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Exploitation of Electronic Medical Records Data in Primary Health Care Resistances and Solutions Study in Eight Walloon Health Care Centres Brussels, 22.

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Presentation on theme: "Exploitation of Electronic Medical Records Data in Primary Health Care Resistances and Solutions Study in Eight Walloon Health Care Centres Brussels, 22."— Presentation transcript:

1 Exploitation of Electronic Medical Records Data in Primary Health Care Resistances and Solutions Study in Eight Walloon Health Care Centres Brussels, 22 nd MIC Congress, november 25, 2004 Prof. Marc VANMEERBEEK Dept. of General Practice, University of Liege French-speaking Federation of Medical Houses

2 Structured electronic medical record (EMR) for each patient To follow his story Giving him the most appropriated care Clinical database Local use: quality of care improvement, a new deal for GPs Regional use: epidemiology, research, teaching

3 Belgian « Medical Houses » Multidisciplinary teams Primary health care Self management Development of EMR for 10 years Development of quality assessment programs for 9 years

4 Promotion of EMR since 2001 Reflection Forum Paper in « Santé conjuguée » Personalized teams meetings Clinical sofware PRICARE free of charge Software use training, by profession (31 teams, 73 participants) Target : 60 teams, 407 workers (doctors, nurses, physiotherapists)

5 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

6 2 Objectives To assess of indicators of the present use of the FMHs 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

7 Methods

8 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

9 Quantitative measures Use 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

10 Qualitative Analysis Nominal groups: per team Providing each participant with an equal voice All participants write the answers they feel are most important Develop a master list of issues Request that each participant rank the top five issues Tally the results by adding the points for each issue Discuss 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 ?

11 Results

12 Use of EMR : clinical data Nr Team Population 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 12452830,12%2,6724192 2185673593,49%1,2412700 338504272827,63%1,5137997 41196156157461,46%2,727042 521632211749,16%1,2714061 6953126346249,04%2,737310 713735008124796,37%4,027516 8338847436311,99%1,3122656 REF129835146223679,07%2,3028191 REF2778226459392,08%3,823780 REF319353657140478,09%2,6014163 REF41087345695995,52%3,608426 Okkes1,3 à 2,5

13 Sub-contacts / acts DoctorsPhysiotherapistsNurses Nr TeamSub- contacts ActsRatio contacts /acts Sub- contacts ActsRatio contacts /acts Sub- contacts ActsRatio contacts /acts 10151210037760052950 212399590,01012260013820 3572423401265190068130 40539400161100370 56288930,01126860523920 605404001085007970 71140856382,0263512520,511976260,31 8883145980394544110,89030050 REF110507175950,6220561820,36044140 REF2553430201,8355820,0111780,01 REF31089082991,31431332511,3373115150,48 REF41323849382,6862016620,37153418260,84 Okkes1,1-1,7

14 3 years of hard work leads to… 1/8 team: high frequency of use 2/8 teams: « rising users » 5/8 teams: occasional use or isolated users

15 Why ?

16 Results: 5 categories of items Ethics Training Search for sense Practice Multidisciplinarity

17 Items split rather differently according to the teams Nr Team 12345678 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 % 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 % Multi disciplinarity 15,4 % 22,7 % 4,2 % 12,5 % 9,1 % 15,0 % 6,9 % 178 verbatims:

18 Ethics 14 verbatims, 9 votes Data security Therapist / patient relation Therapist / informatics relation

19 Ethics Little or not evoked No worry about data security No worry about the relationship with patients (most are not concerned)

20 Training 21 verbatims, 18 votes Fundamental training to informatics Logical reasoning of computerized records Practical organization

21 Training Data structuration Belgian softwares are developping around the « Belgian Bilingual Biclassified Thesaurus (3BT) » and the Process-Thesaurus

22 Search for sense 49 verbatims, 32 votes Local data sharing Specific forming Need of a training personal within the team Increase motivation

23 Search for sense Strong demand to see outcomes Quality Improvement habits No informatics habits

24 Practice 72 verbatims, 45 votes Software improvement Development Easy use Internal organization Equipment (quality, availability) Informatic skills Clear choice between paperless or paper based record Time spent

25 Practice Powerfull software, but uneasy to use Fear of loosing time because of data processing (during the consultation, in forming) Nobody imagines saving time

26 Multidisciplinarity 21 verbatims, 15 votes Better coordination between professional sectors Everyone feels supported by a collective effort Carrying out of projects

27 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 sharing Need of a multidisciplinary software

28 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

29 Discussion Can solutions be generalized ?

30 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

31 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

32 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

33 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

34 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

35 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 patients list of episodes Users associated to the development

36 Thank you

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