities UK 2003). The North West Universities Association (NWUA) and the North West Development Agency (NWDA) are two organisations at the forefront of creating such alliances. The research project, Shaping the Future for Primary Care Education and Training Project is a collaborative partnership between both these organisations and seven North West Higher Education Institutions. In addition, the project brings together for the first time all the key partners in the health, social care and education sectors who are involved in supporting the delivery of integrated health and social care in the North West Region

Impact of electronic medical record on physician practice in office settings: a systematic review

<p>Abstract</p> <p>Background</p> <p>Increased investments are being made for electronic medical records (EMRs) in Canada. There is a need to learn from earlier EMR studies on their impact on physician practice in office settings. To address this need, we conducted a systematic review to examine the impact of EMRs in the physician office, factors that influenced their success, and the lessons learned.</p> <p>Results</p> <p>For this review we included publications cited in Medline and CINAHL between 2000 and 2009 on physician office EMRs. Studies were included if they evaluated the impact of EMR on physician practice in office settings. The Clinical Adoption Framework provided a conceptual scheme to make sense of the findings and allow for future comparison/alignment to other Canadian eHealth initiatives.</p> <p>In the final selection, we included 27 controlled and 16 descriptive studies. We examined six areas: prescribing support, disease management, clinical documentation, work practice, preventive care, and patient-physician interaction. Overall, 22/43 studies (51.2%) and 50/109 individual measures (45.9%) showed positive impacts, 18.6% studies and 18.3% measures had negative impacts, while the remaining had no effect. Forty-eight distinct factors were identified that influenced EMR success. Several lessons learned were repeated across studies: (a) having robust EMR features that support clinical use; (b) redesigning EMR-supported work practices for optimal fit; (c) demonstrating value for money; (d) having realistic expectations on implementation; and (e) engaging patients in the process.</p> <p>Conclusions</p> <p>Currently there is limited positive EMR impact in the physician office. To improve EMR success one needs to draw on the lessons from previous studies such as those in this review.</p

E-referral Solutions: Successful Experiences, Key Features and Challenges- a Systematic Review

Background: around the world health systems constantly face increasing pressures which arise from many factors, such as an ageing population, patients and providers demands for equipment’s and services . In order to respond these challenges and reduction of health system’s transactional costs, referral solutions are considered as a key factor. This study was carried out to identify referral solutions that have had successes. Methods: relevant studies identified using keywords of referrals, consultation, referral system, referral model, referral project, electronic referral, electronic booking, health system, healthcare, health service and medical care. These searches were conducted using PubMed, ProQuest, Google Scholar, Scopus, Emerald, Web of Knowledge, Springer, Science direct, Mosby’s index, SID, Medlib and Iran Doc data bases. 4306 initial articles were obtained and refined step by step. Finally, 27 articles met the inclusion criteria. Results: we identified seventeen e-referral systems developed in UK, Norway, Finland, Netherlands, Denmark, Scotland, New Zealand, Canada, Australia, and U.S. Implemented solutions had variant degrees of successes such as improved access to specialist care, reduced wait times, timeliness and quality of referral communication, accurate health information transfer and integration of health centers and services. Conclusion: each one of referral solutions has both positive and changeable aspects that should be addressed according to sociotechnical conditions. These solutions are mainly formed in a small and localized manner

Impactos da tecnologia da informação na produção de publicações científicas eletrônicas

This paper is a result of an academic research. A study that identifies and tracks the impacts caused by Information Technology (IT) to routines and abilities of production and use of scientific publication, on a community of Science and Technology (C&amp;T). It is also related to technical literature productivity, as well as, institutional visibility. This research has been developed through a case study. An self-administrated electronic questionnaire and semi-structured interviews had been used for data field collection. The e-mail was elected as the main medium of communication with the participants. Therefore, the “electronic reply behaviour” was also object of investigation. The conclusions indicate that the community assumed and legitimised the electronic communication mediated by computers. They perceive IT as a differential of autonomy, optimisation of processes, time saving and a mean of institutional visibility. Significant alterations had been identified in internal and external communication flows. They were also observed on relationships among invisible colleges and peers, on the increase of the real work produced and on productivity. The scientific community recognises the benefits of remote access to bibliographical databases and to digital full texts.Trabalho resultante de pesquisa acadêmica para tese de doutorado, trata da identificação dos impactos ocasionados pela Tecnologia da Informação (TI) às rotinas e competências de geração, comunicação e uso de publicações científicas em uma comunidade de Ciência e Tecnologia (C&amp;T). Também foram considerados os aspectos referentes à produtividade técnico-literária e visibilidade institucional. A pesquisa foi desenvolvida através de estudo de caso, e, para a coleta de dados de campo, foram utilizados um questionário eletrônico auto-administrado e entrevistas semi-estruturadas. O correio eletrônico foi utilizado como principal meio de comunicação com os participantes da pesquisa, e o comportamento de resposta via e-mail também foi observado. As conclusões indicaram que a comunidade assumiu e legitimou a comunicação eletrônica mediada por computadores. Percebem a TI como um diferencial de autonomia, otimização de processos, economia de tempo e ampliação da visibilidade institucional. As alterações significativas foram identificadas nos processos e fluxos de comunicação internos e externos, na relação com pares e colégios invisíveis, na quantidade de trabalho real e na produtividade. Também reconhecem os benefícios do acesso remoto às bases de dados bibliográficas referenciais, e, principalmente, as de textos completos

Atypical organisms affecting the respiratory tract and their sequelae – a series of case studies

The respiratory tract is exposed to a wide range of environmental constituents including potentially infective agents. This thesis presents two series of papers concerning two atypical organisms and their sequelae or potential sequelae – Coxiella burnetii, which causes Q fever, and flagellated protozoa, which is associated with respiratory symptoms and asthma. The first series of papers examine a Q fever outbreak and its sequelae. They describe one of the largest Q fever outbreaks in the UK and demonstrate the benefit of facsimile cascade in supporting case searching in such an outbreak. Chronic fatigue (Chalder Fatigue scores) and depression (PHQ-9 scores) were raised in post Q fever patients six years later (p<0.05 in both cases). Concordance regarding serological status across three international reference laboratories was as low as 35%, indicating a major problem with international standardisation in this area. Unpublished supplementary clinical and serological findings are also presented to inform future outbreak investigation. The second series of papers examine the role of flagellated protozoa in respiratory disease. Flagellated protozoa were shown to be present in a case series of inpatients. In a subsequent community-based case control study, protozoa were present in 67% (20/30) of induced sputum samples taken from asthmatics and 31% (4/13) of samples from non-atopic controls (p=0.046). In another study of inpatients, 67% of those who were on oral steroids had protozoa in their sputum, compared to 35% of those not on oral steroids. In this study, 45% of smokers/ex-smokers had protozoa in their sputum compared to 30% of non-smokers. Unpublished data using molecular techniques to identify eukaryotes in sputum is also presented. The findings provide a basis for a RCT of antibiotics in patients with post Q fever chronic fatigue and a trial of anti-protozoal agents to eradicate flagellated protozoa in patients with asthma.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Communication in Healthcare: Opportunities for information technology and concerns for patient safety

Understanding healthcare workflow is fundamental for design and implementation of information systems. Communication and information exchange between healthcare professionals plays a pivotal role in developing smooth workflow within and between healthcare organizations. The study in this thesis analyzes the interaction between Information Technology (IT) and the medication process within and between healthcare organizations. The focus is on the interactions that lead to communication problems and as a result lead to unintended negative consequences on patient safety. The thesis examines several cases of IT intervention to improve intra- and inter-organizational communication. It raises important implications on how to design and implement IT systems that support healthcare processes without jeopardizing patient safety. The author concludes for IT to improve healthcare communication and patient safety, at intra-organizational level, it has to support the highly integrated nature of the shared healthcare work. At inter-organizational level the main challenge is that different pieces of the shared work are not sufficiently integrated