Enabling laboratory medicine in primary care through EMR systems use: A survey of Canadian physicians

Important problems remain with regard to the efficiency and effectiveness of laboratory testing in primary care. In view of this, a significant function of electronic medical record (EMR) systems is to enable the practice of laboratory medicine by primary care physicians (PCPs). In addressing this issue, the present study aims to deepen our understanding of the nature and effectiveness of PCPs’ use of EMR systems for patient management and care within the laboratory testing process. To achieve our main objective, a survey of 684 Canadian physicians was realized. Results confirm that the artefactual and clinical contexts of EMR use influence the extensiveness of this use for communicational and clinical purposes. In turn, it is confirmed that the more extensive the use of EMR for laboratory medicine, the greater its impacts on the PCPs’ efficiency and on the quality of care provided by these physicians. The implications of these results are discussed

Gesundheitsökonomische Evaluationen in der Primärversorgung

Hintergrund: Unser Gesundheitssystem muss sich in Zukunft neuen Herausforderung stellen. Es liegt in der Verantwortung der Entscheider im Gesundheitswesen und in der Verantwortung der Ärzte, die limitierten Mittel möglichst kosteneffektiv zu nutzen. Vor diesem Hintergrund ist eine Übersicht über gesundheitsökonomische Evaluationen im Setting der Primärversorgung notwendig. Methoden: Studien wurden mittels einer systematischen Suche in Pubmed und der National Health Service Economic Evaluation Darabase bis 2016 identifiziert. Diese Studien wurden von zwei unabhängigen Reviewern ein- oder ausgeschlossen und anschließend kategorisiert. Ergebnisse: Insgesamt wurden 384 Studien für gesundheitsökonomische Evaluationen in der Primärversorgung ermittelt. Im zeitlichen Trend war eine kontinuierliche Zunahme an Erscheinungen erkennbar. Mit 71,61% waren Cost-Effectiveness-Analysen insgesamt am meisten vertreten. Die Nationen, auf die sich die Interventionen am häufigsten bezogen, sind Großbritannien (37,8 %), die USA (16,1 %) und die Niederlande (10,4%). Therapeutische Interventionen mit 48,4% wurden häufig evaluiert. Psychische (22,1%) und Kardiovaskuläre (14,6%) Themen mit bildeten die Schwerpunkte im Bereich der vertretenen Krankheitsbilder. Schlussfolgerungen: Gesundheitsökonomische Evaluationen von Maßnahmen und Strukturen der Primärversorgung haben in den letzten Jahren international deutlich an Bedeutung gewonnen. Forschungsstarke Länder sind in diesem Kontext häufig solche, deren Primärversorgung stark ausgebildet ist. Der Stellenwert gesundheitsökonomischer Evaluationen in der Primärversorgung Deutschlands ist gering. Hoch relevante und dringend notwendige Studien zu vielen primärärztlichen Fragestellungen sind kaum vorhanden. Weitere Arbeiten im Anschluss an dieses Dissertationsprojekt müssen der Verifikation der hier geäußerten Hypothesen in qualitativen und quantiativen Anschlussstudien dienen, die methodische Umsetzung der untersuchten Studien in ausgewählten Bereiche und Fragestellungen prüfen und den in dieser Studie aufgezeigten Entwicklungstrend weiter verfolgen

Implementing a Large-scale Electronic Health Record System in the Primary Healthcare Centres in Saudi Arabia

There is worldwide demand for the implementation of electronic health systems and a transformation to electronic transactions in healthcare organisations. This move to e-health transformation stems from the perceived positive impact that e-health systems have in improving the quality of healthcare and, in turn, reducing expenses. Despite this, more than half of previous Electronic Health Record System (EHRS) implementation projects have failed due to several barriers and challenges. There has been no previous research that has explored the implementation of an EHRS in Primary Healthcare Centres (PHCs). In addition, barriers and facilitators to the implementation of large-scale EHRS in PHCs are not well defined and there is little known about the impact of Financial Resources (FR) and Centralised Management (CM) on such implementation. Thus, this thesis aims to explore the large-scale implementation of EHRS in PHCs in Saudi Arabia (SA). To achieve this aim, a mixed-methods approach comprising both quantitative and qualitative methods was adopted. Data were collected via questionnaire-based studies and semi-structured interviews. Three different populations were targeted: project team members, PHC staff, and EHRS end-users. Descriptive and inferential statistics were applied to the quantitative data, and thematic analysis was used to analyse the qualitative data. The findings revealed high PHCs readiness at the organisational and individual level when compared with the technological level. Both FR and CM were documented to have a positive impact on the implementation of a large scale EHRS. Several facilitators to the implementation of the EHRS were identified, including: strong leadership and appropriate management, PHC specifications, system usability, perceived usefulness and efficiency. The scale of the project, shortage in Health Informatics (HI) expertise, lack of training and support, geographic challenges, software selection and end-user involvement were identified as the main barriers to implementing a large-scale EHRS in the PHCs. No relationships were detected between individual demographic differences, such as age and gender, and level of readiness or satisfaction. Based on the Saudi experience, there may be some important transferable lesson for similar projects elsewhere. Large-scale EHRS projects need to adopt CM. In addition, due to shortage in HI expertise, policymakers may need to carry out some consultations to formulate good implementation plane. Large-scale projects also need to be implemented by more than one vendor and include training and technical support to increase end-user satisfaction. Inadequate infrastructure, lack of interoperability, changing executives and lack of technical support were the main possible causes to the failure of large-scale EHRS projects. Implementation needs to ensure sufficient budget and time have been allocated to mitigate the challenges identified