BackgroundThe purpose of this study was to assess the impact of accessing primary care records on unscheduled care. Unscheduled care is typically delivered in hospital Emergency Departments. Studies published to December 2014 reporting on primary care record access during unscheduled care were retrieved.ResultsTwenty-two articles met inclusion criteria from a pool of 192. Many shared electronic health records (SEHRs) were large in scale, servicing many millions of patients. Reported utilization rates by clinicians was variable, with rates >20% amongst health management organizations but much lower in nation-scale systems. No study reported on clinical outcomes or patient safety, and no economic studies of SEHR access during unscheduled care were available. Design factors that may affect utilization included consent and access models, SEHR content, and system usability and reliability.ConclusionsDespite their size and expense, SEHRs designed to support unscheduled care have been poorly evaluated, and it is not possible to draw conclusions about any likely benefits associated with their use. Heterogeneity across the systems and the populations they serve make generalization about system design or performance difficult. None of the reviewed studies used a theoretical model to guide evaluation. Value of Information models may be a useful theoretical approach to design evaluation metrics, facilitating comparison across systems in future studies. Well-designed SEHRs should in principle be capable of improving the efficiency, quality and safety of unscheduled care, but at present the evidence for such benefits is weak, largely because it has not been sought.

No abstract

This second paper in a series of five looks at how computing in primary care began and provides background to the driving forces for automation in Danish and New Zealand primary care physician offices. It addresses topics such as government funding support, the role of professional colleges and associations, peer influence, change management, and comparative cultures. It also highlights the power of a unifying organisation and introduces the concept of a Health Systems Integrator.

The sooting tendencies of various fuel blends containing either single-ring or polycyclic aromatics have been studied in a model gas turbine combustor at a pressure of 1.0 MPa and varying values of air/fuel ratio. Sooting tendencies were determined by flame radiation, exhaust soot, and infra-red absorption measurements. The results of this study have indicated that, even for fuels containing high concentrations of naphthalenes or tetralins (> 10 percent v), fuel total hydrogen content correlates well with fuel sooting tendency. The present results are explained by a hypothesis that assumes that the majority of soot is formed in regions of high temperature, low oxygen content, and low fuel concentration, e.g., the recirculation zone.

No abstract