Managing complexity in pre-operative information management systems

Bouamrane, Matt-Mouley; Mair, Frances S; Tao, Cui

doi:10.1145/2064747.2064751

Cited by 8 publications

(12 citation statements)

References 30 publications

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“…The interviews were semi-structured and open-ended in order to allow the interviewer or interviewee to elaborate on unanticipated and potentially valuable information with additional questions, and probe for further explanation [24]. The interviews aimed to collect GP views on information management processes in the patient surgical pathway in NHSScotland: information about the GP practice itself, including information management practices and ICT use, the patient consultation, referral processes to hospital outpatient clinics, communication between GPs and hospitals from the point of referral to patient surgery, post-operative discharge information provided by the hospitals, and finally, any issues identified in the patient surgical journey and areas for potential service improvement [7,8,25,26]. …”

Section: Methodsmentioning

confidence: 99%

A study of general practitioners’ perspectives on electronic medical records systems in NHSScotland

Bouamrane

Mair

2013

BMC Med Inform Decis Mak

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BackgroundPrimary care doctors in NHSScotland have been using electronic medical records within their practices routinely for many years. The Scottish Health Executive eHealth strategy (2008-2011) has recently brought radical changes to the primary care computing landscape in Scotland: an information system (GPASS) which was provided free-of-charge by NHSScotland to a majority of GP practices has now been replaced by systems provided by two approved commercial providers. The transition to new electronic medical records had to be completed nationally across all health-boards by March 2012.MethodsWe carried out 25 in-depth semi-structured interviews with primary care doctors to elucidate GPs’ perspectives on their practice information systems and collect more general information on management processes in the patient surgical pathway in NHSScotland. We undertook a thematic analysis of interviewees’ responses, using Normalisation Process Theory as the underpinning conceptual framework.ResultsThe majority of GPs’ interviewed considered that electronic medical records are an integral and essential element of their work during the consultation, playing a key role in facilitating integrated and continuity of care for patients and making clinical information more accessible. However, GPs expressed a number of reservations about various system functionalities – for example: in relation to usability, system navigation and information visualisation.ConclusionOur study highlights that while electronic information systems are perceived as having important benefits, there remains substantial scope to improve GPs’ interaction and overall satisfaction with these systems. Iterative user-centred improvements combined with additional training in the use of technology would promote an increased understanding, familiarity and command of the range of functionalities of electronic medical records among primary care doctors.

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Section: Methodsmentioning

confidence: 99%

A study of general practitioners’ perspectives on electronic medical records systems in NHSScotland

Bouamrane

Mair

2013

BMC Med Inform Decis Mak

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“…We have previously conducted a scoping review of the literature on Pre-Operative Information Systems (POIS) [2,3] and report on a representative sample of the systems which have been implemented to date:…”

Section: Preoperative Information Systemsmentioning

confidence: 99%

Patient Preoperative Web Portal for Remote, Self-completed Assessment & Triage: a Feasibility Study

Bouamrane¹,

Adeyemo²,

McGee‐Lennon³

et al. 2015

Electronic Workshops in Computing

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Golden Jubilee National Hospital (GJNH) is a state-of-the art tertiary referral centre, carrying out a range of major surgical procedures on behalf of the National Health Service (NHS) in Scotland. In order to improve the integrated care pathway for patient surgical assessment at GJNH, we conducted a feasibility study for a Preoperative Patient Web portal. We collaborated with the anaesthetic department to design and develop a web based preoperative questionnaire which can be self-completed remotely by patients through a web-browser (patient portal). An initial feasibility study of the system suggests that a simple self-completed preoperative web-based questionnaire could be deployed in practice at GJNH, with potential anticipated benefits including reduced costs and improved patient preoperative triage. Self-Completed Patient Questionnaires, Preoperative Assessment, Feasibility Study 2. BACKGROUND & RELATED WORK 2.1 Golden Jubilee National Hospital Golden Jubilee National Hospital (Clydebank, Scotland) is a state-of-the art tertiary referral centre, carrying out a range of major surgical procedures across the NHS in Scotland.

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“…The eForm adapts on-the-fly to previous clinical data entry, using underlying multi-level conditional branching, prompting context-specific clinical decision support functionalities for the nursing staff. This adaptive behaviour has previously been described elsewhere as a desirable feature of surgical pre-assessment information systems due to the complexity of information elucidation tasks in POA and the importance of conducting patient-centric screening, risk stratification and care management [ 28 – 35 ]. Consensus guidelines agreed across the health-board through the PCIP programme, and including guidelines developed by the Scottish Intercollegiate Guidelines Network (SIGN) [ 36 ] are embedded in the ICP.…”

Section: Electronic Preoperative Integrated Care Pathway Implementatimentioning

confidence: 99%

Implementation of an integrated preoperative care pathway and regional electronic clinical portal for preoperative assessment

Bouamrane

Mair

2014

BMC Med Inform Decis Mak

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BackgroundEffective surgical pre-assessment will depend upon the collection of relevant medical information, good data management and communication between the members of the preoperative multi-disciplinary team. NHS Greater Glasgow and Clyde has implemented an electronic preoperative integrated care pathway (eForm) allowing all hospitals to access a comprehensive patient medical history via a clinical portal on the health-board intranet.MethodsWe conducted six face-to-face semi-structured interviews and participated in one focus group and two workshops with key stakeholders involved in the Planned Care Improvement (PCIP) and Electronic Patient Record programmes. We used qualitative methods and Normalisation Process Theory in order to identify the key factors which led to the successful deployment of the preoperative eForm in the health-board.ResultsIn January 2013, more than 90,000 patient preoperative assessments had been completed via the electronic portal. Two complementary strategic efforts were instrumental in the successful deployment of the preoperative eForm. At the local health-board level: the PCIP led to the rationalisation of surgical pre-assessment clinics and the standardisation of preoperative processes. At the national level: the eHealth programme selected portal technology as an iterative strategic technology solution towards a virtual electronic patient record. Our study has highlighted clear synergies between these two standardisation efforts.ConclusionThe adoption of the eForm into routine preoperative work practices can be attributed to: (i) a policy context – including performance targets – promoting the rationalisation of surgical pre-assessment pathways, (ii) financial and organisational resources to support service redesign and the use of information technology for operationalising the standardisation of preoperative processes, (iii) a sustained engagement with stakeholders throughout the iterative phases of the preoperative clinics redesign, guidelines standardisation and the eForm development, (iv) the use of a pragmatic and domain-agnostic technology solution and finally: (v) a consensual and contextualised implementation.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6947-14-93) contains supplementary material, which is available to authorized users.

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Managing complexity in pre-operative information management systems

Cited by 8 publications

References 30 publications

A study of general practitioners’ perspectives on electronic medical records systems in NHSScotland

A study of general practitioners’ perspectives on electronic medical records systems in NHSScotland

Patient Preoperative Web Portal for Remote, Self-completed Assessment & Triage: a Feasibility Study

Implementation of an integrated preoperative care pathway and regional electronic clinical portal for preoperative assessment

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