COVID-19: protocol for observational studies utilizing near real-time electronic Australian general practice data to promote effective care and best-practice policy-a design thinking approach.

BACKGROUND: Health systems around the world have been forced to make choices about how to prioritize care, manage infection control and maintain reserve capacity for future disease outbreaks. Primary healthcare has moved into the front line as COVID-19 testing transitions from hospitals to multiple providers, where tracking testing behaviours can be fragmented and delayed. Pooled general practice data are a valuable resource which can be used to inform population and individual care decision-making. This project aims to examine the feasibility of using near real-time electronic general practice data to promote effective care and best-practice policy. METHODS: The project will utilize a design thinking approach involving all collaborators (primary health networks [PHNs], general practices, consumer groups, researchers, and digital health developers, pathology professionals) to enhance the development of meaningful and translational project outcomes. The project will be based on a series of observational studies utilizing near real-time electronic general practice data from a secure and comprehensive digital health platform [POpulation Level Analysis and Reporting (POLAR) general practice data warehouse]. The study will be carried out over 1.5 years (July 2020-December 2021) using data from over 450 general practices within three Victorian PHNs and Gippsland PHN, Eastern Melbourne PHN and South Eastern Melbourne PHN, supplemented by data from consenting general practices from two PHNs in New South Wales, Central and Eastern Sydney PHN and South Western Sydney PHN. DISCUSSION: The project will be developed using a design thinking approach, leading to the building of a meaningful near real-time COVID-19 geospatial reporting framework and dashboard for decision-makers at community, state and nationwide levels, to identify and monitor emerging trends and the impact of interventions/policy decisions. This will integrate timely evidence about the impact of the COVID-19 pandemic related to its diagnosis and treatment, and its impact across clinical, population and general practice levels.

Classification of Long COVID from General Practitioner Diagnosis Text.

Major challenges exist in identifying Long COVID patients from diagnosis texts recorded by general practitioners. A classification framework is proposed that can be used to identify Long COVID patients given these unstructured diagnostic texts. This framework can be leveraged to provide a general understanding of the risk factors, management strategies, and outcomes associated with Long COVID in Australia.

Telehealth Uptake and Impact on Care Activities in Australian General Practice During the COVID-19 Pandemic.

The COVID-19 pandemic necessitated a shift in the delivery of patient care, with telehealth rapidly scaled to facilitate access to care while reducing risks of COVID-19 transmission. In this paper, we present an overview of key findings regarding telehealth use from a large program of work examining the impact of the pandemic on general practice activity in Australia. Our findings demonstrate the pivotal role telehealth played in enabling patient access to care during the first two years of the pandemic. Importantly, however, we identified several facets of telehealth use including equitable access, workflow and infrastructure, and adequate funding, which require attention to optimise telehealth services in practice.

A framework for conducting policy-relevant primary care research: a COVID-19 case study in Australia.

The onset of the coronavirus disease 2019 (COVID-19) pandemic, caused by SARS-CoV-2, and the ensuing implementation of response measures directly impacted the delivery of Australian primary care services. Understanding how these measures affected practice activity is important for gauging both their effectiveness and implications for future service planning. During the first 2years of the COVID-19 pandemic, a research project was undertaken to determine the impact of the pandemic on Australian general practice activity as a collaborative undertaking between researchers, general practitioners, data custodians, and five primary health networks from New South Wales and Victoria, Australia. The project methodology was based on an established research approach called action research, which involves participatory involvement from key stakeholders throughout the research process. The strength and success of the project's methodological approach stemmed from the synergistic interrelationship between the four key elements of: collaboration, repeated action research cycles (utilising electronic general practice data), engaged governance, and the production and dissemination of apposite knowledge outcomes. The project approach, knowledge outputs and lessons learned can be adapted to future research undertakings across any primary care setting and highlight the utility of action research and interdisciplinary research collaboration to produce knowledge directly relevant to clinical practice.

Laptops on trolleys: lessons from a mobile-wireless hospital ward.

Most hospital-based staff can be considered to be mobile but many hospital information systems (HIS) are based on fixed desk top computers. Wireless networks allow HIS to be brought to the point of care using mobile devices such as laptops on trolleys thus providing data which can aid in clinical decision-making. The research objective of this project focusses on the collaborative design of a laptop solution for providing data at the point of care. The research approach was based on a combination of action research and design science. Action research techniques including participant observation and informal one-to-one discussions were used to obtain information that was used to evolve the trolley design as a design artefact while addressing usability limitations. This paper presents three versions of the trolley design and how they evolved based on the feedback provided to the researchers from clinical use. Also these results show that using iterative action research techniques (planning, action, evaluation and reflection) in collaborative research can provide productive outcomes addressing a specific design objective within an acute care setting.

Implementation issues for mobile-wireless infrastructure and mobile health care computing devices for a hospital ward setting.

mWard is a project whose purpose is to enhance existing clinical and administrative decision support and to consider mobile computers, connected via wireless network, for bringing clinical information to the point of care. The mWard project allowed a limited number of users to test and evaluate a selected range of mobile-wireless infrastructure and mobile health care computing devices at the neuroscience ward at Southern Health's Monash Medical Centre, Victoria, Australia. Before the project commenced, the ward had two PC's which were used as terminals by all ward-based staff and numerous multi-disciplinary staff who visited the ward each day. The first stage of the research, outlined in this paper, evaluates a selected range of mobile-wireless infrastructure.