information technology in primary health care: still a long way to go? carlos barbosa, carlos...
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Information Technology in primary health care:
still a long way to go?
Carlos Barbosa, Carlos Ferreira, Cláudia Santos, Diogo Pereira, Inês Grenha, Joana Ferreira, José Costa, Maria Silva, Paulo Ribeiro, Pedro Sousa, Ricardo Coelho, Tiago Oliveira
2010
Introduction: Background and Rationale
«Primary health care is a people-centred approach to health that makes prevention as
important as cure, offering an upstream attack on threats to health (...) [in an]
efficient, fair, and cost-effective way (...) [producing] better outcomes (...) with higher
user satisfaction.»
Primary health carePrimary health care The basis of many health systems Universal service
CHAN, M. (2008). "Primary health care – now more than ever." Retrieved 21 October 2009, from http://www.who.int/dg/speeches/2008/20081014/en/index.html.
Information Technology (IT)Information Technology (IT) Computerization of primary health care: a
priority task Interest for the scientific community
«Health information technology (Health IT) encompasses a wide range of products and systems, including software, hardware and infrastructure, that are used to support the collection, storage and exchange of patient
data throughout the clinical practice of medicine.»
Introduction: Background and Rationale
AMERICAN MEDICAL ASSOCIATION. "Health Information Technology (Health IT)." Retrieved 28 October 2009, from http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/health-information-technology.shtml.
Introduction: Background and Rationale
Portuguese Northern RegionPortuguese Northern Region Location Wide area
Introduction: Background and Rationale
ExistenceExistence Have IT devices (e. g. computers, printers),
appropriate software and networks in:• Doctor’s office• Nursing rooms
UtilizationUtilization Direct application of IT in primary health care Research:
• Diagnosis and prognosis• Protocols (e. g. contingency plans)
Which Information Technologies exist in the
primary health care service and how are they used?
Research Question and Aims
The study has the following aims:estimate the existence of Health IT in the primary
health care system and its usage in the Health Centre Groups (ACES) and Community Health Centers;
estimate the incentive or training programs made available by the ARS Norte or another institution to its health professionals;
establish a comparison between the deployment of Health IT in the primary health care services in the Portuguese Northern Region and the results of related studies developed in Portugal and foreign countries.
Research Question and Aims
Study ParticipantsStudy Participants
Participants and Methods
Dr. CastanheiraDr. CastanheiraExecutive Directors of the
ACES and Community Health Centres
Executive Directors of the ACES and Community
Health Centres
More knowledge about the situation in general
More information about their respective health centres and about the professionals who
work there
Know what is being done regarding IT in primary health careKnow what is being done regarding IT in primary health care
Study DesignStudy Design
The study is classified as: Observational Cross-sectional Ecologic
Participants and Methods
Participants and Methods- Explain aims and methods- Ask collaboration and authorization for the study
- Improve the quality and objectivity of the surveys in order to obtain more relevant and concise information
Contact the Director of ARS Norte
- Gather and process data statistically in order to establish comparisons and come up with the conclusions of the study
Interview Dr. Castanheira
Send a pilot survey to selected director of community health
centre(Dr. Carlos Martins)
Analyse the gathered data
presential interview
telephone
- Ask about the stimulus given by the ARS Norte for the implementation and usage of basic Health IT in Health Centres
e-mail and telephone
-Inform about the authorization from ARS Norte and explain aims- Ask collaboration for the study- Send the final surveys and obtain the required information for the development of the study
Contact the Executive Directors
(ACES, Community Health Centres)
Answered by Dr. Carlos Martins via telephone
Main goalPerform relevant adjustments in some of the questions to make them easier to answer
Pilot Survey
Final version of the survey
Main Results
Description of the institutionDescription of the institutionType of institution
Equipment and its usageEquipment and its usage
Main Results
Percentage of equipments in doctors’ offices and nursing rooms
Doctors’ offices Nursing rooms
Computers
Printers
Scanners
Photocopiers
Equipment and its usageEquipment and its usage
Main Results
Frequency of the utilization of computers by health professionals
Health professionals (doctors and nurses)always use computers in primary health care
Patient Health Record
Administrative management
Internet TeleHealthVideo
conference
Other application
s
Equipment and its usageEquipment and its usage
Main Results
Percentage of computers that allows the usage of specific applications
Main Results
Equipment and its usageEquipment and its usage
Other applications: Alert P1 SAPE Siars SGSR Spark
Percentage of computers that allows the usage of specific applications
GestCare SIMA Rastreios Taonet Impax Hígia
Main Results
Usage of the existing information systemsUsage of the existing information systemsAccess to the patient record and its frequency
Doctors Nurses
Administratives Patients
Access to the patient record and its frequency
Main Results
Usage of the existing information systemsUsage of the existing information systems
Other health professionals
Operational assistantsSocial assistantsPsychologistsNutritionists
Specific software for the doctors
Main Results
Usage of the existing information systemsUsage of the existing information systems
To make prescriptions To make health certificates
Existence
Utilization
Usage of the InternetUsage of the Internet
Main Results
Internet access
Doctors’ offices Nursing rooms
Existence
Utilization
Usage of the InternetUsage of the Internet
Main Results
Purposes of the usage of the Internet
Searchscientific articles
Share datawith other health
entities
Communicatewith other health
professionals
Use toolsto support clinical
practicePersonal use Other usages
Existence and utilization of intranetsExistence and utilization of intranets
Main Results
Existence of intranets
Main Results
Existence and utilization of intranetsExistence and utilization of intranetsUtilization of intranets
Doctors Nurses
SupportSupport
Main Results
ARS Norte is the institution that supports the most, in terms of financial and material support (hardware and software)
One of the respondents referred support by Universidade do Minho, showing a possible active role of external institutions in the improvement of primary health care services.
TrainingTraining
Main Results
Doctors, nurses and administrativesall have/had specific training
to work with the hardware and software available
Sufficiency of the training made available
Doctor Nurses Administratives
Main Results
Hardware Software
The main needs
• Scanners
• Computers
• General improvement of the quality and speed of the devices
• Establish more efficient links between applications
• Faster and more reliable computer programs
What should be changed in terms of usage
• Make network connections faster
• Increase the number of devices available(e.g. scanners, screens for the waiting rooms)
• Make the computers less vulnerable to threats(e.g. virus)
• There is technical support available in case of difficulties
RemarksRemarks
Main Results
Human resources Training for the staff
Different realities in the various health centres/ACES:
• Need for a computing professional to provide help to solve the hardware and software issues which happen daily
• In certain health centres, less than one computer specialist per 300 users
• Improve the teams which give support
• More time for training(due to the high complexity of certain applications)
• Make training and support available whenever necessary
RemarksRemarks
Comparison with Other Studies
Adoption of information technology in primary Adoption of information technology in primary care physician offices in New Zealand and care physician offices in New Zealand and DenmarkDenmark
Study divided into five partsEach part refers to a different aspect of the comparison between New Zealand and Denmark
Legend for the results .1 = <20% of primary care physicians2 = 20-40% of primary care physicians3 = 40-60% of primary care physicians4 = 60-80% of primary care physicians5 = >80% of primary care physicians
Comparison with Other Studies
Adoption of information technology in primary Adoption of information technology in primary care physician offices in New Zealand and care physician offices in New Zealand and DenmarkDenmark Main results
Comparison with Other Studies
Adoption of information technology in primary Adoption of information technology in primary care physician offices in New Zealand and care physician offices in New Zealand and DenmarkDenmark Main results
Comparison with Other Studies
Adoption of information technology in primary Adoption of information technology in primary care physician offices in New Zealand and care physician offices in New Zealand and DenmarkDenmark Main results
Discussion
Need for improvements in the computer equipments available
Reduced existence and utilization of TeleHealth and videoconference in primary health care
High levels of existence and utilization of health record software and specific software for prescriptions and health certificates
Deployment of platforms which promote a nearer connection between health services
Various realities in terms of availability of technical help for the use of computer tools in primary health care, despite the support given by ARS Norte
Checkpoint
Already achievedAlready achieved
Surveys sent to all directors of community health centers and ACESStatistical analysis made with initial resultsQuestions for the interview with Dr. Castanheira are madeComparison with other studyInitial discussion of the results obtainedWhat must be doneWhat must be done
Continue to analyze the data that comes up with timeInterview with Dr.Castanheira (held by an agenda conflict)Final discussion of the results
References ADMINISTRAÇÃO REGIONAL DE SAÚDE DO NORTE. Retrieved 17th
October 2009, from
http://www.arsnorte.min-saude.pt/portal/page/portal/ARSNorte.
AMERICAN MEDICAL ASSOCIATION. "Health Information
Technology (Health IT)." Retrieved 28 October 2009, from
http://www.ama-assn.org/ama/pub/physician-resources/solutions-
managing-your-practice/health-information-technology.shtml.
References CHAN, M. (2008). "Primary health care – now more than ever."
Retrieved 21 October 2009, from
http://www.who.int/dg/speeches/2008/20081014/en/index.html.
CORREIA R, A. F., FREITAS A, COSTA-PEREIRA A (2002). "State of
Electronic Health Records in Portugal." TEHRE.
D. PROTTI et al. (2008) “Adoption of information technology in
primary care physician offices in New Zealand and Denmark,
part 5: final comparisons” Informatics in Primary Care. 17(1):
17-22