Embedding online patient record access in UK primary care: a survey of stakeholder experiences

Summary Objectives To explore the integration of online patient Record Access within UK Primary Care, its perceived impacts on workload and service quality, and barriers to implementation. Design Mixed format survey of clinicians, administrators and patients. Telephone interviews with non-users. Setting Primary care centres within NHS England that had offered online record access for the preceding year. Participants Of the 57 practices initially agreeing to pilot the system, 32 had adopted it and 16 of these returned questionnaires. The 42 individual respondents included 14 practice managers, 15 clinicians and 13 patients. Follow-up interviews were conducted with one participant from 15 of the 25 non-adopter practices. Results Most professionals believed that the system is easy to integrate within primary care; while most patients found it easy to integrate within their daily lives. Professionals perceived no increase in the volume of patient queries or clinical consultations as a result of Record Access; indeed some believed that these had decreased. Most clinicians and patients believed that the service had improved mutual trust, communication, patients’ health knowledge and health behaviour. Inhibiting factors included concerns about security, liability and resource requirements. Non-adoption was most frequently attributed to competing priorities, rather than negative beliefs about the service. Conclusions Record access has an important role to play in supporting patient-focused healthcare policies in the UK and may be easily accommodated within existing services. Additional materials to facilitate patient recruitment, inform system set-up processes, and assure clinicians of their legal position are likely to encourage more widespread adoption. </jats:sec

Giving patients online access to their electronic primary care record: experiences and perceptions of practice staff and service users

The Record Access Collaborative is a voluntary network of clinicians, academics, industry representatives and policymakers interested in emerging Personal Health Record technologies and their impacts on patients and health service providers. This study was commissioned by the Collaborative to explore stakeholders’ experiences with and perceptions of a system that allows patients to access their detailed primary care record online. The specific aims of the analysis were to help understand: 1) How health centres have integrated Record Access into their working practices and its acceptability to providers and recipients of the service 2) How Record Access has influenced clinician behaviour, staff time or workflow, patient self-care and patient-provider relations. 3) The barriers encountered during implementation and any training or support needs that should be addressed 4) Features of the system, or its operational procedures, that may require modification or clarification. This study found overall support amongst clinicians, practice managers and patients for online Record Access. The experience gained from practices participating in this study suggests that Record Access is easy to set up and manage and has few implications for clinical workflow. All three groups articulated benefits that this service will bring to the working practice of health centres, to the health and empowerment of patients, and to the relationships between patients and the health system. At the same time, the study pointed to a number of barriers, uncertainties and areas of improvement that should be addressed before wider deployment. Record access clearly has an important role to play in supporting a more patient focused health system and these findings provide a useful road map for the successful expansion and roll-out of these services

Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit.

BACKGROUND: Continual improvements in diagnostic processes are needed to minimise the proportion of patients with cancer who experience diagnostic delays. Clinical audit is a means of achieving this. AIM: To characterise key aspects of the diagnostic process for cancer and to generate baseline measures for future re-audit. DESIGN AND SETTING: Clinical audit of cancer diagnosis in general practices in England. METHOD: Information on patient and tumour characteristics held in the English National Cancer Registry was supplemented by information from GPs in participating practices. Data items included diagnostic timepoints, patient characteristics, and clinical management. RESULTS: Data were collected on 17 042 patients with a new diagnosis of cancer during 2014 from 439 practices. Participating practices were similar to non-participating ones, particularly regarding population age, urban/rural location, and practice-based patient experience measures. The median diagnostic interval for all patients was 40 days (interquartile range [IQR] 15-86 days). Most patients were referred promptly (median primary care interval 5 days [IQR 0-27 days]). Where GPs deemed diagnostic delays to have occurred (22% of cases), patient, clinician, or system factors were responsible in 26%, 28%, and 34% of instances, respectively. Safety netting was recorded for 44% of patients. At least one primary care-led investigation was carried out for 45% of patients. Most patients (76%) had at least one existing comorbid condition; 21% had three or more. CONCLUSION: The findings identify avenues for quality improvement activity and provide a baseline for future audit of the impact of 2015 National Institute for Health and Care Excellence guidance on management and referral of suspected cancer

Cohort profile: prescriptions dispensed in the community linked to the national cancer registry in England.

PURPOSE: The linked prescriptions cancer registry data resource was set up to extend our understanding of the pathway for patients with cancer past secondary care into the community, to ultimately improve patient outcomes. PARTICIPANTS: The linked prescriptions cancer registry data resource is currently available for April to July 2015, for all patients diagnosed with cancer in England with a dispensed prescription in that time frame.The dispensed prescriptions data are collected by National Health Service (NHS) Prescription Services, and the cancer registry data are processed by Public Health England. All data are routine healthcare data, used for secondary purposes, linked using a pseudonymised version of the patient's NHS number and date of birth.Detailed demographic and clinical information on the type of cancer diagnosed and treatment is collected by the cancer registry. The dispensed prescriptions data contain basic demographic information, geography measures of the dispensed prescription, drug information (quantity, strength and presentation), cost of the drug and the date that the dispensed prescription was submitted to NHS Business Services Authority. FINDINGS TO DATE: Findings include a study of end of life prescribing in the community among patients with cancer, an investigation of repeat prescriptions to derive measures of prior morbidity status in patients with cancer and studies of prescription activity surrounding the date of cancer diagnosis. FUTURE PLANS: This English linked resource could be used for cancer epidemiological studies of diagnostic pathways, health outcomes and inequalities; to establish primary care comorbidity indices and for guideline concordance studies of treatment, particularly hormonal therapy, as a major treatment modality for breast and prostate cancer which has been largely delivered in the community setting for a number of years

Artificial intelligence for dementia research methods optimization

Artificial intelligence (AI) and machine learning (ML) approaches are increasingly being used in dementia research. However, several methodological challenges exist that may limit the insights we can obtain from high-dimensional data and our ability to translate these findings into improved patient outcomes. To improve reproducibility and replicability, researchers should make their well-documented code and modeling pipelines openly available. Data should also be shared where appropriate. To enhance the acceptability of models and AI-enabled systems to users, researchers should prioritize interpretable methods that provide insights into how decisions are generated. Models should be developed using multiple, diverse datasets to improve robustness, generalizability, and reduce potentially harmful bias. To improve clarity and reproducibility, researchers should adhere to reporting guidelines that are co-produced with multiple stakeholders. If these methodological challenges are overcome, AI and ML hold enormous promise for changing the landscape of dementia research and care. HIGHLIGHTS: Machine learning (ML) can improve diagnosis, prevention, and management of dementia. Inadequate reporting of ML procedures affects reproduction/replication of results. ML models built on unrepresentative datasets do not generalize to new datasets. Obligatory metrics for certain model structures and use cases have not been defined. Interpretability and trust in ML predictions are barriers to clinical translation

Innovation in Diabetes - Ideas and Initiatives

A collection of multiple reports on MyDiabetesMyWay (MDMW). Included reports are: MyDiabetesMyWay Patient Portal; MyDiabetesMyWay e-learning hub (Moodle) ; SCI-diabetes/ MDMW Communication Portal- Tools for Remote Communication/ Consultation; Risk Modelling for Care Planning- integration into Informatics Dashboard for Clinical Use; Access to Chronic Medication Service (CMS) and Pharmaceutical Care Planning Medication and Lifestyle Coaching; Multi-media Diabetes Resources; Promoting Diabetes Education; Tele-Pharmacy; Understanding my diabetes medication; Pharmaceutical Industry and Medical Technology (PIMTs); An on-line and interactive education system for young people with type 1 diabetes to understand self-management for their lifestyle; Proof of Concept study to deliver personalised use of information to support diabetes management and behaviour change; right information; right time; right way; Virtual promotion of physical activity for people with type 2 diabetes; Remote foot ulcer management: RAPID (Reducing Amputation in People with Diabetes); Diabetic foot screening – development of technology; Portable capillary HbA1c testing for diagnosis and self-monitoring of diabetes; Possibility of mobile phone adaption for testing; Web app for decision support for patients with type 1 diabetes undertaking sport or exercise; Online level 3 structured education for type 1 diabetes; My Diabetes My Way electronic personal health record – uptake at scale; TeleClinics for diabetes; Develop a diabetes sim / game in which the main character has diabetes. Young people need to keep the sim / character alive as they face the various challenges of life or the game; Development of meaningful automated glucose data to in-patient clinical areas; In-patient Care: Integrated eHealth solutions to improve patient care, safety and outcomes; Innovative model of care to address the 'process of care' in managing people with long term conditions; Young Persons Remote Clinic Consultation; Maximise use of the data to support self-management of patients with co-morbidities; Virtual practice outreach and education in primary care

A História da Alimentação: balizas historiográficas

Os M. pretenderam traçar um quadro da História da Alimentação, não como um novo ramo epistemológico da disciplina, mas como um campo em desenvolvimento de práticas e atividades especializadas, incluindo pesquisa, formação, publicações, associações, encontros acadêmicos, etc. Um breve relato das condições em que tal campo se assentou faz-se preceder de um panorama dos estudos de alimentação e temas correia tos, em geral, segundo cinco abardagens Ia biológica, a econômica, a social, a cultural e a filosófica!, assim como da identificação das contribuições mais relevantes da Antropologia, Arqueologia, Sociologia e Geografia. A fim de comentar a multiforme e volumosa bibliografia histórica, foi ela organizada segundo critérios morfológicos. A seguir, alguns tópicos importantes mereceram tratamento à parte: a fome, o alimento e o domínio religioso, as descobertas européias e a difusão mundial de alimentos, gosto e gastronomia. O artigo se encerra com um rápido balanço crítico da historiografia brasileira sobre o tema

Distributed Middleware Enforcement of Event Flow Security Policy

Distributed, event-driven applications that process sensitive user data and involve multiple organisational domains must comply with complex security requirements. Ideally, developers want to express security policy for such applications in data-centric terms, controlling the flow of information throughout the system. Current middleware does not support the specification of such end-to-end security policy and lacks uniform mechanisms for enforcement. We describe DEFCon-Policy, a middleware that enforces security policy in multi-domain, event-driven applications. Event flow policy is expressed in a high-level language that specifies permitted flows between distributed software components. The middleware limits the interaction of components based on the policy and the data that components have observed. It achieves this by labelling data and assigning privileges to components. We evaluate DEFCon-Policy in a realistic medical scenario and demonstrate that it can provide global security guarantees without burdening application developers

Statistics of e-region backscatter and investigations of auroral convection signatures.

In this thesis data from the Sweden And Britain Radar Experiment is examined in a statistical investigation of the variation of the radar backscatter amplitude due to variations in the ionospheric convection. The response of the radar backscatter is examined over an eight year interval from 1982 until 1989 and a strong dependence of the variation of the backscatter amplitude on flow direction and magnitude determined during the solar cycle. The results are discussed with reference to three geophysical parameters which control the relationship between the backscatter intensity and Doppler velocity, namely the ambient electron density, the electron density fluctuation amplitude and the dimensions of the scattering layer. Data from the SABRE system is further utilised in two studies involving three distinct types of transient perturbations of the ionospheric convection pattern. Substorm Associated Radar Auroral Surges (SARAS) are examined in a statistical manner to obtain a more complete description of the feature. The results of this examination are utilised in a discussion of a possible magnetospheric source and generation mechanism for SARAS. The auroral radar signature of an o band is characterised with the aid of the complementary and coincident information provided by Viking UV images. Characterisation of the VHF radar signature resulting from the passage of this o band structure allows a link between a second o band and a radar flow burst signature to be made. It is suggested that a flow burst signature is observed coincident with the western (trailing edge) of the luminous region of an eastward drifting o band. A preliminary investigation of the field aligned current systems associated with the o band structure is also presented, the results of which compared favourably with models pertaining to the electrodynamics of an o band system