Literature review of SNOMED CT use

With the introduction and implementation of a variety of government programs and policies to encourage adoption of electronic medical records (EMRs), EMRs are being increasingly adopted in North America. We sought to evaluate the completeness of a variety of EMR fields to determine if family physicians were comprehensively using their EMRs and the suitability of use of the data for secondary purposes in Ontario, Canada.

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Are family physicians comprehensively using electronic medical records such that the data can be used for secondary purposes? A Canadian perspective.

Background : The number of patients with multimorbidity (two or more conditions) is increasing. Observational research has shown that having multiple health problems is associated with poorer outcomes in terms of health, quality of care, and costs. Thus, it is imperative to understand how patients with multimorbidity experience their healthcare process. Insight into patient experiences can be used to tailor healthcare provision specifically to the needs of patients with multimorbidity. Objective : To synthesize self-reported experiences with the healthcare process of patients with multimorbidity, and identify overarching themes. Design : A scoping literature review that evaluates both qualitative and quantitative studies published in PubMed, Embase, MEDLINE, and PsycINFO. No restrictions were applied to healthcare setting or year of publication. Studies were included if they reported experiences with the healthcare process of patients with multimorbidity. Patient experiences were extracted and subjected to thematic analysis (interpretative), which revealed overarching themes by mapping their interrelatedness. Results : Overall, 22 empirical studies reported experiences of patients with multimorbidity. Thematic analysis identified 12 themes within these studies. The key overarching theme was the experience of a lack of holistic care. Patients also experienced insufficient guidance from healthcare providers. Patients also perceived system-related issues such as problems stemming from poor professional-to-professional communication. Conclusions : Patients with multimorbidity experience a range of system- and professional-related issues with healthcare delivery. This overview illustrates the diversity of aspects that should be considered in designing healthcare services for patients with multimorbidity. Journal of Comorbidity 2017;7(1):11–21

https://journals.sagepub.com/doi/pdf/10.15256/joc.2017.7.97

Patients with multimorbidity and their experiences with the healthcare process: a scoping review

Data quality of electronic medical records in Manitoba: do problem lists accurately reflect chronic disease billing diagnoses?

Background: The increasing use of routinely collected data in electronic health record (EHR) systems for business analytics, quality improvement and research requires an extraction process fit for purpose. Little is known about the quality of EHR data extracts. We examined the accuracy of three data extraction tools (DETs) with two EHR systems in Australia. Methods: The hardware, software environment and extraction instructions were kept the same for the extraction of relevant demographic and clinical data for all active patients with diabetes. The counts of identified patients and their demographic and clinical information were compared by EHR and DET. Results: The DETs identified different numbers of diabetics and measures of quality of care under the same conditions. Discussion: Current DETs are not reliable and potentially unsafe. Proprietary EHRs and DETs must support transparency and independent testing with standardised queries. Quality control within an appropriate policy and legislative environment is essential.

Data extraction from electronic health records - existing tools may be unreliable and potentially unsafe

Objective: Little has been reported about the completeness and accuracy of data in existing Australian clinical information systems. We examined the accuracy of the diagnoses of some chronic diseases in an ED information system (EDIS), a module of the NSW Health electronic medical record (EMR), and the consistency of the reports generated by the EMR.



Methods: A list of ED attendees and those admitted was generated from the EDIS, using specific (e.g. angina) and possible clinical terms (e.g. chest pain) for the selected chronic diseases. This EDIS list was validated with an audit of discharge summaries, and compared with a list generated, using similar specific and possible Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT), from the underlying EMR database.



Results: Of the 33 115 ED attendees, 2559 had diabetes mellitus (DM), cardiovascular disease or asthma/chronic obstructive pulmonary disease; of these 2559, 876 were admitted. Discharge summaries were missing for 12–15% of patients. Only three-quarters or fewer of the diagnoses were confirmed by the discharge summary audit, best for DM and worst for cardiovascular disease. Proportion of agreement between the lists generated from the EDIS and EMR was best for DM and worst for asthma/chronic obstructive pulmonary disease. Possible reasons for this discrepancy are technical, such as use of different extraction terms or system inconsistency; or clinical, such as data entry, decision-making, professional behaviour and organizational performance.



Conclusions: Variations in information quality and consistency of the EDIS/EMR raise concerns about the ‘fitness for purpose’ of the information for care and planning, information sharing, research and quality assurance.

Health reform: Is routinely collected electronic information fit for purpose?

The rapidly increasing prevalence of diabetes with its high morbidity and mortality raises the need for an integratedmultidisciplinaryservicefromhealthcareprovidersacrosshealthsectors.Theaimofthisstudywastoexplorethe diabetic patients' experience of multidisciplinary care, in particular their perceptions, perceived barriers and facilitators. Thirteenpatientswithtype-2diabetesadmittedtotheemergencydepartmentofalocalhospitalinNSWwereinterviewedand completed a demographic questionnaire. Results showed that patients found it inconvenient to be referred to many health professionals because of multiple physical and psychosocial barriers. Separate sets of instructions from different health professionalswereoverwhelming,confusingandconflicting.Lackofadedicatedcoordinatorofcare,followupandsupport forself-managementfromhealthprofessionalswerefactorsthatcontributedtopatients'challengesinbeingactivelyinvolved in their care. The presence of multiple co-morbidities made it more difficult for patients to juggle priorities and 'commitments' to many health professionals. In addition, complex socioeconomic and cultural issues, such as financial difficulties, lack of transport and language barriers, intensified the challenge for these patients to navigate the health system independently.Fewpatientsfeltthathavingmanyhealthprofessionalsinvolvedintheircareimprovedtheirdiabetescontrol. Communicationamongthemultidisciplinarycareteamwasfragmentedandhadanegativeeffectonthecoordinationofcare. The patients' perspective is important to identify the problems they experience and to formulate strategies for improving multidisciplinary care for patients with diabetes.

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Huei Yang Chen

Papers

Health reform: Is routinely collected electronic information fit for purpose?

Multidisciplinary care: Experience of patients with complex needs