A Model for Developing Clinical Analytics Capacity: Closing the Loops on Outcomes to Optimize Quality.

Closed Loop Analytics© is receiving growing interest in healthcare as a term referring to information technology, local data and clinical analytics working together to generate evidence for improvement. The Closed Loop Analytics model consists of three loops corresponding to the decision-making levels of an organization and the associated data within each loop - Patients, Protocols, and Populations. The authors propose that each of these levels should utilize the same ecosystem of electronic health record (EHR) and enterprise data warehouse (EDW) enabled data, in a closed-loop fashion, with that data being repackaged and delivered to suit the analytic and decision support needs of each level, in support of better outcomes.

Integrated care, information management and information technology in Canada: have we made any progress in the past 12 years?

A dozen years ago, a seminal article was written by Leatt, Pink and Guerriere that boldly stated that Canada did not have integrated healthcare but, rather, a hodgepodge of disconnected parts! The article also stated categorically that Canadian regional health authorities could not provide comprehensive integrated care since they were not responsible for drugs dispensed from retail pharmacies or for medical care provided by physicians. Twelve years later, some progress toward integrated care has been made, though many would argue that it is both inadequate and disappointing - even if Canada's provincial health systems would like to integrate services across an ever-expanding continuum of care to better serve patients.

Widespread adoption of information technology in primary care physician offices in Denmark: a case study.

Denmark is one of the world's leading countries in the use of health care technology. Virtually all primary care physicians have electronic medical records with full clinical functionality. Their systems are also connected to a national network, which allows them to electronically send and receive clinical data to and from consultant specialists, hospitals, pharmacies, and other health care providers. Under the auspices of a nonprofit organization called MedCom, over 5 million clinical messages are transferred monthly. One of the most important innovations has been the "one-letter solution," which allows one electronic form to be used for all types of letters to and from primary care physicians; it is used in over 5,000 health institutions with 50 different technology vendor systems.

Adoption of information technology in primary care physician offices in New Zealand and Denmark, part 5: final comparisons.

This is the last in a series of five papers about the use of computing technology in general practitioner (GP) practices in Denmark and New Zealand. This paper introduces a unique comparison instrument developed for this study using the best evidence available namely data was pulled from centralised databases and was indisputable (e.g. percentage of primary care physicians who send medication prescriptions electronically to pharmacies). Where the data was simply not available, estimates were made. Since the reliability of the data on the use of computers by primary care physicians is so variable and in some case simply not available, the authors also introduce the use of a Cochrane-like confidence factor (CF) to each comparison measure. The paper draws particular attention to the fact that both countries have a highly visible central unifying body or what might be called a Health System Integrator; though Denmark s Medcom is a pseudo government agency New Zealand's HealthLink is a private company, both play critical roles in the success story of these two countries.

National health information management/information technology strategies in Hong Kong, Taiwan and Singapore.

A national health information management/information technology (IM/IT) strategy is crucially important for a country in planning and implementing healthcare priorities. However, little comparative research has been performed in this area, especially in Asian countries. This paper reviews, assesses and compares the healthcare systems, as well as the national health IM/IT initiatives and strategies in Hong Kong, Taiwan and Singapore. Although the proportion of public and private health services, IT infrastructure development, and government involvement in these three jurisdictions are different, they experience similar challenges with limited resources. By outlining the approaches being taken in the three Asian jurisdictions, this paper provides comparison, evaluation and insights that may be useful to other jurisdictions.

Integrated care needs integrated information management and technology.

Integrated care entails that professionals from different organizations have to work together in a team-oriented way to provide high-quality care for a patient. This requires that healthcare professionals share information about--and with--patients at appropriate points in the care or treatment process. The necessary infrastructural arrangements--such as shared patient records, regional collaboration and a clear, transparent incentive structure--must be in place. It is increasingly hard to imagine integrative initiatives without a strong information management and technology component. However, information is a necessary condition but not sufficient to achieve integrated care; organizational change is the more critical component.

Adoption of information technology in primary care physician offices in New Zealand and Denmark, Part 3: Medical record environment comparisons.

This is the third in a series of five papers about the use of computing technology in general practitioner (GP) practices in Denmark and New Zealand. This paper looks at the environments within which electronic medical records (EMRs) operate, including their functionality and the extent to which electronic communications are used to send and receive clinical information. It also introduces the notion of a longitudinal electronic health record (versus an EMR).

Adoption of information technology in primary care physician offices in New Zealand and Denmark, Part 4: Benefits comparisons.

This is the fourth in a series of five papers about the use of computing technology in general practitioner (GP) practices in Denmark and New Zealand. This paper looks at the reasons why physicians use computers with a particular emphasis on the benefits gained from automated medication prescriptions. It includes an assessment of the growth of key applications in New Zealand as well as a comparative summary of the success factors in both countries.

Adoption of information technology in primary care physician offices in New Zealand and Denmark, part 1: healthcare system comparisons.

Denmark and New Zealand are two small countries whose primary care physicians are at the forefront of the use of electronic medical records (EMRs). This is the first of a series of five papers which contrasts the health care systems in Denmark and New Zealand. Though the delivery of care at the patient level is virtually the same in New Zealand and Denmark the way in which the health care is financed, administered and managed does vary. This paper highlights the differences, particularly in terms of the approaches taken to primary care and out-of-office-hours services.

Adoption of information technology in primary care physician offices in New Zealand and Denmark, part 2: historical comparisons.

This second paper in a series of five looks at how computing in primary care began and provides background to the driving forces for automation in Danish and New Zealand primary care physician offices. It addresses topics such as government funding support, the role of professional colleges and associations, peer influence, change management, and comparative cultures. It also highlights the power of a unifying organisation and introduces the concept of a Health Systems Integrator.

US regional health information organizations and the nationwide health information network: any lessons for Canadians?

The creation of regional clinical data exchanges (usually referred to as RHIOs) is a centerpiece of the US national healthcare information technology strategy. How well are they doing and what lessons can we learn that might be applied here in Canada?

Implementation of the Veterans Health Administration VistA clinical information system around the world.

The success story of the Veterans Health Administration (VHA) within the US Department of Veterans Affairs has been well documented and is generally well known. What is generally not known is that the VHA's clinical information system, known as VistA, and the computerized patient record system clinical user interface front end have been successfully transported and implemented to a number of non-VHA healthcare organizations across the United States. Moreover, VistA software modules have been installed, or are being considered for installation, in healthcare institutions around the world in countries such as Mexico, Finland, Jordan, Germany, Nigeria, Egypt, Malaysia, India, Brazil, Pakistan and Samoa.

Comparison of information technology in general practice in 10 countries.

A study commissioned by Canada Health Infoway provides a comparative analysis of automation in general practice in 10 countries. The most common clinical application is the automation of medication prescriptions--even if it is not a mandatory requirement as it is in Norway. It is the clinical application that provides one of the biggest benefits to general practitioners as it addresses legibility concerns, can be a significant time saver (particularly for repeat prescriptions) and offers the potential to make use of decision-support capabilities. The transmission of laboratory results is the most common electronic clinical communication application.

Moving toward a single comprehensive electronic health record for every citizen in Andalucía, Spain.

In 2001, less than 3% of primary care physicians were fully automated in the region of Andalucia, Spain. Now, six years later, more than 70% use a computer system called DIRAYA (Arabic for knowledge), which integrates all the information on each patient so that it is available when and where it is needed for his or her care. The DIRAYA system is a remarkable success story and is impressive in its achievements within a relatively short period of time, its acceptance by healthcare providers and institutions, its rapid implementation and its continued momentum and progress.

Adoption of information technology in primary care physician offices in Alberta and Denmark, Part 1: Historical, technical and cultural forces.

Denmark and Alberta are both advanced in the application of the Western scientific model of healthcare and both currently enjoy similar levels of economic prosperity. This article evaluates the current state, driving forces and general health system factors that have impacted two culturally and historically different medical jurisdictions--Denmark and Alberta, Canada.

Primary care computing in England and Scotland: a comparison with Denmark.

This paper compares the status of primary care computing in England and Scotland with that of Denmark. The rate of utilisation by Danish GPs is among the highest in the world and the MedCom national health network handles over 90% of the country's primary sector clinical communications. A high proportion of English and Scottish GPs also use computers in their clinical practices, and like their Danish colleagues, they benefit from more accurate and streamlined medications management, particularly in terms of repeat prescriptions. The historical forces and factors which influenced the development of primary care computing are identified and discussed.

Clinical electronic communications: a new paradigm that is here to stay?

The authors discuss the current status of clinical electronic communication, including e-mail and secure Web messaging, among physicians and between physicians and their patients. The paper provides a concise summary of what is known about clinical electronic communications in healthcare: what is working, what the challenges are and what is promising.

A review of information management practices for health ministries.

This is a review paper on best practices in information management for health ministries in governments. It is based on a recent study in which we examined information management (IM) and information technology (IT) functions inside a provincial health ministry. In order to foster best IM practices we offer five key guiding principles followed by five recommendations for action. We urge governments to consider these principles and recommendations when planning the IM function for their health ministries.