Family Medicine

Recommendations

Info

World Book of Family Medicine – European Edition 2015 Ilkka Kunnamo ilkka.kunnamo@duodecim.fi 88 – How to Build an Ideal Healthcare Information System? Ilkka Kunnamo, MD, PhD, Adjunct Professor of General Practice, University of Helsinki An ideal healthcare information system (HIS) improves the quality of care and patient safety, and makes work easier and faster. Whilst achieving both of these goals, it also increases the cost-effectiveness of healthcare. The HIS should support the key tasks of the FD, particularly the provision of patient-centred and coordinated care, easy access and continuity. Best available knowledge at fingertips The first task of a HIS is to provide access to all medical knowledge and display it to both clinicians and patients in a format that is user-friendly. The knowledge must be searchable with any terms that the users come across in their daily practice and communication. The knowledge should be updated continuously and assessed for the quality of evidence with guideline recommendations transparently derived on the basis of the evidence. The recommendations should be graded for strength. Personalized medicine and decision support The total number of different data items (the sum of all diagnoses, tests, drugs, procedures…) is already about 100 000. This number will increase exponentially when whole-genome sequencing and analysis of gene expressions and proteins become routine. Computer systems are needed to integrate this data alongside available medical knowledge. Clinical decision support integrated with EHRs can already improve care and patient safety. It allows personalized medicine – the tailoring and application of guideline recommendations individually for each patient. HIS supporting the specific tasks of the FD The HIS facilitates communication between patients and their FD, as well as within the network of professionals that create virtual teams to provide patient-centred care. Patient empowerment is promoted through the sharing of medical knowledge, by supporting home measurements, and motivating and guiding self-care. Safe communication via personal health records, e-mail and video messages enables contact sometimes outside office hours, and simultaneously reduces long hours spent in the office and provides more flexible schedules for the FD. Continuity of care is improved. The HIS supports the role of the family doctor as the coordinator of care. The FD has access to data recorded by other health professionals. Much of the data will be recorded by patients, either by themselves via intuitive user interfaces of personal health records (PHRs), or automatic monitoring devices. All professionals must have access to this data through consent of the patient. Correspondingly, data recorded by professionals into electronic health records (EHRs) must be available for patients via their PHRs or via a national EHR archive. Measures of functional ability and quality of life are used in the assessment of 270
World Book of Family Medicine – European Edition 2015 patients and care planning. The HIS protects the FD from information overflow and excessive workload by filtering important information, displaying summary data on one screen and prioritizing tasks. It gives primary responsibility to the patient as long as they are able to interpret the information. The HIS continuously monitors the data of all patients and simultaneously displays gaps in care to the FD. The HIS supports patient-centred care when a treatment plan is established by the patient, the FD, and multi-professional team. Care protocol templates are available for creating evidence-based plans, which are tailored to meet the goals and preferences of the patient. The HIS monitors that the goals set by the patient and FD together are met, and sends reminders to both the patient and the professional when necessary. Health inequalities will be reduced by targeting resources for people who have the most to gain from healthcare interventions. A comprehensive decision support system is particularly helpful in the care of typical primary care patients with multimorbidity when discordant recommendations from single-disease guidelines need to be streamlined. The comprehensive medication review is a tool that analyses data from the EHR against decision support regulations and drug databases, checking evidence-based indications, laboratory monitoring alerts, warnings on reduced dosage in renal insufficiency, drug interactions and contraindications, potentially inappropriate drugs in the elderly, cumulative adverse effect risks of polypharmacy, maximum dosing and cross-allergies. The tool facilitates safe reduction in polypharmacy. Practice and research united An ideal healthcare information system (HIS) learns from every patient, every intervention and its outcome. Every data item in the electronic health record contributes to the body of medical knowledge as it is anonymously stored in a research database that contains the follow-up data of all patients. Associations can be detected, and hypotheses tested using such nationwide and international databases. Targeted, multi-centre randomized trials will be easy to perform by using software that automatically collects baseline and follow-up data from the EHR, and helps to record study-specific data on web-based electronic case record forms. The HIS also maintains a portfolio of the FDs experience in caring for different types of patients, and performing various interventions, and helps in identifying needs for continuous medical education. Basic principles of HIS To achieve these goals, certain basic principles need to be followed. The database where patient data are stored and the software applications displaying and processing the data must be separated and connected via open interfaces. This will allow the development of user-friendly software, including mobile apps, which are connected to the data. Competition in software development will improve usability. All data regarding each patient from both primary and secondary care must be accessible by means of the patient’s permission (“one patient – one record”). Data confidentiality and safe communication between healthcare providers and their patients must be ensured. The coding of data must be nationally and internationally agreed to make automatic processing of the data possible, and allow high-quality software to be distributed across borders and languages. The key structured data set consists of a problem list, current medication list, results of measurements and laboratory tests, performed procedures, and functional assessment. Responsibility of the whole population (for the FD, a list of patients and practice population) is enabled via patient data that can be aggregated, monitored, sorted and searched. Patient-centredness should be the guiding principle in software design, with virtual team building around patients, and patients themselves (not only professionals) as key users of medical software. Take home messages Empowerment of patients is a strategic goal in building health information systems. Patient-centredness requires that one patient has one record – across primary and secondary health care. Coding of patient data allows processing by computer and enables clinical decision support, personalized medicine, and automation of many tasks. The primary care team can take care of the whole population via the information system and ensure that care can be offered equally to everyone who would benefit from health care interventions. 271
Page 1 and 2:
The World Book of Family Medicine -
Page 3 and 4:
World Book of Family Medicine - Eur
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
The WP workshops on Ethics describe
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
References: World Book of Family Me
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Original Abstract World Book of Fam
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Original abstract World Book of Fam
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
References World Book of Family Med
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Original abstract World Book of Fam
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Take home messages World Book of
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
Page 219 and 220: World Book of Family Medicine - Eur
Page 245 and 246: References World Book of Family Med
Page 269: World Book of Family Medicine - Eur
Page 287 and 288: Quaternary Prevention rubric (www.p
show all

Family Medicine

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?