Impact of EPR systems on information flow in Finnish health centers.

INTRODUCTION: We studied how well healthcare personnel in healthcare centers (HCs) in the South Ostrobothnia region of Finland are able to obtain patient information thorough electronic patient record (EPR) systems. This study followed the changes in availability of patient information during a 7-year period, from 2003 to the end of 2010. The patient group studied focused on those involved in anticoagulant (AC) treatment. SUBJECTS AND METHODS: A structured questionnaire was sent in 2003 to the staff of 15 HCs. The questionnaire dealt with access and availability of patient information from the EPR. Respondents were asked to rate how often they obtain information concerning AC treatment from various sources. RESULTS: In total, 1,114 questionnaires were sent, and 860 answers were received; the response rate was 77%. A repeat study was conducted in 2010, and 932 responses were obtained (response rate, 56%). Paper-based AC treatment cards carried by the patients were an important information source for 75.0% of the respondents in 2003 and 55.4% in 2010. For all new AC treatments, the EPR was a primary information source for 33.3% of respondents in 2003 and 60.2% in 2010. CONCLUSIONS: This study indicated that during the study period there was an improvement in access to EPR but that this did not always improve the overall availability of data. Results show that problems in information flow from secondary care to the HCs persist. Almost half of the patients dealt with in the HCs were affected by at least some problems. In the 7 years covered by this study, EPR systems have become more important as information sources for clinical data, but there is still room for improvement.

Management of electronic patient record systems in primary healthcare in a Finnish county.

We investigated factors that could govern the use and user competence of electronic patient record (EPR) systems used in Finnish primary healthcare in the county of South Ostrobothnia. A structured questionnaire was sent to 400 health center (HC) staff (general practitioner, nurse, and clerical) from eight HCs. The questions dealt with Information Technology (IT) management, use, and potential problems with EPR and user EPR training within the HC. The response rate to the questionnaire was 79%. This study shows that there are large differences in working practices and in the way EPR systems are managed and utilized in the primary care organizations studied. A relatively high level of self-reported lack of competence in EPR use (21%) was indicated by the HC staff, clearly indicating that there is a need to improve user training. Results also indicate clear correlations between the incidence of user problems and whether there were routine procedures to disseminate best EPR user practices at the HC. If the HC had a clear IT development strategy, personnel were more likely to utilize the EPR system to develop the workflow and work practices of the HC. This study showed the importance of the EPR as a tool for a wide variety of tasks not restricted to patient data access. To improve and broaden the use of the EPR systems, more emphasis should be placed on IT management, support, training, and "best practices" dissemination.

Who receives anticoagulant treatment with warfarin and why? A population-based study in Finland.

OBJECTIVE: To ascertain the age and gender distribution of patients receiving anticoagulant (AC) treatment with warfarin, and to establish the prevalence of AC treatment and its indications among the Finnish population. DESIGN: A cross-sectional study in which the patients were identified from the patient records of health centres. SETTING: Primary health care in the Hospital District of South Ostrobothnia in Finland. PATIENTS: Those inhabitants of 15 municipalities in the study area who received AC treatment with warfarin on 1 April 2004. The total number of inhabitants was 132 621 at the end of 2003. MAIN OUTCOME MEASURES: Patient age and gender distributions, the prevalence of AC treatment in the study area, and indications for AC treatment. RESULTS: Altogether 2389 patients were identified, 51.4% of them men. The mean age of the patients was 72.4 years. The prevalence of AC treatment was 1.8%; when age-adjusted to match the Finnish population it was 1.64%. The proportion of men receiving AC treatment was higher than that of women in all age groups. Atrial fibrillation (AF) was the most common main (60.2%) and second (7.2%) indication for AC treatment. CONCLUSION: Compared with Finnish figures 12 years earlier the prevalence of AC treatment has more than doubled, and the proportion of AF among indications has increased from 47% to 67%. New current care guidelines on AF and the increasing proportion of the elderly among the population are probable explanations.