Instant availability of patient records, but diminished availability of patient information: A multi-method study of GP's use of electronic patient records

<p>Abstract</p> <p>Background</p> <p>In spite of succesful adoption of electronic patient records (EPR) by Norwegian GPs, what constitutes the actual benefits and effects of the use of EPRs in the perspective of the GPs and patients has not been fully characterized. We wanted to study primary care physicians' use of electronic patient record (EPR) systems in terms of use of different EPR functions and the time spent on using the records, as well as the potential effects of EPR systems on the clinician-patient relationship.</p> <p>Methods</p> <p>A combined qualitative and quantitative study that uses data collected from focus groups, observations of primary care encounters and a questionnaire survey of a random sample of general practitioners to describe their use of EPR in primary care.</p> <p>Results</p> <p>The overall availability of individual patient records had improved, but the availability of the information within each EPR was not satisfactory. GPs' use of EPRs were efficient and comprehensive, but have resulted in transfer of administrative work from secretaries to physicians. We found no indications of disturbance of the clinician-patient relationship by use of computers in this study.</p> <p>Conclusion</p> <p>Although GPs are generally satisfied with their EPRs systems, there are still unmet needs and functionality to be covered. It is urgent to find methods that can make a better representation of information in large patient records as well as prevent EPRs from contributing to increased administrative workload of physicians.</p

Electronic Medical Records: Provotype visualisation maximises clinical usability

The Electronic Medical Record (EMR) is the essential tool of the clinical consultation, effectively replacing the paper medical record. Since its gradual adoption in the early 2000s there has been a failure to achieve even moderate levels of EMR usability in clinical settings, resulting in a negative impact on clinical care, time efficiency and patient safety. This research explores how deeper collaboration with clinical users through participatory design, drawing on the disciplines of visual design, user experience (UX) design and visual analytics, might offer a more effective approach to this important problem. The lead researcher for this project is both a practising doctor and design researcher. Usability of two commercial EMR interfaces in the field of sexual health is explored through a mixed method survey, with responses used to inform the design of an interface provotype. This in turn is evaluated through repeat survey and ‘test-drive’ talk-aloud workshops. Results from the survey on two commercial EMR interfaces (n=49) revealed deep dissatisfaction particularly around issues of navigation, flow of consultation, frustration, safety, time-dependent and time-independent data, data complexity and data salience. Comparative provotype evaluation (n=63) showed that clinically-relevant visualisation offers marked gains in clinical usability and performance. This research argues for a re-imagining of the way we look at medical data during the clinical consultation so that the affordances and benefits of the digital format can be exploited more fully. It highlights the value of combining participatory design with visualisation to embed explicit, experiential and even tacit clinical knowledge into the EMR interface

Automated Online Transition from the Medical Record to the Psychiatric Literature

Abstract:Psych Topix is a knowledge-based program which guides the clinician from an on-line clinical report to a search of the psychiatric literature or of other relevant databases. It provides this guidance by using an outline of key topics in a clinical field to provide “concept-based” links. Each topic is augmented with an activation expression to signal when that topic is potentially relevant to a case, and with database search expressions to allow focused retrieval of information. The bibliographic retrieval component of PsychTopix is currently operational as part of the daily, routine operation of a psychiatric consultation service. The system is also implemented in a demonstration mode to provide retrieval from three additional textual databases. The current PsychTopix system provides a working demonstration of the clinical feasibility of using concept-based links to facilitate the focused, automated transition between on-line medical databases.</jats:p

Review of Methods for Studying Maturation of Human Erythroblasts in Vitro: Evaluation of a New Method of Culture of Cell Suspensions in a Clot-Free Medium

Abstract Characteristics of various tissue and cell culture methods for studying maturation of human erythroblasts were reviewed and the basic assumptions required in their use were examined. The relationship of maturation and proliferation of erythroblasts in different types of cultures was considered. Criteria for selection of an in vitro model for studying maturation were established. A new clot-free culture system in roller tubes was found to be superior to those previously described because of convenience, replicability and adaptability to studies of proliferation. The results of challenging the new culture system with various types of cell-plasma relationships indicated that it was effective in distinguishing among erythroblasts and plasmas of iron deficiency anemia, thalassemia, azotemia and erythrocytosis, and that the deductions arrived at were similar to those derived from the use of less convenient in vitro systems in which different parameters of maturation were used. Experience with the new method suggests that it may be useful in the study of humoral factors affecting maturation of human erythroblasts. The chief limitation of the proposed method, as for other in vitro methods, is that only direct effects of humoral agents on erythroblasts can be studied.</jats:p