Curricular unit: Introduction to Medicine II Adviser: Ricardo João Cruz Correia

The perceived usefulness of a national electronic health record

system measured by the expected improvement on health care delivery

– a survey on health professionals’ believes

Curricular unit: Introduction to Medicine IIAdviser: Ricardo João Cruz Correia

Class 17. 1st year. 2010/2011

INDEX

• IntroductionBackgroundJustificationResearch question and aims

• Development of the investigationStudy participantsStudy designData collection methodsPlanned statistical analysis/Variables description

• Results• Conclusion• References• Survey

2

The usefulness of a national electronic health record system

Background• General government’s objective:

• Related projects being carried out:– epSOS (1) – the European-wide project to patient data interchange among

countries, particularly focused on emergency situations– RSE (2) – the Portuguese program for a centralized patient records

database and sharing system


3(1) http://www.epsos.eu/(2) http://www.portaldasaude.pt/portal/conteudos/a+saude+em+portugal/politica+da+saude/discussao/arquivo/registo+electronico.htm

centralization of all medical records in a single country-wide electronic sharing system

•One known evaluation study(3) about the importance of a regional electronic health information exchange system:

– Based on questionnaires answered by New York ER Doctors;

– Possible bias due to the distribution method used.

• In Portugal: no released investigations about the subject.

4

Conclusion

(3) Shapiro JS, Kannry J, Kushniruk AW, Kuperman G. Emergency Physicians’ Perceptions of Health Information Exchange. J Am Med Inform Assoc. 2007 Nov–Dec; 14(6) :700-705

Background


developing a patient record database is important.

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Justification


1 •Scarcity of studies/evaluations proving the viability of the projects and low quality of the available information;

2 •Reduced query to specialists working in the fields that the projects would potencially give benefit to;

3 •Ambiguous justifications by the entities working on the projects for their implementation;

• Main question:

Research question and aims

•Objectives/Aims:

– Gathering opinions from health professionals about the usefulness of this kind of systems;

– Determining which type of information and type of institution whose information health professionals would find the most important to have access to;

– Comparing results obtained in this project to those of Shapiro’s study.6


Would the health professionals find the existence of an electronic system sharing medical information among

health institutions useful?

INDEX




7



TARGET POPULATION Doctors Nurses

SAMPLING LOCATIONS(institutions chosenfor convenience)

Hospitals

Hospital S. João

Hospital Pedro Hispano (data share system implemented)

Hospital Cuf Porto

Primary Care Health Centers of ARS Norte – doctors of primary care

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DEPARTMENTSEmergency departmentInternal medicineGeneral surgery PediatricsOtorhinolaryngology

Study participants Departments’ selection criteria: addition of

variables of (potential) interest

DATA COLLECTING METHODS: survey (paper and online)


Study design

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•Cross-sectional study– Pointed to a specific moment in time

•Observational study– No intervention


Pilot Tests

10

Main critics to the survey:• Nurses, some doctors: asking for percentages with no sense in some questions;

gradatory scale

• Difficulties on the comprehension of question 4 (which features would benefit from the system) ;

modified

• Several suggestions for the answer of question 6 (which type of information would be the most useful) ;

turned into an open question

9 doctors

4 nurses


Letters requesting permission

Sent 11 March (after phone conversation)

Hand-delivered (after direct conversation)

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Contents:• Request for Authorization (letter)• Survey• Written Protocol

Letters

Online Survey

Support in study Disclosure of the survey by e-mail

General Practice (GP’s) Doctors

12http://http://newdbserver.med.up.pt/projext/medquest/verprod/index.php?mdl=3&qtr=MTQyNzcxMDUxNDI=

MedQuest



Survey’s distribution

13

Hospital

Department

Hospital S. João Hospital Pedro Hispano Hospital Cuf Porto

Online

Delivered Filled Delivered Filled Delivered Filled

N=46

Emergency department

Required written approval : Ethics committee Hospital’s direction X X

Internal medicine X X X X X

General surgery Unavailable X X

Pediatrics X Lost X X X

Otorhinolaryngology X X X X XN=67


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Statistical analysis

• Descriptive analysis- using PASW (SPSS)

• Comparative analysis– acording to selected variables

• Type of health professional: Doctors/ Nurses

• Type of institution: Public/ Private institutions

• Gender: Female/ Male

• Age: Younger/ Older professionals

• Survey format: Online/ Printed version

Variables description

INDEX




15


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Results


Occupation

•Doctor: 40%•Nurse: 59%

Gender

• Female: 65%• Male: 34%

Age

• 21 – 30: 50%• 31 – 40: 26%• 41 – 50: 14%• 51 – 60: 7%

•Female: 47%•Male: 52%

PAPE

RO

NLI

NE • All primary care

doctors

• 21 – 30: 20%• 31 – 40: 20%• 41 – 50: 11%• 51 – 60: 48%

N=67

N=46

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Results

1. Com que frequência é que actualmente procura obter informações clínicas sobre os doentes a quem presta cuidados de saúde, de fontes fora da sua instituição de saúde?


Attempt to get outside clinical information 0-10% of the time 0

2

4

6

8

10

12

2

11

5

Doctors Primary Care (N=46) Doctors Hospital (N=27) Nurses Hospital (N=40)

Perc

enta

ge (%

)

Comparative Analysis

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2. Se lhe fosse dado um fácil acesso a informação clínica proveniente de fora da sua instituição de saúde, quais as fontes de dados que lhe seriam mais úteis? (Por favor, ordene as seguintes fontes em função da sua utilidade, em que a 1ª é a mais útil e a 4ª é a menos útil. Use cada número apenas uma vez.)

Results


Ordem de

utilidade Hospitais Centros de

Saúde

Laboratórios de análises e

imagiologia

Clínicas e/ou consultórios

médicos privados

1º 60,6% 22,7% 12,1% 4,5% 2º 29,8% 40,2% 19,4% 10,4% 3º 9% 25,4% 41,8% 23,9% 4º 1,5% 11,7% 26,5% 60,3% 1º 69,4% 12,2% 14,3% 4,1% 2º 17,4% 28,3% 47,8% 6,5% 3º 2,4% 45,2% 33,3% 19,0% 4º 4,9% 14,6% 4,9% 75,6%

Heal

th

Cent

ers

Hosp

itals

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3. Qual a proporção de doentes a quem presta cuidados de saúde que beneficiariam, se o acesso à informação clínica proveniente de fora da sua instituição de saúde fosse imediato?

Results


>1/2 of patients would benefit if access to outside clinical information were immediate

>1/4 of patients would benefit if access to outside clinical informationwere immediate

0

20

40

60

80

100

84

93

52

7875

100

Doctors Primary Care (N=46)

Doctors Hospital (N=27)

Nurses Hospital (N=40)Perc

enta

ge (%

)Comparative

Analysis

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4. Assinale a sua concordância relativamente aos aspectos/instituições que iriam ser beneficiados, caso existisse a possibilidade de obter informação clínica de outras instituições de saúde de maneira rápida e fácil.

Results


A forma como presta os cuidados

de saúde

O seu serviço/departamen

to

A sua instituição de saúde

O Sistema Nacional de Saúde

Hospitals Health centers Hospitals Health

centers Hospitals Health centers Hospitals Health

centers

Concordo Plenamente 24,2% 63% 18,5% 54,3% 25,4% 56,5% 35,8% 63%

Concordo 65,2% 34,8% 76,9% 43,5% 70,1% 43,5% 59,7% 32,6%Discordo 10,6% 2,2% 4,6% - 3% - 1,5% 2,2%Discordo Totalmente - - - - - - - 2,2%

Sem opinião - - - 2,2% 1,5% - 3% -

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5.Em relação a cada um dos seguintes factores assinale o tipo e grau de efeito que, na sua opinião, iria ter pelo acesso a informação proveniente de outra instituição de saúde.


Results

Eficiência (melhor utilização de

recursos) com que os cuidados de

saúde são prestados

Tempo necessário para tomar decisões sobre os utentes a

quem presto cuidados de saúde

Número de Meios Complementares de

Diagnostico e Terapêutica (MCDT)

solicitados

Número de erros na prestação de

cuidados de saúde

Hospitals Health centers Hospitals Health

centers Hospitals Health centers Hospitals Health

centers

Piorar muito - - - - - - - 2,3%Piorar - - - - - - - -Sem alterações 9% - 3% 4,3% 3% - 24,6% 18,2%

Melhorar 44,8% 21,7% 52,2% 50% 43,3% 34,8% 45,9% 52,3%Melhorar muito 46,3% 78,3% 44,8% 43,5% 53,7% 65,2% 29,5% 27,3%

Não sei - - - 2,2% - - - -

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6. Faça uma lista de pelo menos 5 tipos de documentos clínicos que, se disponíveis noutras instituições de saúde, lhe seriam muito úteis na sua prática clínica.


Results

MCDT

Clinica

l histo

ry

Clinica

l analy

sis

Imagi

ng exa

ms

Discharg

e rep

orts

Current th

erapeu

tics

Reports

of appointm

ents

and su

bspeci

alties

Clinica

l reports

Clinica

l diar

y

Emerg

ency

episo

des0

20

40

60

80

100

120

140

160

180

200

DPCNHDH

Perc

enta

ge (%

)Comparative

Analysis

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7 - RSE7.1 Já alguma vez ouviu falar deste projecto?

Results


50.0%50.0%

Nurses

48.6%51.4%

Doctors

SimNão

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Results


7.2 Qual acha que será a utilidade da sua implementação?

7 - RSE

RSE implementation is very useful/indispensable0

10

20

30

40

50

60

70

80

90 85

69

75

Doctors Primary Care (N=46)

Doctors Hospital (N=27)

Nurses Hospital (N=40)

Perc

enta

ge (%

)


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Results


7.2 Qual acha que será a utilidade da sua implementação?

7 - RSE

Hospital S. João vs. Hospital CUF Porto → Public vs. Private

Irrelevante Pouco útil Útil Muito útil Indispensável0%

10%

20%

30%

40%

50%

60%

70%

Hospital S. JoãoHospital Cuf Porto

27% 27%

59%55%

14%18%


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Results of Shapiro’s survey Results of our survey

Response rate: 58% (n=216) 63% of the doctors said that more than 1/4 of their patients would benefit from the data sharing system 85% said it was difficult to access information from external sources 56% said that they try to access external data < than 10% of the times needed

Response rate: 26% (Doctors CUF=44) 66% of the doctors said that a lot/all of their patients would benefit from the data sharing system 48% said they frequently/always search for information89% said the efficiency of the health care would improve/greatly improve if they could access the external data

Results



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Meeting the objectives:

Conclusion


The majority of health professionals believe that a patient record exchange system, particularly RSE in our country’s context, would be very useful or even essential.

Hospitals are the most searched sources of external patient data.

The medical documents that health professionals would find more useful to obtain are:

MCDT Clinical analysis Imaging exams Appointment and subspecialties’ reports Discharge reports

.

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• (1) Welcome to epSOS – a European eHealth Project. In epSOS: Home. Retrieved October 21, 2010, from http://www.epsos.eu/

• (2) Registo de saúde electrónico. In Portal da Saúde. Retrieved October 21, 2010, from http://www.portaldasaude.pt/portal/conteudos/a+saude+em+portugal/politica+da+saude/discussao/arquivo/registo+electronico.htm

• (3) Shapiro JS, Kannry J, Kushniruk AW, Kuperman G. Emergency Physicians’ Perceptions of Health Information Exchange. J Am Med Inform Assoc. 2007 Nov–Dec; 14(6) :700-705

References


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Survey


30

Survey


31

Survey


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Survey


Documents

Curricular unit: Introduction to Medicine II Adviser: Ricardo João Cruz Correia