Exploitation of Electronic Medical Records Data in Primary Health Care
Resistances and Solutions
Study in Eight Walloon Health Care Centres
Brussels, 22nd MIC Congress, november 25, 2004
Prof. Marc VANMEERBEEKDept. of General Practice, University of LiegeFrench-speaking Federation of Medical Houses
Structured electronic medical record (EMR) for each patient
To follow his storyGiving him the most appropriated careClinical database Local use: quality of care
improvement, a new deal for GP’s Regional use: epidemiology, research,
teaching
Belgian « Medical Houses »
Multidisciplinary teamsPrimary health careSelf management
Development of EMR for 10 yearsDevelopment of quality assessment programs for 9 years
Promotion of EMR since 2001
Reflection ForumPaper in « Santé conjuguée »Personalized teams meetings Clinical sofware PRICARE free of chargeSoftware use training, by profession (31 teams, 73 participants) Target : 60 teams, 407 workers (doctors, nurses, physiotherapists)
3 years after
The use of EMR seems to remain very slight
The quality of some collected data is very insufficient in the sight of what could be done
2 Objectives
To assess of indicators of the present use of the FMH’s EMR
To define, with the participation of users, the content of an action program for Medical Houses, with having in mind the removing of the resistances to the data collection in Primary Care through the use of EMR
Methods
Target
8 Walloons teams who , at their demand, had enjoyed in 2002-2003 actions of promotion of the use of EMR 4 reference teams
Comparison with the measures of Okkes et al. for the doctors.
Okkes IM et al. The role of family practice in different health care systems: a comparison of reasons for encounter, diagnoses, and interventions in primary care populations in the Netherlands, Japan, Poland, and the United States. J Fam Pract. 2002.51(Jan):72-3
Quantitative measuresUse of EMR : indicators
Minimal frequency of use: at least 1 episode/year
Intensivity of use: new episodes/patient/year
Use during consultations: ratio sub-contacts/acts
Qualitative AnalysisNominal groups: per team
Providing each participant with an equal voiceAll participants write the answers they feel are most importantDevelop a master list of issuesRequest that each participant rank the top five issues Tally the results by adding the points for each issueDiscuss the results and generate a final ranked list for action planning
“How can we beat the present blockings to valorise the data our EMR can contain ?”
Results
Use of EMR : clinical data
Nr TeamPopulation at 12/31/03
New episodes in
2003
Patients concerned by those episodes
Proport. patients with min. 1 episode
Episode per
patient
Total contacts
2003
1 2452 8 3 0,12% 2,67 24192
2 1856 73 59 3,49% 1,24 12700
3 3850 427 282 7,63% 1,51 37997
4 1196 1561 574 61,46% 2,72 7042
5 2163 221 174 9,16% 1,27 14061
6 953 1263 462 49,04% 2,73 7310
7 1373 5008 1247 96,37% 4,02 7516
8 3388 474 363 11,99% 1,31 22656
REF1 2983 5146 2236 79,07% 2,30 28191
REF2 778 2264 593 92,08% 3,82 3780
REF3 1935 3657 1404 78,09% 2,60 14163
REF4 1087 3456 959 95,52% 3,60 8426
Okkes 1,3 à 2,5
Sub-contacts / acts
Doctors Physiotherapists Nurses
Nr Team Sub-contacts
Acts Ratio contacts/acts
Sub-contacts
Acts Ratio contacts/acts
Sub-contacts
Acts Ratio contacts
/acts
1 0 15121 0 0 3776 0 0 5295 0
2 123 9959 0,01 0 1226 0 0 1382 0
3 57 24234 0 12 6519 0 0 6813 0
4 0 5394 0 0 1611 0 0 37 0
5 62 8893 0,01 1 2686 0 5 2392 0
6 0 5404 0 0 1085 0 0 797 0
7 11408 5638 2,02 635 1252 0,51 197 626 0,31
8 883 14598 0 3945 4411 0,89 0 3005 0
REF1 10507 17595 0,6 2205 6182 0,36 0 4414 0
REF2 5534 3020 1,83 5 582 0,01 1 178 0,01
REF3 10890 8299 1,31 4313 3251 1,33 731 1515 0,48
REF4 13238 4938 2,68 620 1662 0,37 1534 1826 0,84
Okkes 1,1-1,7
3 years of hard work leads to…
1/8 team: high frequency of use2/8 teams: « rising users »5/8 teams: occasional use or isolated users
Why ?
Results: 5 categories of items
Ethics Training Search for sense Practice Multidisciplinarity
Items split rather differently according to the teams
Nr Team 1 2 3 4 5 6 7 8
Proportion of verbatims
Ethics 0,0%
4,5%
29,2%
12,5%
4,2%
0,0%
5,0%
3,4%
Training 30,8%
9,1%
12,5%
12,5%
12,5%
4,5%
5,0%
17,2%
Search for sense
23,1%
22,7%
33,3%
4,2%
41,7%
45,5%
30,0%
20,7%
Practice 30,8%
40,9%
20,8%
58,3%
29,2%
40,9%
45,0%
51,7%
Multidisciplinarity
15,4%
22,7%
4,2%
12,5%
12,5%
9,1%
15,0%
6,9%
178 verbatims:
Ethics
14 verbatims, 9 votesData securityTherapist / patient relationTherapist / informatics relation
Ethics: priorities
0
1
2
3
4
5
6
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Rank of priority
Occ
urr
ence
s o
f ve
rbat
ims
Ethics
Little or not evoked
No worry about data security
No worry about the relationship with patients (most are not concerned)
Training
21 verbatims, 18 votesFundamental training to informaticsLogical reasoning of computerized records Practical organization
Training: priorities
0
1
2
3
4
5
6
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
rank of priority and tendency curve
Occ
urr
ence
s o
f ve
rbat
ims
Training
Data structuration
Belgian softwares are developping around the « Belgian Bilingual Biclassified Thesaurus (3BT) » and the Process-Thesaurus
Search for sense
49 verbatims, 32 votesLocal data sharing Specific formingNeed of a training personal within the team Increase motivation
Search for sense: priorities
0
1
2
3
4
5
6
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
rank of priority and tendency curve
Occ
urr
ence
s o
f ve
rbat
ims
Search for sense
Strong demand to see outcomes
Quality Improvement habits
No informatics habits
Practice
72 verbatims, 45 votesSoftware improvement Development Easy use
Internal organization Equipment (quality,
availability) Informatic skills Clear choice between
paperless or paper based record
Time spent
Practice: priorities
0
1
2
3
4
5
6
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
rank of priority and tendency curve
Occ
urr
ence
s o
f ve
rbat
ims
Practice
Powerfull software, but uneasy to use
Fear of loosing time because of data processing (during the consultation, in forming)
Nobody imagines saving time
Multidisciplinarity
21 verbatims, 15 votesBetter coordination between professional sectors Everyone feels supported by a collective effort Carrying out of projects
Multidisciplinarity: priorities
0
1
2
3
4
5
6
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
rank of priority and tendency curve
Occ
ure
nce
s o
f ve
rbat
ims
Multidisciplinarity
Self administrative way of working can make the change to informatics difficult Differences between the members: facing the technique, facing motivation, facing available time Data sharing, power sharingNeed of a multidisciplinary software
Possible bias
Little sample, teams that were very motivated by computerization Those teams forms a rather heterogeneous unity as for the solutions they view, the priority stage they gave them Qualitative reflection of the blockings
Discussion
Can solutions be generalized ?
Data collection with an epidemiological aim: short range objective accessible to some teams
Local use of the consultation data in the aim of quality of care improvement should be generalized
The practitioners are willing to improve the quality of care through self evaluation or projects
Quality improvement habits are the result of an effort over 9 years
A distinctive accompaniment in a whole movement Specific tools and training have to be developed and proposed Professional organizations, universities and authorities have a leading part in developing this quality improvement
Action proposals
Motivation improvement: A widely spread information to show the
obtained results and their impact on practice, as the met difficulties
A support structure
Security: Information about security strategies,
procedures and official requirements is all the more essential since the demand is weak
Action proposals
Training Informatic skills Data management ? Meet the users on their workplace Failure can be discussed Public Health information during studying
and continuous formation
Lobbying: The Belgian situation is developing in the
right direction
Action proposals
Practical: Audit of the situation before
computerization
Software improvement: Easy coding of clinical data, data entry tool Typical interfaces for paramedical
professions, structured around the central point of record: the patient’s list of episodes
Users associated to the development
Thank you
Top Related