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Yearb Med Inform 2015; 24(01): 22-29
DOI: 10.15265/IY-2015-017
Original Article
Georg Thieme Verlag KG Stuttgart

Does Informatics Enable or Inhibit the Delivery of Patient-centred, Coordinated, and Quality-assured Care: a Delphi Study

A Contribution of the IMIA Primary Health Care Informatics Working Group
H. Liyanage
1   Department of Health Care Management & Policy, University of Surrey, Guildford, Surrey, UK
,
S-T. Correa
2   School of Public Health & Community Medicine, UNSW Medicine, Australia
,
C. Kuziemsky
3   Telfer School of Management, University of Ottawa, Ontario, Canada
,
A. L. Terry
4   Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
,
S. de Lusignan
1   Department of Health Care Management & Policy, University of Surrey, Guildford, Surrey, UK
› Author Affiliations
Further Information

Publication History

30 June 2015

Publication Date:
10 March 2018 (online)

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Summary

Background: Primary care delivers patient-centred and coordinated care, which should be quality-assured. Much of family practice now routinely uses computerised medical record (CMR) systems, these systems being linked at varying levels to laboratories and other care providers. CMR systems have the potential to support care.

Objective: To achieve a consensus among an international panel of health care professionals and informatics experts about the role of informatics in the delivery of patient-centred, coordinated, and quality-assured care.

Method: The consensus building exercise involved 20 individuals, five general practitioners and 15 informatics academics, members of the International Medical Informatics Association Primary Care Informatics Working Group. A thematic analysis of the literature was carried out according to the defined themes. Results:The first round of the analysis developed 27 statements on how the CMR, or any other information system, including paper-based medical records, supports care delivery. Round 2 aimed at achieving a consensus about the statements of round one. Round 3 stated that there was an agreement on informatics principles and structures that should be put in place. However, there was a disagreement about the processes involved in the implementation, and about the clinical interaction with the systems after the implementation.

Conclusions: The panel had a strong agreement about the core concepts and structures that should be put in place to support high quality care. However, this agreement evaporated over statements related to implementation. These findings reflect literature and personal experiences: whilst there is consensus about how informatics structures and processes support good quality care, implementation is difficult.

Keywords

Patient-centred care - clinical informatics - healthcare quality assurance - computerised medical records - patient participation
 

  • References

  • 1 Institute of Medicine (US) Committee on Quality of Health Care in America.. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001
    Google Scholar
  • 2 Finkelstein J, Knight A, Marinopoulos S, Gibbons MC, Berger Z, Aboumatar H. et al. Enabling patient-centered care through health information technology. Evid Rep Technol Assess 2012; Jun (206) 1-1531.
    PubMedGoogle Scholar
  • 3 Stewart M. Towards a global definition of patient centred care. BMJ 2001; 322 7284 444-5.
    CrossrefPubMedGoogle Scholar
  • 4 Martin CM, Félix-Bortolotti M. Person-centred health care: a critical assessment of current and emerging research approaches. J Eval Clin Pract 2014 Dec 10.
    PubMedGoogle Scholar
  • 5 de Lusignan S. What is primary care informatics?. J Am Med Inform Assoc 2003; Jul-Aug 10 (04) 304-9. Epub 2003 Mar 28.
    CrossrefPubMedGoogle Scholar
  • 6 van Bemmel JH, Musen MA. editors. Handbook of Medical Informatics. Heidelberg: Springer-Verlag; 1997
    Google Scholar
  • 7 de Lusignan S. Making sense of taxonomies in health informatics. Inform Prim Care 2014; 21 (03) 1-5.
    PubMedGoogle Scholar
  • 8 Liyanage H, Liaw ST, Kuziemsky C, de Lusignan S. Ontologies to improve chronic disease management research and quality improvement studies - a conceptual framework. Stud Health Technol Inform 2013; 192: 180-4.
    PubMedGoogle Scholar
  • 9 Ruland CM, Bakken S. Developing, implementing, and evaluating decision support systems for shared decision making in patient care: a conceptual model and case illustration. J Biomed Inform 2002; 35 (05) 313-21.
    CrossrefPubMedGoogle Scholar
  • 10 Ruland CM, Bakken S, Røislien J. Reliability and validity issues related to interactive tailored patient assessments: a case study. J Med Internet Res 2007 ;9(3).
    PubMedGoogle Scholar
  • 11 Klinkman M, van Weel C. Prospects for person‐ centred diagnosis in general medicine. J Eval Clin Pract 2011; 17 (02) 365-70.
    CrossrefPubMedGoogle Scholar
  • 12 Chawla NV, Davis DA. Bringing big data to personalized healthcare: a patient-centered framework. J Gen Intern Med 2013; Sep 28 Suppl 3: S660-5.
    PubMedGoogle Scholar
  • 13 Weiss JB, Berner ES, Johnson KB, Giuse DA, Murphy BA. et al. Recommendations for the design, implementation and evaluation of social support in online communities, networks, and groups. J Biomed Inform 2013; 46 (06) 970-6.
    CrossrefPubMedGoogle Scholar
  • 14 Ricciardi L, Mostashari F, Murphy J, Daniel JG, Siminerio EP. A national action plan to support consumer engagement via e-health. Health Affairs 2013; 32 (02) 376-84.
    CrossrefPubMedGoogle Scholar
  • 15 Archambault PM. WikiBuild: a new application to support patient and health care professional involvement in the development of patient support tools. J Med Internet Res 2011 13(4).
    PubMedGoogle Scholar
  • 16 Velianoff GD. Advancing the Evolution of Health-care: Information Technology in a Person-Focused Population Health Model. J Nurs Admin 2014; 44 7/8 381-7.
    CrossrefPubMedGoogle Scholar
  • 17 Sama L, Dykes PC, Greenberg J, Hasan O, Venkatesh AK, Volk LA, Bates DW. et al. The current capabilities of health information technology to support care transitions. AMIA Annu Symp Proc 2013; Nov 16 2013: 1231.
    PubMedGoogle Scholar
  • 18 Wald HS, George P, Reis SP, Taylor JS. Electronic Health Record Training in Undergraduate Medical Education: Bridging Theory to Practice With Curricula for Empowering Patient-and Relationship-Centered Care in the Computerized Setting. Acad Med 2014; Mar 89 (03) 380-6.
    CrossrefPubMedGoogle Scholar
  • 19 Brown KK, Master-Hunter TA, Cooke JM, Wimsatt LA, Green LA. Applying health information technology and team-based care to residency education. Family Medicine-Kansas City 2011; 43 (10) 726.
    PubMedGoogle Scholar
  • 20 Krist AH, Woolf SH, Bello GA, Sabo RT, Longo DR, Kashiri P. et al. Engaging primary care patients to use a patient-centered personal health record. Ann Family Med 2014; 12 (05) 418-26.
    CrossrefPubMedGoogle Scholar
  • 21 Liyanage H, Liaw ST, Kuziemsky C, Terry AL, Jones S, Soler JK. et al. The Evidence-base for Using Ontologies and Semantic Integration Methodologies to Support Integrated Chronic Disease Management in Primary and Ambulatory Care: Realist Review. Contribution of the IMIA Primary Health Care. Informatics WG. Yearb Med Inform 2013; 8 (01) 147-54.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Gooch P, Roudsari A. Computerization of work-flows, guidelines, and care pathways: a review of implementation challenges for process-oriented health information systems. J Am Med Inform Assoc 2011; Nov-Dec 18 (06) 738-48.
    CrossrefPubMedGoogle Scholar
  • 23 Tawfik H, Anya O, Nagar AK. Understanding clinical work practices for cross-boundary decision support in e-health. IEEE Trans Inf Technol Biomed 2012; Jul 16 (04) 530-41.
    CrossrefPubMedGoogle Scholar
  • 24 Liyanage H, de Lusignan S, Liaw ST, Kuziemsky CE, Mold F, Krause P. et al. Big Data Usage Patterns in the Health Care Domain: A Use Case Driven Approach Applied to the Assessment of Vaccination Benefits and Risks. Contribution of the IMIA Primary Healthcare Working Group. Yearb Med Inform 2014; Aug 15 9 (01) 27-35.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Finkelstein J, Knight A, Marinopoulos S, Gibbons MC, Berger Z, Aboumatar H. et al. Enabling patient-centered care through health information technology. Evid Rep Technol Assess (Full Rep) 2012; Jun (206) 1-1531.
    PubMedGoogle Scholar
  • 26 Chawla NV, Davis DA. Bringing big data to personalized healthcare: a patient-centered framework. J Gen Intern Med 2013; Sep 28 Suppl 3: S660-5.
    PubMedGoogle Scholar
  • 27 Gonzales MJ, O’Connor MF, Riek LD. Contextual constraints for the design of patient-centered health IT tools. Stud Health Technol Inform 2013; 194: 75-81.
    PubMedGoogle Scholar
  • 28 Krist AH, Woolf SH, Bello GA, Sabo RT, Longo DR, Kashiri P. Etz et al. Engaging primary care patients to use a patient-centered personal health record. Ann Fam Med 2014; Sep-Oct 12 (05) 418-26.
    CrossrefPubMedGoogle Scholar
  • 29 LeRouge C, Wickramasinghe N. A review of user-centered design for diabetes-related consumer health informatics technologies. J Diabetes Sci Technol 2013; Jul 1 7 (04) 1039-56.
    CrossrefPubMedGoogle Scholar
  • 30 Adler-Milstein J, Cohen GR. Implementing the IT infrastructure for health reform: adoption of health IT among patient-centered medical home practices. AMIA Annu Symp Proc 2013; Nov 16 2013: 11-6.
    PubMedGoogle Scholar
  • 31 Hung M, Conrad J, Hon SD, Cheng C, Franklin JD, Tang P. Uncovering patterns of technology use in consumer health informatics. Wiley Interdiscip Rev Comput Stat 2013; Nov 5 (06) 432-47.
    CrossrefPubMedGoogle Scholar
  • 32 Kraschnewski JL, Gabbay RA. Role of Health Information Technologies in the Patient-Centered Medical Home. J Diabetes Sci Technol 2013; 7 (05) 1376-85.
    CrossrefPubMedGoogle Scholar
  • 33 Adler-Milstein J, Cohen GR. Implementing the IT Infrastructure for Health Reform: Adoption of Health IT among Patient-Centered Medical Home Practices. AMIA Annu Symp Proc 2013: 11.
    PubMedGoogle Scholar
  • 34 Kraschnewski JL, Gabbay RA. Role of health information technologies in the Patient-centered Medical Home. J Diabetes Sci Technol 2013; Sep 1 7 (05) 1376-85.
    CrossrefPubMedGoogle Scholar
  • 35 Saleem JJ, Flanagan ME, Wilck NR, Demetriades J, Doebbeling BN. The next-generation electronic health record: perspectives of key leaders from the US Department of Veterans Affairs. J Am Med Inform Assoc 2013; Jun 20 e1 e175-7.
    CrossrefPubMedGoogle Scholar
  • 36 Ozkaynak M, Brennan PF, Hanauer DA, Johnson S, Aarts J, Zheng K. et al. Patient-centered care requires a patient-oriented workflow model. J Am Med Inform Assoc 2013; Jun 20 e1 e14-6.
    CrossrefPubMedGoogle Scholar
  • 37 Daaleman TP, Hay S, Prentice A, Gwynne MD. Embedding Care Management in the Medical Home A Case Study. J Prim Care Community Health 2014; 5 (02) 97-100.
    CrossrefPubMedGoogle Scholar
  • 38 Dixon BE, Jabour AM, Phillips EO, Marrero DG. An informatics approach to medication adherence assessment and improvement using clinical, billing, and patient-entered data. J Am Med Inform Assoc 2014; May-Jun 21 (03) 517-21.
    CrossrefPubMedGoogle Scholar
  • 39 Wald HS, George P, Reis SP, Taylor JS. Electronic health record training in undergraduate medical education: bridging theory to practice with curricula for empowering patient- and relationship-centered care in the computerized setting. Acad Med 2014; Mar 89 (03) 380-6.
    CrossrefPubMedGoogle Scholar
  • 40 Brown KK, Master-Hunter TA, Cooke JM, Wimsatt LA, Green LA. Applying health information technology and team-based care to residency education. Fam Med 2011; Nov-Dec 43 (10) 726-30.
    PubMedGoogle Scholar
  • 41 Staggers N, Thompson CB. The Evolution of Definitions for Nursing Informatics A Critical Analysis and Revised Definition. J Am Med Inform Assoc 2002; 9 (03) 255-61.
    CrossrefPubMedGoogle Scholar
  • 42 Duffield C, Diers D, O’Brien-Pallas L, Aisbett C, Roche M, King M. et al. Nursing staffing, nursing workload, the work environment and patient outcomes. Appl Nurs Res 2011; Nov 24 (04) 244-55.
    CrossrefPubMedGoogle Scholar
  • 43 Huston C. The impact of emerging technology on nursing care: warp speed ahead. Online J Issues Nurs 2013; May 31 18 (02) 1.
    PubMedGoogle Scholar
  • 44 Finkelstein J, Knight A, Marinopoulos S, Gibbons MC, Berger Z, Aboumatar H. et al. Enabling patient-centered care through health information technology. Evid Rep Technol Assess (Full Rep) 2012; Jun (206) 1-1531.
    PubMedGoogle Scholar
  • 45 Snyder CF, Wu AW, Miller RS, Jensen RE, Bantug ET, Wolff AC. The role of informatics in promoting patient-centered care. Cancer J 2011; Jul-Aug 17 (04) 211-8.
    CrossrefPubMedGoogle Scholar
  • 46 de Lusignan S, Mold F, Sheikh A, Majeed A, Wyatt JC, Quinn T, Cavill M. et al. Patients’ online access to their electronic health records and linked online services: a systematic interpretative review. BMJ Open 2014; Sep 8 4 (09) e006021.
    CrossrefPubMedGoogle Scholar
  • 47 Davis Giardina T, Menon S, Parrish DE, Sittig DF, Singh H. Patient access to medical records and healthcare outcomes: a systematic review. J Am Med Inform Assoc 2014; Jul-Aug 21 (04) 737-41.
    CrossrefPubMedGoogle Scholar