Literature Review of Patient Record Structures from the Physician's Perspective.

The Finnish Patient Data Repository is a nationwide electronic health record (EHR) system collecting patient data from all healthcare providers. The usefulness of the large amount of data stored in the system depends on the underlying data structures, and thus a solid understanding of these structures is in focus in further development of the data repository. This study seeks to improve that understanding by a systematic literature review. The review takes the physician's perspective to the use and usefulness of the data structures. The articles included in this review study data structures intended to be used in the actual care process. Secondary use and nursing aspects have been covered in separate reviews. After applying the predefined inclusion and exclusion criteria only 40 articles were included in the review. The research on widespread systems in everyday use was especially scarce, most studies concentrated on narrow fields. Majority of these studies were primarily developed for specialist use in secondary care units. Most structures or applications studied were at an early stage of development. In many applications the use of structured data was found to improve the completeness of the documented data and facilitate its automated use. However, there seem to be some applications where narrative text cannot be easily replaced by structured data. Usability results regarding structured representation were conflicting. The scattered nature and paucity of research hinders the generalizability of the findings, and from the system design or implementation point of view the practical value of the scientific literature reviewed is limited.

Teleconsultation: changes in technology and costs over a 12-year period.

In our previous study, in 1997, we evaluated the cost of teleconsultations in a primary care centre compared with the cost of the conventional alternative, travelling to the hospital. The results showed that teleconsultations were cheaper than patient travel when the annual workload was more than 110 patients in ophthalmology and 115 patients in dermatology. Using the same method of analysis for 2009 data showed that cost savings would occur if the annual workload was 20 patients in ophthalmology and 17 patients in dermatology. The main differences between the two studies are the reduced cost of the technology (which was based on PCs in 2009) and the increased cost of staff. Both studies show that teleconsultations can be cost-effective in a relatively small health centre. The cost of technology continues to decrease, although the other costs in our break-even analysis continue to increase. However, the usability of technology continues to improve, and this will make telemedicine a more attractive alternative in the future.