Int J Med Inform - Caring for individual patients and beyond: enhancing care through secondary use of data in a general practice setting.

Tópicos

{ data(3963) clinic(1234) research(1004) }
{ care(1570) inform(1187) nurs(1089) }
{ record(1888) medic(1808) patient(1693) }
{ studi(1410) differ(1259) use(1210) }
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Resumo

LABELLED: It is argued that with the introduction of electronic medical record (EMR) systems into the primary care sector, data collected can be used for secondary purposes which extend beyond individual patient care (e.g., for chronic disease management, prevention and clinical performance evaluation). However, EMR systems are primarily designed to support clinical tasks, and data entry practices of clinicians focus on the treatment of individual patients. Hence data collected through EMRs is not always useful in meeting these ends.PURPOSE: In this paper we follow a community health centre (CHC), and document the changes in work practices of the personnel that were necessary in order to make EMR data useful for secondary purposes.METHODS: This project followed an action research approach, in which ethnographic data were collected mainly by participant observations, by a researcher who also acted as an IT support person for the clinic's secondary usage of EMR data. Additionally, interviews were carried out with the clinical and administrative personnel of the CHC.RESULTS: The case study demonstrates that meaningful use of secondary data occurs only after a long process, aimed at creating the pre-conditions for meaningful use of secondary data, has taken place. PRECONDITIONS: Specific areas of focus have to be chosen for secondary data use, and initiatives have to be continuously evaluated and adapted to the workflow through a team approach. Collaboration between IT support and physicians is necessary to tailor the software to allow for the collection of clinically relevant data. Data entry procedures may have to be changed to encourage the usage of an agreed-upon coding scheme, required for meaningful use of secondary data. And finally resources in terms of additional personnel or dedicated time are necessary to keep up with data collection and other tasks required as a pre-condition to secondary use of data, communication of the results to the clinic, and eventual re-evaluation.CONSEQUENCES: Changes in the work practices observed in this case which were required to support secondary data use from the EMR included completion of additional tasks by clinical and administrative personnel related to the organization of follow-up tasks. Among physicians increased awareness of specific initiatives and guideline compliance in terms of chronic disease management and prevention was noticed. Finally, the clinic was able to evaluate their own practice and present the results to varied stakeholders.CONCLUSIONS: The case describes the secondary usage of data by a clinic aimed at improving management of the clinic's patients. It illustrates that creating the pre-conditions for secondary use of data from EMRs is a complex process which can be seen as a shift in paradigms from a focus on individual patient care to chronic disease management and performance measurement. More research is needed about how to best support clinics in the process of change management necessitated by emerging clinical management goals.

Resumo Limpo

label argu introduct electron medic record emr system primari care sector data collect can use secondari purpos extend beyond individu patient care eg chronic diseas manag prevent clinic perform evalu howev emr system primarili design support clinic task data entri practic clinician focus treatment individu patient henc data collect emr alway use meet endspurpos paper follow communiti health centr chc document chang work practic personnel necessari order make emr data use secondari purposesmethod project follow action research approach ethnograph data collect main particip observ research also act support person clinic secondari usag emr data addit interview carri clinic administr personnel chcresult case studi demonstr meaning use secondari data occur long process aim creat precondit meaning use secondari data taken place precondit specif area focus chosen secondari data use initi continu evalu adapt workflow team approach collabor support physician necessari tailor softwar allow collect clinic relev data data entri procedur may chang encourag usag agreedupon code scheme requir meaning use secondari data final resourc term addit personnel dedic time necessari keep data collect task requir precondit secondari use data communic result clinic eventu reevaluationconsequ chang work practic observ case requir support secondari data use emr includ complet addit task clinic administr personnel relat organ followup task among physician increas awar specif initi guidelin complianc term chronic diseas manag prevent notic final clinic abl evalu practic present result vari stakeholdersconclus case describ secondari usag data clinic aim improv manag clinic patient illustr creat precondit secondari use data emr complex process can seen shift paradigm focus individu patient care chronic diseas manag perform measur research need best support clinic process chang manag necessit emerg clinic manag goal

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