Curricular unit: Introduction to Medicine II Adviser: Ricardo João Cruz Correia

1. The perceived usefulness of a national electronic health record system measured by the expected improvement on health care delivery – a survey on health professionals’ believes Curricular unit: Introduction to Medicine II Adviser: Ricardo João Cruz Correia Class 17. 1st year. 2010/2011

2. INDEX • Introduction • Background • Justification • Researchquestion and aims • Development of theinvestigation • Study participants • Study design • Data collectionmethods • Planned statisticalanalysis/Variablesdescription • Results • Conclusion • References • Survey The usefulness of a national electronic health record system

3. Background • General government’s objective: • 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 centralization of all medical records in a single country-wide electronic sharing system http://www.epsos.eu/ http://www.portaldasaude.pt/portal/conteudos/a+saude+em+portugal/politica+da+saude/discussao/arquivo/registo+electronico.htm The usefulness of a national electronic health record system

4. Background • 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; • Possiblebiasdue to the distribution method used. • In Portugal: no released investigations about the subject. Conclusion • developing a patient record database is important. • (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 The usefulness of a national electronic health record system

5. Justification The usefulness of a national electronic health record system

6. Researchquestion and aims • Main question: Would the health professionals find the existence of an electronic system sharing medical information among health institutions useful? • Objectives/Aims: • Gatheringopinionsfromhealthprofessionalsabouttheusefulnessof this kind of systems; • Determining which type of information and type of institution whose information health professionals would find the most importantto have access to; • Comparingresultsobtainedinthisproject to those of Shapiro’sstudy. The usefulness of a national electronic health record system

7. INDEX • Introduction • Background • Justification • Researchquestion and aims • Development of theinvestigation • Study participants • Study design • Data collectionmethods • Planned statisticalanalysis/Variablesdescription • Results • Conclusion • References • Survey The usefulness of a national electronic health record system

8. Study participants Departments’ selectioncriteria: addition of variables of (potential) interest DEPARTMENTS Emergency department Internal medicine General surgery Pediatrics Otorhinolaryngology DATA COLLECTING METHODS: survey (paperand online) 8 The usefulness of a national electronic health record system

9. Study design • Cross-sectional study • Pointed to a specific moment in time • Observationalstudy • No intervention The usefulness of a national electronic health record system

10. Pilot Tests 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 10 The usefulness of a national electronic health record system

11. Letters requestingpermission Letters Sent 11 March (afterphoneconversation) Hand-delivered(afterdirectconversation) • Contents: • Request for Authorization (letter) • Survey • Written Protocol 11 The usefulness of a national electronic health record system

12. Online Survey Supportinstudy • Disclosure of thesurvey by e-mail General Practice (GP’s) Doctors MedQuest 12 http://http://newdbserver.med.up.pt/projext/medquest/verprod/index.php?mdl=3&qtr=MTQyNzcxMDUxNDI= The usefulness of a national electronic health record system

13. Survey’sdistribution N=67 13 The usefulness of a national electronic health record system

14. Statisticalanalysis • Descriptiveanalysis • - using PASW (SPSS) • Comparativeanalysis • acording to selectedvariables • Type of health professional: Doctors/ Nurses • Type of institution: Public/ Privateinstitutions • Gender: Female/ Male • Age:Younger/ Olderprofessionals • Surveyformat: Online/ Printedversion Variablesdescription The usefulness of a national electronic health record system

15. INDEX • Introduction • Background • Justification • Researchquestion and aims • Development of theinvestigation • Study participants • Study design • Data collectionmethods • Planned statisticalanalysis/Variablesdescription • Results • Conclusion • References • Survey The usefulness of a national electronic health record system

16. Results Occupation • Doctor:40% • Nurse:59% • Age • 21 – 30: 50% • 31 – 40: 26% • 41 – 50: 14% • 51 – 60: 7% • Gender • Female: 65% • Male: 34% • PAPER N=67 • 21 – 30: 20% • 31 – 40: 20% • 41 – 50: 11% • 51 – 60: 48% • All primary care doctors • Female:47% • Male:52% • ONLINE N=46 The usefulness of a national electronic health record system

17. ComparativeAnalysis Results • 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? 17 The usefulness of a national electronic health record system

18. Results • 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.) Hospitals HealthCenters 18 The usefulness of a national electronic health record system

19. ComparativeAnalysis Results 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? 19 The usefulness of a national electronic health record system

20. Results • 4.Assinale a sua concordânciarelativamente 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. 20 The usefulness of a national electronic health record system

21. Results • 5.Em relação a cada um dos seguintes factores assinale o tipo e grau de efeitoque, na sua opinião, iria ter pelo acesso a informação proveniente de outra instituição de saúde. 21 The usefulness of a national electronic health record system

22. ComparativeAnalysis Results 6. Faça uma lista de pelo menos5 tipos de documentos clínicosque, se disponíveis noutras instituições de saúde, lhe seriam muito úteis na sua prática clínica. 22 The usefulness of a national electronic health record system

23. Results • 7 - RSE • 7.1 Já alguma vez ouviu falar deste projecto? 23 The usefulness of a national electronic health record system

24. ComparativeAnalysis Results 7 - RSE • 7.2 Qual acha que será a utilidade da sua implementação? 24 The usefulness of a national electronic health record system

25. ComparativeAnalysis Results 7 - RSE • 7.2 Qual acha que será a utilidade da sua implementação? 59% 55% 27% 27% 18% 14% • Hospital S. João vs. Hospital CUF Porto → Public vs. Private The usefulness of a national electronic health record system

26. ComparativeAnalysis Results The usefulness of a national electronic health record system

27. Conclusion • 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 • . The usefulness of a national electronic health record system

28. References • (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. InPortal da Saúde. RetrievedOctober 21, 2010, fromhttp://www.portaldasaude.pt/portal/conteudos/a+saude+em+portugal/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 The usefulness of a national electronic health record system

29. Survey The usefulness of a national electronic health record system

30. Survey The usefulness of a national electronic health record system

31. Survey The usefulness of a national electronic health record system

32. Survey The usefulness of a national electronic health record system