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PubMed2005

The core data elements of electronic health record in Finland.

Delivery of good care, ability to communicate effectively about patient care and the decision-making during the care process depends on the quality of the information available to all professions and between sectors. The main purpose of an electronic health record is to support the multidisciplinary communication, cooperation and decision-making in the patient's care process. In addition, the data in electronic health records are used, e.g. in clinical research, health system management, the planning of health services and government reporting. A nationwide electronic health record will be introduced in Finland by the end 2007. Reaching this target has been a special part of the national health project. In a subproject of the introduction of a national electronic health record, core data elements of electronic health record have been defined through a consensus-based approach. The main elements are the patient identification information, the provider's identification information, care episode, risk factors, health patterns, vital signs, health problems and diagnosis, nursing minimum data set, surgical procedures, tests and examinations, information about medication, preventive measures, medical statements, functional status, technical aids, living will, tissue donor will, discharge summary, follow-up care plan and consent information. Furthermore, existing vocabularies, nomenclatures, classifications and codes were clarified. The HL7 Finland has defined the manner in which this information is expressed in the CDA R2 structure. The core information elements will be implemented in regional development projects which are partly funded by the Ministry of Social Affairs and Health. This paper presents the defining process of the national core data elements of electronic health record systems in Finland.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Use of referral reply letters for continuing medical education: a review.

INTRODUCTION: Referrals between generalists and specialists are a central component of the health care system and necessitate effective communication between the involved providers. Despite the high prevalence of patient referrals and their crucial role in continuity and quality of care, the medical literature demonstrates that generalists may receive little or no information about the care their patients received and little information about the appropriateness of the referral or recommendations for follow-up care. General practitioners (GPs) prefer teaching that is directly related to their clinical work rather than traditional continuing education such as formal lectures. The purpose of this review is to assess the role of referral reply letters in the continuing education of GPs. METHODS: A comprehensive literature search was conducted to November 2001 using MEDLINE, EMBASE, the Cochrane Library, and the Research and Development Resource Base developed by Continuing Education, Faculty of Medicine, University of Toronto, to identify studies that examined the use of referral letters for the transfer of information from specialists to referring physicians. Data on methodology, unit of analysis, main outcome measures, and results were extracted. RESULTS: Of 1,250 articles retrieved, 9 met the eligibility criteria. Three of these analyzed the content of referral reply letters and 6 described the results of surveys of general and specialty physicians. DISCUSSION: Little educational content is currently included in letters from specialists to referring GPs. GPs are receptive to the use of referral replies as sources of learning.

Canada↗
PubMed2006

Interspecialty referrals: evaluation of quality and pattern of referral letters to an oral and maxillofacial surgery clinic.

Referral letters are the most desirable means of communication between medical practitioners in patients' management, however many studies have indicated that this form of communication is often lacking in essential information necessary for prompt treatment. This study sets out primarily to evaluate the quality and secondarily pattern of referrals from other specialties within the University College Hospital, Ibadan, Nigeria, to the department of Oral and Maxillofacial surgery of the same institution. The information sought for in each letter were patient's name, age, sex: is the letter dated or not, referring department, history ofcomplaint, management already instituted, reason for the referral, name and the signature of the referring doctor. Each of these ten items was scored I when present and 0 when absent. Thus, a maximum score of 10 was recorded when all items were present. Referrals were graded into grade A-D. A being referrals with the maximum score of 10, B: scores of 7-9, C: scores of 4-6, D: scores of 0-3. There were only 9 grade A letters accounting for 3% of the total. Majority of the letters, 201 (77%) were of grade B while the remaining 52 (20%) were of grade C. The accident and emergency unit provided most of the letters i.e. 176 accounting for 67.7%. Plastic surgery and Accident/ Emergency units individually produced 3 out of the 9 grade A letters, however, no statistically significant association was found between specialty units and grades of letters.

Correspondence as Topic↗
PubMed2004

Exploratory cluster randomised controlled trial of shared care development for long-term mental illness.

BACKGROUND: Primary care clinicians have a considerable amount of contact with patients suffering from long-term mental illness. The United Kingdom's National Health Service now requires general practices to contribute more systematically to care for this group of patients. AIMS: To determine the effects of Mental Health Link, a facilitation-based quality improvement programme designed to improve communication between the teams and systems of care within general practice. DESIGN OF STUDY: Exploratory cluster randomised controlled trial. SETTING: Twenty-three urban general practices and associated community mental health teams. METHOD: Practices were randomised to service development as usual or to the Mental Health Link programme. Questionnaires and an audit of notes assessed 335 patients' satisfaction, unmet need, mental health status, processes of mental and physical care, and general practitioners' satisfaction with services and beliefs about service development. Service use and intervention costs were also measured. RESULTS: There were no significant differences in patients' perception of their unmet need, satisfaction or general health. Intervention patients had fewer psychiatric relapses than control patients (mean = 0.39 versus 0.71, respectively, P = 0.02) but there were no differences in documented processes of care. Intervention practitioners were more satisfied and services improved significantly for intervention practices. There was an additional mean direct cost of pound 63 per patient with long-term mental illness for the intervention compared with the control. CONCLUSION: Significant differences were seen in relapse rates and practitioner satisfaction. Improvements in service development did not translate into documented improvements in care. This could be explained by the intervention working via the improvements in informal shared care developed through better link working. This type of facilitated intervention tailored to context has the potential to improve care and interface working.

Adult↗
PubMed2002

The communication of information about older people between health and social care practitioners.

AIM: to provide an evidence base for strategies, and effectiveness of the transfer of patient information between hospital and community for older people with physical illness. DESIGN: a systematic review of qualitative and quantitative literature. SEARCH STRATEGY: literature from medical, health-related and social science databases as well as work in progress from national databases, the Internet, British PhD theses and other grey literature and policy documents. SELECTION CRITERIA: literature relating to similar healthcare systems published between January 1994 and June 2000 on hospital discharge planning. Empirical studies from peer reviewed sources; theoretical papers from non-peer reviewed sources; research papers from non-peer reviewed sources and professional documents. DATA COLLECTION AND ANALYSIS: extracted data from empirical studies under the headings of location, sector, research questions and study design and duration. We made structured summaries of all other data sources and used them to supply context and background. We categorized literature and analysed it in terms of method and analysis, quality and strength of evidence and its relevance to the research questions. We synthesized the results and presented them in terms of answers to our research questions. RESULTS: a database of 373 potentially relevant studies and of these, 53 were accepted for further analysis. Thirty-one were empirical studies, most of which were qualitative or a combination of qualitative and quantitative in design. The most effective strategy for transferring information is the appointment of a 'key worker', who can provide a point of contact for workers from hospital and community. Nevertheless, problems have arisen because both settings are under pressure and pursuing different goals. Neither setting is fully aware of the needs, limitations and pressures of the other. CONCLUSION: raised awareness and the establishment of common goals are the first steps needed to bridge the divide between health and social care staff in hospital and the community.

Aged↗
PubMedDate not supplied

Strengthening your ties to referring physicians through RIS/PACS integration.

Many imaging centers are turning to technology solutions to increase refering physician satisfaction, implementing such enhancements as automated report distribution, picture archiving and communications system (PACS), radiology information systems (RIS), and web-based results access. However, without seamless integration, these technology investments don't address the challenge at its core: convenient and reliable, two-way communication and interaction with referring physicians. In an integrated RIS/PACS solution, patient tracking in the RIS and PACS study status are logged and available to users. The time of the patient's registration at the imaging center, the exam start and completion time, the patient's departure time from the imaging center, and results status are all tracked and logged. An integrated RIS/PACS solution provides additional support to the radiologist, a critical factor that can improve the turnaround time of results to referring physicians. The RIS/PACS enhances the interpretation by providing the patient's history, which gives the radiologist additional insight and decreases the likelihood of missing a diagnostic element. In a tightly integrated RIS/PACS solution, results information is more complete. Physicians can view reports with associated images selected by the radiologist. They will also have full order information and complete imaging history including prior reports and images. Referring physicians can access and view images and exam notes at the same time that the radiologist is interpreting the exam. Without the benefit of an integrated RIS/PACS system, the referring physician would have to wait for the signed transcription to be released. In a seamlessly integrated solution, film-tracking modules within the RIS are fused with digital imaging workflow in the PACS. Users can see at a glance if a historical exam is available on film and benefit when a complete study history--both film-based and digital--is presented with the current case. It is up to the imaging center to market the benefits of reduced errors, reduced turnaround times, and a higher level of service to referring physician community, and encourage them to take advantage of the convenience it provides. The savvy imaging center will also regard the integrated RIS/PACS as a valuable marketing tool for use in attracting radiologists.

Appointments and Schedules↗
PubMed2006

Qualitative evaluation of a form for standardized information exchange between orthopedic surgeons and occupational physicians.

BACKGROUND: Both occupational physicians and orthopedic surgeons can be involved in the management of work relevant musculoskeletal disorders. These physicians hardly communicate with each other and this might lead to different advice to the patient. Therefore, we evaluated a standardized information exchange form for the exchange of relevant information between the orthopedic surgeon and the occupational physician. The main goals of this qualitative study are to evaluate whether the form improved information exchange, whether the form gave relevant information, and to generate ideas to further improve this information exchange. METHODS: The information exchange form was developed in two consensus meetings with five orthopedic surgeons and five occupational physicians. To evaluate the information exchange form, a qualitative evaluation was set up. Structured telephone interviews were undertaken with the patients, interviews with the physicians were face-to-face and semi-structured, based on a topic list. These interviews were recorded and literally transcribed. Each interview was analyzed separately in Atlas-Ti. RESULTS: The form was used for 8 patients, 7 patients agreed to participate in the qualitative evaluation. All three orthopedic surgeons involved and three of the six involved occupational physicians agreed to be interviewed. The form was transferred to 4 occupational physicians, the other 3 patients recovered before they visited the occupational physician. The information on the form was regarded to be useful. All orthopedic surgeons agreed that the occupational physician should take the initiative. Most physicians felt that the form should not be filled out for each patient visiting an orthopedic surgeon, but only for those patients who do not recover as expected. Orthopedic surgeons suggested that a copy of the medical information provided to the general practitioner could also be provided to occupational physicians. CONCLUSION: The information exchange form was regarded to be useful and could be used in practice. The occupational physician should take the initiative for using this form and most physicians felt the information should only be exchanged for patients who do not recover as expected. That means that the advantage of giving information early in the treatment is lost.

Adolescent↗
PubMed2006

Data withholding and the next generation of scientists: results of a national survey.

PURPOSE: To provide the first national data on the nature, extent, and consequences of withholding among life science trainees. METHOD: In 2003, the authors surveyed 1,077 second-year doctoral students and postdoctoral fellows in life sciences at 50 U.S. universities, with a comparison group of trainees in computer science and chemical engineering. The study variables examined trainees' exposure to and the consequences of data withholding. RESULTS: Two hundred forty-six trainees (23.0%) reported that they had asked for and been denied access to information, data, materials, or programming associated with published research and 221 (20.6%) to unpublished research. Eighty-five trainees (7.9%) reported that they had denied another academic scientist's request(s) related to their own published research. Five hundred thirty-three trainees (50.8%) reported that withholding had had a negative effect on the progress of their research, 508 (48.5%) on the rate of discovery in their lab/research group, 472 (45.0%) on the quality of their relationships with academic scientists, 346 (33.0%) on the quality of their education, and 299 (28.5%) on the level of communication in their lab/research group. Trainees denied access to research were significantly more likely to report that data withholding had had a negative effect on several aspects of the educational experience. CONCLUSIONS: Data withholding had demonstrated negative effects on trainees. The life sciences, more so than chemical engineering or computer science, will have to address this issue among its trainees. Failure to do so could result in delayed research, inefficient training, and a culture of withholding among future life scientists.

Access to Information↗
PubMed1976

Medical ethics teaching. Report of a National Medical School Survey.

Medical ethics teaching was surveyed at American medical schools. Of 107 schools that responded, 97 indicated some kind of medical ethics teaching. This included, however, 19 schools where teaching was only by discussion of ethical issues in courses not primarily identified as ethics courses. Fifty-six institutions (up from 17 in 1972) reported that they conducted special conferences, lectures, or seminars on issues in medical ethics. Specific medical ethics electives were offered in 47 schools; some kind of required course existed at six institutions. The number of faculties with major commitments to medical ethics teaching increased approximately 50% (from 19 to 31). Several schools now have departments or interdepartmental teaching programs with formal structure and permanent staff.

Curriculum↗
PubMed1985

Oregon Health Decisions. An experiment with informed community consent.

Oregon Health Decisions is a citizen-based project intended to develop statewide awareness of severe bioethical dilemmas. The project has set in motion civic means for addressing and resolving problems in Oregon's health provision system associated with personal autonomy, equity of access, prevention of illness, and humane cost containment. The process of civic involvement with consequent results is described together with the implications for future health policy in Oregon and elsewhere.

Advisory Committees↗
PubMed2003

Restoring balance to industry-academia relationships in an era of institutional financial conflicts of interest: promoting research while maintaining trust.

Economic partnerships between industry and academia accelerate medical innovation and enhance patient access to medical advances, but such partnerships have sometimes eroded public trust in the research enterprise. There is particular risk for conflict of interest when economic partnerships extend beyond a university's corporate interests to involve institutional decision makers. Institutions and institutional decision makers should fully disclose industry-related financial interests and relationships. Without legitimate justification for such interests, individuals should divest themselves from these interests or recuse themselves from responsibility for research oversight. Management of institutional partnerships also might entail the physical separation of certain facilities, the placement of restrictions on information shared between investment and research staffs, and provision of oversight by independent review panels made up of persons who have expertise in intellectual property, finance, and research, but who are not financially or otherwise dependent on the institution. Through these means, it is possible to restore balance to industry-academia relationships, thereby promoting progress while maintaining public trust in research.

Academies and Institutes↗
PubMed2004

Health care delivery in the Texas prison system: the role of academic medicine.

Faced with explosive growth in its prison population and a legal mandate to improve medical care for incarcerated offenders, the state of Texas implemented a novel correctional managed health care program in 1994. The organizational structure of the program is based on a series of contractual relationships between the state prison system, 2 of the state's academic medical centers, and a separate governing body composed of 9 appointed members, which include 5 physicians. All medical, dental, and psychiatric care for more than 145,000 offenders, incarcerated under the jurisdiction of the Texas Department of Criminal Justice, is provided by the University of Texas Medical Branch and Texas Tech University Health Sciences Center. The health delivery system is composed of several levels of care, including primary ambulatory care clinics in each prison unit, 16 infirmaries at strategic locations throughout the state, several regional medical facilities, and a dedicated prison hospital with a full range of services. Specialized treatment programs have been established at various units for patients with chronic conditions, such as hypertension, diabetes mellitus, major psychiatric disorders, hepatitis, and human immunodeficiency virus infection. Significant improvements in health outcomes have occurred since the managed care program was established.

Academic Medical Centers↗