Information management in community health and primary care

Integrated healthcare, sometimes called the continuum of care, aims to add value to the delivery of health care services by providing care at lower cost and improving services to patients and to their families.1 In primary care there is a large variation in patients using the general practitioner services. Young children, elderly people, residents of socially deprived areas and members of ethnic minorities have a greater need of care and have higher than average consultation rates. However, deprived areas that might be expected to have a greater need for care often have lower quality general practitioner services than more affluent areas. The introduction of GP fundholding changed the face of GP and primary care in the United Kingdom.2 Today, healthcare managers are being asked to think of better ways to upgrade services, to finance healthcare and to respond to customer priorities. There is also a greater demand for more innovative approaches and faster response times and, with community and political involvement in healthcare management, decisions are increasingly more complicated and demanding. With healthcare costs rising, technology expanding, and resources decreasing, there is mounting pressure to optimize the relationship between outcomes and resource. To achieve international best practice in the primary healthcare sector will require the development of methods which integrate communications and information technologies with clinical practice. This will have far-reaching effects both on the pattern of medical practice and domiciliary care, and on patient outcomes.2 The primary care sector represents the base of the healthcare pyramid, and plays a fundamental role in the delivery of preventive health care, and in the decision as to whether patients need more expensive specialist or hospital services. The most important measure in respect of equity and health gain is to develop a strong primary health care system which will be seen as the key for health policy. The development of such a system involves provision of curative, preventive and health promotion services, with a shift away from highly specialized care to care by general practitioners, and away from costly medical procedures and medications towards those which are less expensive but equally effective. Success will depend on an organization's ability to fully understand how information supports the critical services of each department and how information sources and users are linked both internally and externally. Computers have enabled the automation and systematization of the collection and transfer of data. Many practices now have patient numbers, information and notes recorded on the GP clinical computer system.3 As health enterprises focus more of our effort on the collection, storage and analysis of clinical data we must rely less on the automated systems provided by the vendor and more on our own ability to organize data from multiple sources into information. Successful organizations have built processes and systems which respond to the needs of the decision maker. The foundation for these structures is a systematic ongoing measurement of what data is important in supporting the critical services of each department and then using that information to improve the overall operations of the enterprise.4 Experience has led us to conclude that the most successful systems are those that use the simplest and least expensive technology. The first stage in planning is to consider the status quo. It is important that users are involved from the beginning of the project and their needs taken into account in order to avoid developing a 'white elephant'— a system that is never used. User support is essential5 if the system is to be viewed as useful. The main elements of a strategic plan to introduce a new or upgraded computer system for primary care are as follows: formulate goals and objectives for the automated function as a whole; market research; establishment of data systems; database development and management; discuss budgets plans; elect the representative staff at all levels in the capture, management and use of information; co-ordinate activities of the function's organizational units; share progress reports of activities within the function; encourage health professionals to use these systems; implementation process; measure business results and the effectiveness of key business processes; act on that information for continues improvement of both the processes and the results. The analysis task. The main aim of systems analysis is to know in detail what kind of transformations and what data the new system will deal with, the new types of procedures, and the new jobs and work roles that will be created. The final aim is to reduce the cost of health care services, adding value and providing care at lower cost, with better services to the patient and to their support networks. The job design in the development process. The literature suggests6,7 that a number of factors contribute to people's job satisfaction. Psychologists find that the achievement, recognition, responsibility or status are some of the elements which provide motivation for work and job satisfaction. The decision point. Put the decision point where the work is performed, and build control into the process. This may mean that current structures of management may have to change with a new system. The common data resources. To create and use common data resources, between units of operations so that, for example the clinical measurement system can easily be interfaced to the PC. Confidentiality, security and integrity of information. Every department within the organization needs to ensure the safety of enterprise data. Security of information is documented. Integrating learning tools. It is necessary to provide continuing education so that health care workers have the medical knowledge and workplace skills which are needed in a rapidly changing environment. Thus, with computerization of GP practices it is becoming increasingly necessary for GPs to be computer literate. One example of an integrated and comprehensive pattern of education, is the following description of a model for computer access to education. This is a system that aims to provide a user-friendly computer package of patient education 'leaflets' that can be effectively used in primary care. Appropriate formats, have been identified for the leaflets by researches from the European Federation of Road Victims (FEVR).8 The leaflets comprise text, diagrams, and space for GP details and specific patient (road victim) instructions. Information is provided in paper form for the patient to take home and read or can be provided via the computer screen. On the doctor's disk, is a structured form of patient education within the consultation. By the use of a simple interface, standards and protocols, both of clinical measurement, patient education and clinical decision support modules, can be integrated very easily with existing patient management systems (Fig. 1). Simple connectivity scheme for transfer of clinical data using individual modules The success of the system as a whole will be measured by the organization's ability to: Provide information to decision makers that is timely, accurate and complete. Appropriate application of information technology in primary health care will extend traditional diagnosis and patient management beyond the doctor's clinic into the every day environment. Using individual modules and the simple connectivity scheme described previously, a telemedicine trial is proposed.9 One of the most significant challenges in health care today is the ability to effectively manage information. Computers have done a great deal to automate and systematize the collection and transfer of data. Information technology has the potential to transform the way work is accomplished in the health care environment. A number of key elements of clinical service provision have been highlighted, including integrated clinical measurements and computerized patient education. A strategy should be focused on the support of a policy of co-operation and collaboration to deliver timely, appropriate, resource-efficient and patient-centred care and advice to all those who need it. The importance of an appropriate network, communications and computing framework is evident. Telemedicine, personal computing and integrated management software, will be essential factors in ensuring that the information management process provides a mechanism to measure and manage any health enterprise.