Morris L et al. 2003 "How will practices cope with information for the new GMS contract? Coronary heart disease data recording in five Scottish practices."
Reference
Morris L, Taylor M, Campbell LM, et al. How will practices cope with information for the new GMS contract? Coronary heart disease data recording in five Scottish practices. Inform Prim Care 2003;11(3):121-127.
Abstract
"Objectives: To investigate whether practices will be ready for the data reporting requirements for the new General Medical Services (GMS) contract, using coronary heart disease (CHD) as an example.
Design: Cross-sectional survey.
Data sources: Electronic general practitioner (GP) records of all CHD patients in five Scottish practices, validated by manual searches in 50 randomly selected patients in each practice.
Main outcome measures: Recording of family history, smoking status, blood pressure (BP), diabetes testing, aspirin therapy, and cholesterol measurement.
Results: It is extremely easy for practices with completely electronic patient records to extract a disease register (mean 10 min, range 38 sec to 3 hr 6 min). Extraction of a complete dataset takes several days if it involves checking through paper records, whereas setting up and running a search from electronic records is possible in less than two hours. If practices use the same clinical system and identical data entry templates, the data can be directly compared. Some items that are easily recorded as part of routine clinical practice, such as prescribing of aspirin, are well recorded, but others, such as BP recording, are more of a problem. One hundred percent of the CHD patients sampled had a BP recording within the previous year, but some practices had these data in the paper records where they were not readily accessible.
Conclusions: We have shown that in Scotland there is a high level of testing and recording of all the important information regarding patients with recorded CHD, irrespective of whether practices have fully electronic records, paper-based records, or a mixture of the two. If practices have fully electronic patient records, the information can be extracted easily, but unless there is a standard template, the information can only be viewed in isolation and is of little value for comparative purposes."
Design: Cross-sectional survey.
Data sources: Electronic general practitioner (GP) records of all CHD patients in five Scottish practices, validated by manual searches in 50 randomly selected patients in each practice.
Main outcome measures: Recording of family history, smoking status, blood pressure (BP), diabetes testing, aspirin therapy, and cholesterol measurement.
Results: It is extremely easy for practices with completely electronic patient records to extract a disease register (mean 10 min, range 38 sec to 3 hr 6 min). Extraction of a complete dataset takes several days if it involves checking through paper records, whereas setting up and running a search from electronic records is possible in less than two hours. If practices use the same clinical system and identical data entry templates, the data can be directly compared. Some items that are easily recorded as part of routine clinical practice, such as prescribing of aspirin, are well recorded, but others, such as BP recording, are more of a problem. One hundred percent of the CHD patients sampled had a BP recording within the previous year, but some practices had these data in the paper records where they were not readily accessible.
Conclusions: We have shown that in Scotland there is a high level of testing and recording of all the important information regarding patients with recorded CHD, irrespective of whether practices have fully electronic records, paper-based records, or a mixture of the two. If practices have fully electronic patient records, the information can be extracted easily, but unless there is a standard template, the information can only be viewed in isolation and is of little value for comparative purposes."
Objective
To examine the ease of extracting data from the electronic and paper patient records in five Scottish practices, using coronary heart disease as an example.
Type Clinic
Primary care
Size
Small and/or medium
Other Information
The study sites were five practices in Scotland.
Type of Health IT
Electronic medical records (EMR)
Type of Health IT Functions
Functions included electronic patient summaries (80 percent of practices), electronic records system (20 percent), electronic method of recording data for chronic disease management (40 percent), and mixed paper and electronic method of recording data for chronic disease management (60 percent). The function being tested was extraction of data from patient records to create a patient chronic disease registry.
Context or other IT in place
In place was an electronic appointment system (100 percent of practices) and use of email (80 percent of practices).
Workflow-Related Findings
"It is extremely easy for practices with completely electronic patient records to extract a disease register..., on average taking ten minutes (range 38 sec to 3 hr 6 min). Conversely, it takes considerable time and effort for practices with paper records to compile a disease register, usually involving a search of prescribing records, discussion with clinicians who know the patients and final checking from the paper notes. For a disease register with 50-100 patients, it can take a total of several hours, and the results in our study varied from 10 hours 30 minutes to 18 hours of work for the practice."
"As with disease registers, extraction of a complete dataset can take several days if it involves checking through paper records, whereas setting up and running a search from electronic records can be done in less than two hours."
Study Design
Only postintervention (no control group)
Study Participants
Each practice created a registry of their patients with CHD and randomly selected 50 patient charts to be reviewed in detail.