J Biomed Inform - Sharing clinical decisions for multimorbidity case management using social network and open-source tools.

Tópicos

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Resumo

TRODUCTION: Social networks applied through Web 2.0 tools have gained importance in health domain, because they produce improvements on the communication and coordination capabilities among health professionals. This is highly relevant for multimorbidity patients care because there is a large number of health professionals in charge of patient care, and this requires to obtain clinical consensus in their decisions. Our objective is to develop a tool for collaborative work among health professionals for multimorbidity patient care. We describe the architecture to incorporate decision support functionalities in a social network tool to enable the adoption of shared decisions among health professionals from different care levels. As part of the first stage of the project, this paper describes the results obtained in a pilot study about acceptance and use of the social network component in our healthcare setting.METHODS: At Virgen del Roc?o University Hospital we have designed and developed the Shared Care Platform (SCP) to provide support in the continuity of care for multimorbidity patients. The SCP has two consecutively developed components: social network component, called Clinical Wall, and Clinical Decision Support (CDS) system. The Clinical Wall contains a record where health professionals are able to debate and define shared decisions. We conducted a pilot study to assess the use and acceptance of the SCP by healthcare professionals through questionnaire based on the theory of the Technology Acceptance Model.RESULTS: In March 2012 we released and deployed the SCP, but only with the social network component. The pilot project lasted 6 months in the hospital and 2 primary care centers. From March to September 2012 we created 16 records in the Clinical Wall, all with a high priority. A total of 10 professionals took part in the exchange of messages: 3 internists and 7 general practitioners generated 33 messages. 12 of the 16 record (75%) were answered by the destination health professionals. The professionals valued positively all the items in the questionnaire. As part of the SCP, opensource tools for CDS will be incorporated to provide recommendations for medication and problem interactions, as well as to calculate indexes or scales from validated questionnaires. They will receive the patient summary information provided by the regional Electronic Health Record system through a web service with the information defined according to the virtual Medical Record specification.CONCLUSIONS: Clinical Wall has been developed to allow communication and coordination between the healthcare professionals involved in multimorbidity patient care. Agreed decisions were about coordination for appointment changing, patient conditions, diagnosis tests, and prescription changes and renewal. The application of interoperability standards and open source software can bridge the gap between knowledge and clinical practice, while enabling interoperability and scalability. Open source with the social network encourages adoption and facilitates collaboration. Although the results obtained for use indicators are still not as high as it was expected, based on the promising results obtained in the acceptance questionnaire of SMP, we expect that the new CDS tools will increase the use by the health professionals.

Resumo Limpo

troduct social network appli web tool gain import health domain produc improv communic coordin capabl among health profession high relev multimorbid patient care larg number health profession charg patient care requir obtain clinic consensus decis object develop tool collabor work among health profession multimorbid patient care describ architectur incorpor decis support function social network tool enabl adopt share decis among health profession differ care level part first stage project paper describ result obtain pilot studi accept use social network compon healthcar settingmethod virgen del roco univers hospit design develop share care platform scp provid support continu care multimorbid patient scp two consecut develop compon social network compon call clinic wall clinic decis support cds system clinic wall contain record health profession abl debat defin share decis conduct pilot studi assess use accept scp healthcar profession questionnair base theori technolog accept modelresult march releas deploy scp social network compon pilot project last month hospit primari care center march septemb creat record clinic wall high prioriti total profession took part exchang messag internist general practition generat messag record answer destin health profession profession valu posit item questionnair part scp opensourc tool cds will incorpor provid recommend medic problem interact well calcul index scale valid questionnair will receiv patient summari inform provid region electron health record system web servic inform defin accord virtual medic record specificationconclus clinic wall develop allow communic coordin healthcar profession involv multimorbid patient care agre decis coordin appoint chang patient condit diagnosi test prescript chang renew applic interoper standard open sourc softwar can bridg gap knowledg clinic practic enabl interoper scalabl open sourc social network encourag adopt facilit collabor although result obtain use indic still high expect base promis result obtain accept questionnair smp expect new cds tool will increas use health profession

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