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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
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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
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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
The usefulness of a national electronic health record 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
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•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
The usefulness of a national electronic health record system
developing a patient record database is important.
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Justification
The usefulness of a national electronic health record system
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;
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• 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
The usefulness of a national electronic health record system
Would the health professionals find the existence of an electronic system sharing medical information among
health institutions useful?
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INDEX
• IntroductionBackgroundJustificationResearch question and aims
• Development of the investigationStudy participantsStudy designData collection methodsPlanned statistical analysis/Variables description
• Results
• Conclusion
• References
• Survey7
The usefulness of a national electronic health record system
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The usefulness of a national electronic health record system
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
8
DEPARTMENTSEmergency departmentInternal medicineGeneral surgery PediatricsOtorhinolaryngology
Study participants Departments’ selection criteria: addition of
variables of (potential) interest
DATA COLLECTING METHODS: survey (paper and online)
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The usefulness of a national electronic health record system
Study design
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•Cross-sectional study
– Pointed to a specific moment in time
•Observational study
– No intervention
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The usefulness of a national electronic health record system
Pilot Tests
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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
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The usefulness of a national electronic health record system
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
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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
The usefulness of a national electronic health record system
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The usefulness of a national electronic health record system
Survey’s distribution
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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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The usefulness of a national electronic health record system
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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
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INDEX
• IntroductionBackgroundJustificationResearch question and aims
• Development of the investigationStudy participantsStudy designData collection methodsPlanned statistical analysis/Variables description
• Results
• Conclusion
• References
• Survey
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The usefulness of a national electronic health record system
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Results
The usefulness of a national electronic health record system
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?
The usefulness of a national electronic health record system
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
The usefulness of a national electronic health record system
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%
Hea
lth
Cent
ers
Hos
pita
ls
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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
The usefulness of a national electronic health record system
>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
The usefulness of a national electronic health record system
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.
The usefulness of a national electronic health record system
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.
The usefulness of a national electronic health record system
Results
MCDT
Clinica
l hist
ory
Clinica
l analy
sis
Imag
ing 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
The usefulness of a national electronic health record system
50.0%50.0%
Nurses
48.6%51.4%
Doctors
Sim
Não
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Results
The usefulness of a national electronic health record system
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 (%
)
Comparative Analysis
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Results
The usefulness of a national electronic health record system
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%
Comparative Analysis
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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
The usefulness of a national electronic health record system
Comparative Analysis
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Meeting the objectives:
Conclusion
The usefulness of a national electronic health record system
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
The usefulness of a national electronic health record system
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Survey
The usefulness of a national electronic health record system
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Survey
The usefulness of a national electronic health record system
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Survey
The usefulness of a national electronic health record system
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Survey
The usefulness of a national electronic health record system