Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 10 de 10
Filter
1.
Scott Med J ; 60(3): 126-31, 2015 Aug.
Article in English | MEDLINE | ID: mdl-25805773

ABSTRACT

BACKGROUND AND AIMS: Key information summary is one of the first national shared electronic patient records enabling GPs to share clinical information with unscheduled care providers, including out-of-hours. Implemented during 2013, over 90,000 patient records have been created. This evaluation identified the impact of key information summary on healthcare services. METHODS: Evidence was collected using online questionnaires and structured telephone interviews. Opinions providing a numerical estimate of value were analysed using statistical methods, while qualitative responses were synthesised using thematic analysis. RESULTS: The vast majority of respondents from 441 GP practices and 33 out-of-hours clinicians show that key information summary enhances patient safety, improves clinical management, reduces hospital admissions, empowers clinicians, aids communication across services and enables decisions to be responsive to patients' wishes. CONCLUSIONS: Patients willingly consent to share data with unscheduled care clinicians. Patients benefitting include those with palliative, complex or multiple conditions, at high risk of using emergency services. Out-of-hours clinicians would welcome more key information summaries, all well-completed and including social care information. Improvements include software enhancements and wider sharing of information with all unscheduled care services.


Subject(s)
After-Hours Care/organization & administration , Electronic Health Records , Emergency Medical Services/organization & administration , General Practice/organization & administration , Information Dissemination , Confidentiality , Continuity of Patient Care , Health Services Needs and Demand/organization & administration , Humans , Scotland/epidemiology , State Medicine , Surveys and Questionnaires
2.
Disabil Rehabil ; 36(22): 1875-82, 2014.
Article in English | MEDLINE | ID: mdl-24555685

ABSTRACT

PURPOSE: It is acknowledged in the literature that the physical and cognitive effects of the degenerative neurological condition of multiple sclerosis can impact upon driver safety. The aim of this study was to identify the experiences and needs of people with multiple sclerosis in relation to driver assessment and rehabilitation. METHODS: Focus group discussions were conducted with people with multiple sclerosis (MS) who were: currently driving; no longer licensed or no longer driving and health professionals. RESULTS: The four themes that emerged from the data were: (1) from self-management to formal assessment - a journey of uncertainty and emotional dilemmas; (2) lost independence with grieving and adjustment by self and family; (3) alternative transport is challenging and unsatisfactory; (4) gaps in information and services exist. CONCLUSIONS: The results of this study highlight the need for ongoing support in relation to driving for people with MS, ranging from support for self-management, driving assessment and retraining, and preparation for loss of license. Standardised information needs to be developed and health professionals and licensing authorities require knowledge and skills to ensure driver assessment and rehabilitation processes and resources can better meet the needs of people with MS. IMPLICATIONS FOR REHABILITATION: There is a need for health professionals to examine driving in people with MS in a holistic manner taking into account the context for the person and the supports available. Self-management and self-assessment emerged as a preferred approach for the participants in this study, indicating that health professionals may need to engage with the process. Tools to support self-assessment of driving abilities for people with MS require further research. Indicators for review and formal assessment of driving abilities is needed. Alternative forms of transport require further investigation and improvement for people with MS.


Subject(s)
Automobile Driving , Multiple Sclerosis/physiopathology , Multiple Sclerosis/psychology , Access to Information , Adaptation, Psychological , Adult , Australia , Female , Focus Groups , Humans , Life Change Events , Male , Middle Aged , Needs Assessment , Personal Autonomy , Self Care
4.
Int J Med Inform ; 82(5): e125-38, 2013 May.
Article in English | MEDLINE | ID: mdl-23434362

ABSTRACT

AIM: To compare the experience of the four UK countries in introducing nationally accessible electronic summaries of patients' key medical details, intended for use in emergency and unscheduled care episodes, and generate transferable lessons for other countries. METHOD: Secondary analysis of data collected previously on all four schemes; cross-case comparison using a framework derived from diffusion of innovations theory. MAIN FINDINGS: Whilst all four programmes shared a similar vision, they differed widely in their strategy, budget, implementation plan, approach to clinical and public engagement and approach to evaluation and learning. They also differed, for various reasons, in stakeholder alignments, the nature and extent of resistance to the programme and the rate at which records were created. A nationally shared, widely accessible electronic record has powerful symbolic meaning; it may or may not be perceived as improving the quality and safety of care or (alternatively) as threatening patient confidentiality or the traditional role of the doctor or nurse. 'Hard' project management oriented to achieving specific milestones and deadlines sometimes appeared counterproductive when it cut across the 'softer' aspects of the programmes. CONCLUSION: When designing and implementing complex technologies with pervasive implications, policymakers must consider not only technical issues but also the personal, social and organisational aspects of the programme. A judicious blend of 'hard' and 'soft' management appears key to managing such programmes.


Subject(s)
Cooperative Behavior , Electronic Health Records/organization & administration , State Medicine/organization & administration , Electronic Health Records/economics , England , Humans , Northern Ireland , Scotland , State Medicine/economics , Wales
5.
Inform Prim Care ; 20(1): 41-9, 2012.
Article in English | MEDLINE | ID: mdl-23336834

ABSTRACT

BACKGROUND: In Scotland, out-of-hours calls are all triaged by the National Health Service emergency service (NHS24) but the clinicians receiving calls have no direct access to patient records. OBJECTIVE: To improve the safety of patient care in unscheduled consultations when the usual primary care record is not available. TECHNOLOGY: The Emergency Care Summary (ECS) is a record system offering controlled access to medication and adverse reactions details for nearly every person registered with a general practice in Scotland. It holds a secure central copy of these parts of the general practitioner (GP) practice record and is updated automatically twice daily. It is accessible under specified unplanned clinical circumstances by clinicians working in out-of-hours organisations, NHS24 and accident and emergency departments if they have consent from the patient and a current legitimate relationship for that patient's care. APPLICATION: We describe the design of the security model, management of data quality, deployment, costs and clinical benefits of the ECS over four years nationwide in Scotland, to inform the debate on the safe and effective sharing of health data in other nations. EVALUATION: Forms were emailed to 300 NHS24 clinicians and 81% of the 113 respondents said that the ECS was helpful or very helpful and felt that it changed their clinical management in 20% of cases. CONCLUSION: The ECS is acceptable to patients and helpful for clinicians and is used routinely for unscheduled care when normal medical records are unavailable. Benefits include more efficient assessment and reduced drug interaction, adverse reaction and duplicate prescribing.


Subject(s)
After-Hours Care/methods , Continuity of Patient Care/organization & administration , Electronic Health Records , Emergency Medical Services/methods , Attitude of Health Personnel , Computer Security , General Practitioners , Humans , Medication Reconciliation/methods , Scotland , State Medicine/organization & administration
7.
J Telemed Telecare ; 15(3): 129-31, 2009.
Article in English | MEDLINE | ID: mdl-19364894

ABSTRACT

The Emergency Care Summary (ECS) in Scotland provides essential clinical and demographic information about patients needing unscheduled or emergency care. Information about patients' medications, adverse drug reactions and allergies is transferred twice every day from GP systems to the ECS. Access is then available to authorised health-care professionals at the national help line, at out-of-hours services and in accident and emergency departments. An economic analysis of the ECS implementation showed that annual benefits exceeded annual costs after about seven years. Approximately 77% of the benefits were non-financial and 23% from redeployed finance. No cash savings were planned and none were realised. As ECS utilisation increased from 2006, the net benefits became positive. This relationship between utilisation and net benefits is a common feature of successful e-health investment.


Subject(s)
Emergency Medical Services/economics , Medical Records Systems, Computerized/economics , National Health Programs/economics , After-Hours Care/economics , Cost-Benefit Analysis , Health Services Accessibility/economics , Humans , Medical Record Linkage , Medical Records Systems, Computerized/statistics & numerical data , Scotland
9.
Inform Prim Care ; 11(3): 121-7, 2003.
Article in English | MEDLINE | ID: mdl-14680534

ABSTRACT

OBJECTIVES: To investigate whether practices will be ready for the data reporting requirements for the new General Medical Services (GMS) contract, using coronary heart disease (CHD) as an example. DESIGN: Cross-sectional survey. DATA SOURCES: Electronic general practitioner (GP) records of all CHD patients in five Scottish practices, validated by manual searches in 50 randomly selected patients in each practice. MAIN OUTCOME MEASURES: Recording of family history, smoking status, blood pressure (BP), diabetes testing, aspirin therapy and cholesterol measurement. RESULTS: It is extremely easy for practices with completely electronic patient records to extract a disease register (mean 10 min, range 38 sec to 3 hr 6 min). Extraction of a complete dataset takes several days if it involves checking through paper records, whereas setting up and running a search from electronic records is possible in less than two hours. If practices use the same clinical system and identical data entry templates, the data can be directly compared. Some items that are easily recorded as part of routine clinical practice, such as prescribing of aspirin, are well recorded, but others, such as BP recording, are more of a problem. One hundred percent of the CHD patients sampled had a BP recording within the previous year, but some practices had these data in the paper records where they were not readily accessible. CONCLUSIONS: We have shown that in Scotland there is a high level of testing and recording of all the important information regarding patients with recorded CHD, irrespective of whether practices have fully electronic records, paper-based records, or a mixture of the two. If practices have fully electronic patient records, the information can be extracted easily, but unless there is a standard template, the information can only be viewed in isolation and is of little value for comparative purposes.


Subject(s)
Coronary Disease/diagnosis , Coronary Disease/drug therapy , Family Practice/organization & administration , Medical Records Systems, Computerized , Medical Records, Problem-Oriented , Quality Indicators, Health Care , Registries , Cross-Sectional Studies , Data Collection , Family Practice/economics , Family Practice/standards , Humans , Medical History Taking/statistics & numerical data , Medical Records Systems, Computerized/statistics & numerical data , Medical Records, Problem-Oriented/statistics & numerical data , Pilot Projects , Reimbursement Mechanisms , Scotland , State Medicine , Time and Motion Studies
10.
Inform Prim Care ; 11(1): 5-11, 2003.
Article in English | MEDLINE | ID: mdl-16274587

ABSTRACT

OBJECTIVE: To describe the use of computing systems by primary care staff in Scotland. Participants Practice managers in Scotland on behalf of their practice teams. METHODS: A survey of computer use in Scottish general practices was carried out by the Scottish Clinical Information Management in Primary Care (SCIMP) group in April 2001. Every practice was sent an electronic copy of a questionnaire using NHSnet. Practices that did not respond to the electronic version were sent a paper version of the questionnaire. MAIN OUTCOME MEASURES: Access to computers, use during consultations, links to laboratories, problems experienced by users. RESULTS: A total of 308 practices (30%) replied to the electronic questionnaire and 346 practices (33%) to a paper version, giving an overall response rate of 63% (654 practices). A total of 296 (29%) of practices could not receive the electronic version. It was reported that 94% of general practitioners and 74% of practice nurses frequently used a computer; 72% of practices used their computer for chronic disease management. There was great variability in links to laboratories for lab results (range 1-30% by region). Of responding practices, 16% had plans for a unified patient record, but access to a computer is still a major problem for community nurses. Satisfaction was expressed for all systems and many practices also use third-party programs. CONCLUSIONS: Most Scottish doctors make frequent use of computers for a variety of clinical and practice management activities. Many other staff want to make greater use of computers, but are often unable to obtain access.


Subject(s)
Computers/statistics & numerical data , Family Practice/methods , Information Systems/statistics & numerical data , Primary Health Care , Attitude to Computers , Family Practice/organization & administration , Humans , Nurses , Physicians, Family , Scotland
SELECTION OF CITATIONS
SEARCH DETAIL
...