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Current state of information technology use in a US primary care practice-based research network.

OBJECTIVES: To examine the current levels of information technology (IT) use in a primary care practice-based research network (PBRN) in order to inform future development of its infrastructure. PARTICIPANTS: Every primary care practitioner who is a member of the Kentucky Ambulatory Network (KAN),as well as the office managers of each practice. Practitioners included family practitioners, general practitioners, nurse practitioners and physician assistants. METHODS: A cross-sectional study using two survey instruments: one for office managers and one for practitioners. The office manager survey included questions related to the current state of IT within the practice, plans for enhancement and general IT issues from the perspective of managing a practice. The practitioner survey was designed to measure current IT use and attitudes of primary care practitioners. RESULTS: Response rates for the surveys were 46% (n = 68) for the office managers and 51% (n = 116) for practitioners. All but one practice had internet access; however, 43% had only dial-up service. Only 21% of practitioners use an electronic medical record (EMR), with dollar cost being the barrier reported most frequently (58%). More than half of the office managers were either 'somewhat interested' (45%) or 'very interested' (17%) in a low-cost, standardised EMR that was, at the time, to be sponsored by the American Academy of Family Physicians. For practitioners, 71% were either 'somewhat' or 'very' interested in such a system. Responses to other IT issues are reported. CONCLUSION: While interest in enabling information technologies was high in KAN, adoption was variable, with use of several key technologies reported as low.The results suggest that research in this network that would be dependent on or enhanced by IT might be impeded and, generally, greater attention should be given to enhancing the IT infrastructure in primary care.

Cross-Sectional Studies↗

Comprehensive computer system in the outpatient clinic.

A clinical computing system in a one-physician outpatient clinic is described. It consists of a computer-stored medical history at its center with associated blood examination equipment, a drug delivering machine and a cost calculation program. Two-month's experience has demonstrated its eligibility to clinical practice.

Ambulatory Care Information Systems↗

F:\DOCS\DOCS--physicians and automation.

While a paperless system may not be commonplace today, strides are being taken by groups such as CPRI to ensure the development of such a system. Several hospitals and clinics are moving toward or have implemented paperless or limited paper environments using patient-centered systems where charting is performed at the "bedside" of the patient through sophisticated software and hardware systems. Such systems will continue to evolve until the ATM of patient care is created. At that time, patients' access to their own information will be an acceptable phenomenon, physician use of computers will be commonplace, acceptance that adjunct knowledge bases must be coupled with the human skills of the physician, and test redundancy will be considered intolerable. These steps will contribute to the cost reductions needed to truly "reform" health care and create a value-added product for the United States.

Attitude to Computers↗

Group practice computing: the road to managing information.

Electronic information processing will have major implications for group practices in the near future, according to John T. Douglas, president and CEO of PD Medical Systems. Computer systems must be able to cope with electronic data interchange (EDI), electronic medical records (EMR) and outcome measurements to best serve groups under managed care.

Ambulatory Care Information Systems↗

A short story: it is possible, are you ready for it?

EDI is in the future of the medical practice field. Frances F. Manning, FACMPE, presents one scenario with the story of a mother attempting to obtain health care for her daughter and encountering a vast federal network of data bases. Also, members respond on page 36 to Manning's vision. Donald J. Lloyd, FACMPE, writes that it is possible and calls for limiting the prospects of such a robotic system. Sam J.W. Romeo, M.D., believes that Manning could have gone even further on technological advances while pointing out the side benefits of such a system.

Ambulatory Care Information Systems↗

The computer in the consulting room. What can it do for the physician?

Helen Mawhinney, M.D., of McLure, Moynihan and Associates and the University of California-Los Angeles, and Brad Dodge of Health Communication Services Inc., write about the use of computer-based medical records and their effects on patient care, decision making and data generation.

Cost-Benefit Analysis↗

The marriage of financial and clinical software.

As physicians feel increased pressure from managed care to operate more efficiently, they're expecting more from their practice management software than the streamlining of administrative tasks. Vendors are responding by adding clinical functions to their products.

Ambulatory Care Information Systems↗

Information management for managed care.

A key concern for medical groups is how to manage information in a dual environment of capitation and fee for service. Information systems that work for one may not work for the other. Finding a system that works for both is critical. Some of the data that would be beneficial to collect for starting managing capitation contracts include: age/sex ratios of the practice patient population, average number of visits per patient per year, average number of visits by ICD-9 code for total population, average procedures per patient per year, and analysis of paverage payment per visit/procedure for commercial and Medicare patients. Some of the major concerns addressed include operational issues, financial viability and automated billing systems.

Capitation Fee↗

Electronic medical records in the outpatient setting (Part 2).

Electronic medical records are on the verge of becoming the standard within ambulatory practice. Some of the savings available to medical groups are summarized, including labor savings in clerical, front-desk, transcription, nurse and medical assistant, and physician personnel, as well as malpractice premiums, and storage and supplies. In addition to savings, an expanded revenue base may be available as electronic medical records allow personnel to see more patients. The article gives some examples of how medical practices have used electronic medical records to obtain increased revenues.

Ambulatory Care↗

Medical EDI message specification and interchange formats.

Assessment of the current medical edi environment learns that "old" interchange formats are being used to represent information of highly complex and quickly evolving nature. Whenever the domain requirements are translated into acceptable messages according to these interchange format specifications, system developers use the latest technologies to implement the messages towards the distorted view imposed by the interchange format constraints. This situation, combined with the fact of coexistence of several interchange formats and the urgent need for more standardised message types, led to the specification of a new meta-syntax, supporting easy message definition and allowing the data-driven conversion between multiple interchange formats. As such, and supported by the development of interchange format independent message descriptions, it may become a tool to support the medical edi needs of the future.

Artificial Intelligence↗