Barriers integrating dedicated software for quality management in pain centres.

OBJECTIVES: Explore the feasibility of integrating a dedicated pain centre information system as part of a quality management network with a number of different Hospital Information Systems. MATERIAL & METHODS: A systematic approach integrating and implementing the system in 15 selected hospital organisations (a nationwide 15% non-random sample). RESULTS: Hospitals have widely varying policies on integration and implementation of additional clinically required 3rd party software. Financial and organisational constraints are considerable. Partial data integration could be realised in one third of the hospital organisations within the project timeframe. Linking with various types of Hospital Information Systems from the same or different vendors caused no technical difficulties. The total effort required, however, varies considerably; different versions of a HIS of the same vendor require substantial additional effort. IT departments hardly use standard rules to accept this type of systems, causing substantial increases in completion time for installation. CONCLUSIONS: Although it is feasible to integrate a local departmental system as required (download of general patient, provider and referrer data basically, and also upload of certain data) the workload of scaling to the national level is considered far beyond what is reasonable for a national quality management network for pain. Alternatives for recording and capturing data (which comply with the requirements of the national system) are currently being explored.

Dynamics of Internet usage during the stages of in vitro fertilization.

Hospitals and clinics develop Internet strategies to emancipate and empower their patient population. At Radboud University Nijmegen Medical Centre, we developed an Internet-based personal health record that provides patients with general and personal information about their treatment and that provides facilities for communication with fellow patients and with physicians. Because not much is known about information and communication needs of IVF and ICSI patients in relation to their treatment, we observed the intensity of use of this personal health record during the various stages of IVF treatment. We measured the numbers of page views and the number of contributions to the chat room. Data regarding Website use and treatment schedules were available for 51 couples. These couples generated 25,420 page views and posted 11,403 utterances. Two-way analysis of variance showed that significant individual changes occurred in the intensity of use during the different stages of the treatment. During the stages in which there is no contact between the patient and the clinic, patients make use of the Website's communication functions. This reflects the patients' need for continued communication and support during the last stages of treatment, a service that IVF clinics traditionally cannot or do not provide.

Empowering patients undergoing in vitro fertilization by providing Internet access to medical data.

OBJECTIVE: To study the effect of an Internet-based personal health record on the empowerment of patients undergoing IVF. DESIGN: Randomized clinical trial. SETTING: Patients undergoing IVF and intracytoplasmic sperm injection (ICSI) in an academic research environment. PATIENT(S): We selected patients who were undergoing an IVF or ICSI treatment, have an Internet connection, and speak fluent Dutch. INTERVENTION(S): An Internet-based personal health record that provides patients with general and personal information concerning their given treatment and that also provides facilities for communication with fellow patients and physicians. MAIN OUTCOME MEASURE(S): Patient empowerment (measured as a multidimensional concept consisting of self-efficacy, actual and perceived knowledge, and involvement in the decision process), patient satisfaction, meaning of infertility problems, social support, anxiety, and depression. RESULT(S): A total of 91 female and 89 male participants were suitable for analysis. No significant differences were observed in per person change in patient empowerment. We did not find any significant differences regarding per person change in patient satisfaction, the meaning of infertility problems, social support, anxiety, and depression. CONCLUSION(S): Usage of the personal health record did not have any effects on patient empowerment, but, at the same time, the study did not find that the personal health record had any significant adverse effects either.