Improving the quality of primary care through tailored interventions and customizable software linked to electronic medical records

Abstract

The principal information system used in Norwegian primary healthcare - the electronic medical record (EMR) - is a rich but underused source of data for quality improvement purposes.

This paper describes two systems that aim to make better use of the EMR. First, ‘Best Possible Practice’ provides general practitioners with online support for the treatment of urinary tract infections and sore throats, tailored to the patient via the EMR. The second system, ‘QTools’, will allow health professionals, researchers and others to create a wide range of quality improvement tools.

Studies with both systems are under way. Early results from ‘Best Possible Practice’ provide information on antibiotic use, use of laboratory tests and use of telephone consultations. These data will be used to assess the ability of the system to change the behaviour of health professionals. ‘QTools’ is under development but several elements of the system are in place, primarily a flexible data extraction tool.

EMR systems offer many possibilities for quality improvement systems tailored to individual patients. Although working in this area is a challenge, such systems have the potential to chart and change practice at the local, regional and national levels.

Keywords

electronic medical record quality improvement tailored interventions primary care

References

World Health Organization (1998) Health21: health for all in the 21st century. European Health for All series no. 6.

Oslo: Ministry of Health and Social Affairs og Statens helsetilsyn (1995) Nasjonal strategi for kvalitetsutvikling i helsetjenesten. IK-2482 [National strategy for quality improvement in healthcare].

Oslo: Statens helsetilsyn (1997) Nasjonal strategi for kvalitetsutvikling i helsetjenesten. [National strategy for quality improvement in healthcare].

Grimsmo A. Helsedataprosjektet. Report on the Helsedata project for the Information Technology Committee for Primary Medicine, Norway, 1998.

Oxman A D , Thomson M A , Davis D A , Haines RB . No magic bullets: a systematic review of 102 trials of interventions to help health care professionals deliver services more effectively or efficiently. Can. Med. Assoc. J. 1995; 153: 1423-1431.

Sullivan F , Mitchell E. Has general practitioner computing made a difference to patient care? A systematic review of published reports. BMJ 1995; 311: 848-852.

Balas E A , Austin S M , Mitchel J A , Ewigman B G , Bopp K D , Brown G D. The clinical value of computerized information services: a review of 98 randomized clinical trials. Arch. Fam. Med. 1996; 5: 271-278.

Shea S , DuMouchel W , Bahamonde L. A meta-analysis of 16 randomised controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. JAMIA 1996; 3: 399-409.

Hunt D L , Haynes B , Hanna S E , Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA 1998; 280: 1339-1346.

10.

Woolf S H , Grol R , Hutchinson A , Eccles M , Grimshaw J. Potential benefits, limitations, and harms of clinical guidelines. BMJ 1999; 318: 527-530.

11.

Grimshaw J M , Russell I T. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 1993; 342: 1317-1322.

12.

Bero L A , Grilli R , Grimshaw J M , Harvey E , Oxman A D , Thomson M A. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. BMJ 1998; 317: 465-468.

13.

NHS Centre for Reviews and Dissemination , University of York . Getting evidence into practice. Effective Health Care 1999; 5: 1-16.

14.

Oxman A , Flottorp S. An overview of strategies to promote implementation of evidence based health care. In: Silagy C , Haines A , (Eds.) Evidence Based Practice in Primary Care. London: BMJ Books; 1998, pp. 91-109.

15.

Granados A , Jonsson E , Banta H D , Bero L , Bonair A , Cochet C , Freemantle N , Grilli R , Grimshaw J , Harvey E , et al . EUR-ASSESS Project Subgroup Report on Dissemination and Impact. Int J Technol Assess Health Care 1997; 13: 220-286.

16.

Flottorp S , Oxman AD , Cooper JG , Hjortdahl P , Sandberg S and Vorland LH . Retningslinjer for diagnostikk og behandling av akutte vannlatingsplayer hos kvinner (Guidelines for the diagnosis and treatment of sore throat.) Tidsskr. Nor. Laegeforen 2000; 120: 1748-1753.

17.

Flottorp S , Oxman AD , Cooper JG , Hjortdahl P , Sandberg S and Vorland LH . Retningslinjer for diagnostikk og behandling av sår hals (Guidelines for the diagnosis and treatment of urinary tract infections in women.) Tidsskr. Nor. Laegeforen 2000; 120: 1754-1760.

18.

Altman D G. Practical statistics for medical research. London: CRC Press; 1991.

19.

Hogan W , Wagner M. Accuracy of data in computer-based patient records. JAMIA 1997; 4: 342-355.

20.

Hofmann B , Torstad J. EDB-basert journalsystem i primærhelsetjenesten. [IT-based medical record systems in primary healthcare] Tidsskr. Nor. Lægeforen 1996; 116: 1470-1473.