Curricular unit: Introduction to Medicine II
Adviser: Ricardo João Cruz Correia
Class 17. 1st year. 2010/2011
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• General government’s objective:
centralization of all medical records in a single country-wide electronic
sharing system
• Related projects being carried out:
– epSOS (1) – the European-wide project to patient data interchange among
countries, particularly focused on emergency situations
– RSE (2) – the Portuguese program for a centralized patient records
database and sharing system
(1) http://www.epsos.eu/
(2) http://www.portaldasaude.pt/portal/conteudos/a+saude+em+portugal/politica+da+saude/discussao/arquivo/registo+electronico.htm 3
• One known evaluation study(3) about the importance of a regional
electronic health information exchange system:
– Based on questionnaires answered by New York ER Doctors;
Conclusion
developing a patient record database is important.
– Possible bias due to the distribution method used.
• In Portugal: no released investigations about the subject.
(3) Shapiro JS, Kannry J, Kushniruk AW, Kuperman G. Emergency Physicians’ Perceptions of Health Information Exchange. J Am
Med Inform Assoc. 2007 Nov–Dec; 14(6) :700-705
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1
2
3
• Scarcity of studies/evaluations proving the viability of
the projects and low quality of the available information;
• Reduced query to specialists working in the fields that
the projects would potencially give benefit to;
• Ambiguous justifications by the entities working on the
projects for their implementation;
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• Main question:
Would the health professionals find the existence of an
electronic system sharing medical information among
health institutions useful?
• Objectives/Aims:
– Gathering opinions from health professionals about the usefulness of
this kind of systems;
– Determining which type of information and type of institution whose
information health professionals would find the most important to have
access to;
– Comparing results obtained in this project to those of Shapiro’s study.
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Doctors
Nurses
TARGET POPULATION
Hospital S. João
Hospitals
Hospital Pedro Hispano
(data share system implemented)
SAMPLING
LOCATIONS
Hospital Cuf Porto
Departments’ selection
criteria: addition of
variables of (potential)
interest
DEPARTMENTS
Emergency department
Internal medicine
General surgery
Pediatrics
Otorhinolaryngology
(institutions chosen
for convenience)
Primary Care
Health Centers of ARS Norte – doctors of
primary care
DATA COLLECTING METHODS: survey (paper and online)
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•Cross-sectional study
– Pointed to a specific moment in time
•Observational study
– No intervention
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9 doctors
4 nurses
Main critics to the survey:
•Nurses, some doctors: asking for percentages with no sense in some questions;
gradatory scale
•Difficulties on the comprehension of question 4 (which features would benefit from the system) ;
modified
•Several suggestions for the answer of question 6 (which type of information would be the most useful) ;
turned into an open question
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Letters
Sent 11 March
(after phone conversation)
Hand-delivered
(after direct conversation)
Contents:
• Request for Authorization (letter)
• Survey
• Written Protocol
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Support in study
 Disclosure of the survey by e-mail
General Practice (GP’s) Doctors
MedQuest
http://http://newdbserver.med.up.pt/projext/medquest/verprod/index.php?mdl=3&qtr=MTQyNzcxMDUxNDI=
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Hospital
Hospital S. João
Department
Delivered
Emergency
department
Required written approval :
Ethics committee
Hospital’s direction
Internal medicine
X
Filled
X
Hospital Pedro
Hispano
Delivered
Filled
Hospital Cuf Porto
Delivered
X
X
X
X
Online
Filled
X
N=46
General surgery
Unavailable
X
X
Pediatrics
X
Lost
X
X
X
Otorhinolaryngology
X
X
X
X
X
N=67
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• Descriptive analysis
- using PASW (SPSS)
•
Comparative analysis
– acording to selected variables
• Type of health professional: Doctors/ Nurses
• Type of institution: Public/ Private institutions
• Gender: Female/ Male
• Age: Younger/ Older professionals
• Survey format: Online/ Printed version
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PAPER
Age
•Female: 65%
•21 – 30:
•31 – 40:
•41 – 50:
•51 – 60:
50%
26%
14%
7%
•21 – 30:
•31 – 40:
•41 – 50:
•51 – 60:
20%
20%
11%
48%
•Male:
34%
ONLINE
N=67
N=46
Occupation
Gender
•Female:
47%
•Male:
52%
•Doctor: 40%
•Nurse:
59%
•All primary care
doctors
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Comparative
Analysis
1. Com que frequência é que actualmente procura obter informações clínicas sobre os
doentes a quem presta cuidados de saúde, de fontes fora da sua instituição de saúde?
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Percentage (%)
10
8
6
5
4
2
2
0
Attempt to get outside clinical information 0-10% of the time
Doctors Primary Care (N=46)
Doctors Hospital (N=27)
Nurses Hospital (N=40)
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Health
Centers
Hospitals
2. Se lhe fosse dado um fácil acesso a informação clínica proveniente de fora da sua
instituição de saúde, quais as fontes de dados que lhe seriam mais úteis? (Por favor,
ordene as seguintes fontes em função da sua utilidade, em que a 1ª é a mais útil e a 4ª
é a menos útil. Use cada número apenas uma vez.)
Ordem
de
utilidade
Hospitais
1º
2º
3º
4º
1º
2º
3º
4º
60,6%
29,8%
9%
1,5%
69,4%
17,4%
2,4%
4,9%
Centros de
Saúde
Laboratórios de
análises e
imagiologia
Clínicas e/ou
consultórios
médicos
privados
22,7%
40,2%
25,4%
11,7%
12,2%
28,3%
45,2%
14,6%
12,1%
19,4%
41,8%
26,5%
14,3%
47,8%
33,3%
4,9%
4,5%
10,4%
23,9%
60,3%
4,1%
6,5%
19,0%
75,6%
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Comparative
Analysis
3. Qual a proporção de doentes a quem presta cuidados de saúde que beneficiariam, se o
acesso à informação clínica proveniente de fora da sua instituição de saúde fosse imediato?
100
100
93
84
Percentage (%)
80
60
75
78
52
Doctors Primary Care
(N=46)
Doctors Hospital
(N=27)
40
Nurses Hospital
(N=40)
20
0
>1/2 of patients would benefit if access to outside clinical
information were immediate
>1/4 of patients would benefit if access to outside clinical
informationwere immediate
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4. Assinale a sua concordância relativamente aos aspectos/instituições que iriam ser
beneficiados, caso existisse a possibilidade de obter informação clínica de outras instituições
de saúde de maneira rápida e fácil.
A forma como
presta os cuidados
de saúde
O seu
serviço/departame
nto
A sua instituição de
saúde
O Sistema Nacional
de Saúde
Hospitals
Health
centers
Hospitals
Health
centers
Hospitals
Health
centers
Hospitals
Health
centers
24,2%
63%
18,5%
54,3%
25,4%
56,5%
35,8%
63%
65,2%
10,6%
34,8%
2,2%
76,9%
4,6%
43,5%
-
70,1%
3%
43,5%
-
59,7%
1,5%
32,6%
2,2%
Discordo
Totalmente
-
-
-
-
-
-
-
2,2%
Sem opinião
-
-
-
2,2%
1,5%
-
3%
-
Concordo
Plenamente
Concordo
Discordo
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5.Em relação a cada um dos seguintes factores assinale o tipo e grau de efeito que, na sua
opinião, iria ter pelo acesso a informação proveniente de outra instituição de saúde.
Eficiência (melhor
Tempo necessário
Número de Meios
utilização de
para tomar decisões Complementares de Número de erros na
recursos) com que
sobre os utentes a
Diagnostico e
prestação de
os cuidados de
quem presto
Terapêutica (MCDT) cuidados de saúde
saúde são prestados cuidados de saúde
solicitados
Piorar muito
Piorar
Sem
alterações
Melhorar
Melhorar
muito
Não sei
Hospitals
Health
centers
Hospitals
Health
centers
Hospitals
Health
centers
Hospitals
Health
centers
-
-
-
-
-
-
-
2,3%
-
9%
-
3%
4,3%
3%
-
24,6%
18,2%
44,8%
21,7%
52,2%
50%
43,3%
34,8%
45,9%
52,3%
46,3%
78,3%
44,8%
43,5%
53,7%
65,2%
29,5%
27,3%
-
-
-
2,2%
-
-
-
-
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Comparative
Analysis
6. Faça uma lista de pelo menos 5 tipos de documentos clínicos que, se disponíveis
noutras instituições de saúde, lhe seriam muito úteis na sua prática clínica.
200
180
Percentage (%)
160
140
120
100
DPC
80
NH
DH
60
40
20
0
MCDT
Clinical
history
Clinical
analysis
Imaging
exams
Discharge
reports
Current
Reports of
therapeutics appointments
and
subspecialties
Clinical
reports
Clinical diary
Emergency
episodes
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7 - RSE
7.1 Já alguma vez ouviu falar deste projecto?
Doctors
Nurses
Sim
51.4%
48.6%
Não
50.0%
50.0%
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Comparative
Analysis
7 - RSE
7.2 Qual acha que será a utilidade da sua implementação?
90
85
80
Percentage (%)
70
75
69
60
Doctors Primary Care (N=46)
50
Doctors Hospital (N=27)
Nurses Hospital (N=40)
40
30
20
10
0
RSE implementation is very useful/indispensable
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Comparative
Analysis
7 - RSE
7.2 Qual acha que será a utilidade da sua implementação?
70%
59%
55%
60%
50%
40%
Hospital S. João
27% 27%
Hospital Cuf Porto
30%
18%
14%
20%
10%
0%
Irrelevante
Pouco útil
Útil
Muito útil
Indispensável
Hospital S. João vs. Hospital CUF Porto → Public vs. Private
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Comparative
Analysis
Results of Shapiro’s survey
Results of our survey
Response rate: 58% (n=216)
Response rate: 26% (Doctors CUF=44)
 63% of the doctors said that more than
 66% of the doctors said that a lot/all of
1/4 of their patients would benefit from the their patients would benefit from the data
data sharing system
sharing system
 85% said it was difficult to access
 48% said they frequently/always search
information from external sources
for information
 56% said that they try to access external
89% said the efficiency of the health care
data < than 10% of the times needed
would improve/greatly improve if they
could access the external data
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Meeting the objectives:
The majority of health professionals believe that a patient record exchange
system, particularly RSE in our country’s context, would be very useful or even
essential.
Hospitals are the most searched sources of external patient data.
The medical documents that health professionals would find more useful to
obtain are:
MCDT
Clinical analysis
Imaging exams
Appointment and subspecialties’ reports
Discharge reports
.
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•
(1) Welcome to epSOS – a European eHealth Project. In epSOS: Home.
Retrieved October 21, 2010, from http://www.epsos.eu/
•
(2) Registo de saúde electrónico. In Portal da Saúde. Retrieved
October 21, 2010, from
http://www.portaldasaude.pt/portal/conteudos/a+saude+em+port
ugal/politica+da+saude/discussao/arquivo/registo+electronico.htm
• (3) Shapiro JS, Kannry J, Kushniruk AW, Kuperman G. Emergency
Physicians’ Perceptions of Health Information Exchange. J Am Med
Inform Assoc. 2007 Nov–Dec; 14(6) :700-705
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