The Impact and Usability of the eRIC System in the ICU - A Qualitative Study.

The Intensive Care Unit (ICU) is an information-intense environment where more patient data points are recorded than in other wards. The electronic Record for Intensive Care (eRIC) is an ICU information system that integrates patient data every minute from multiple systems. Once implemented across New South Wales (NSW), eRIC will be one of the largest system-wide ICU clinical information systems in the world. This study explored experiences with the use of eRIC by ICU clinicians at an Australian metropolitan teaching hospital. Semi-structured, in-depth interviews relating to physician electronic test management processes were conducted with 11 ICU clinicians and one clinical information system manager was observed in their use of the system. The introduction of eRIC resulted in an additional patient record, which was perceived to hold implications for workflow and patient safety. Study findings are valuable for informing implementation as the rollout of eRIC continues.

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 retrospective observational study of telehealth utilisation for mental health consultations during the COVID-19 pandemic in Australian general practices.

Objectives and importance of study: Despite the abundance of mental health research during the pandemic, there is limited evidence exploring mental health presentations to Australian general practice. This study examined the utilisation of telehealth for mental health consultations in Australian general practice during the COVID-19 pandemic. The objectives were to: 1) determine the proportion of mental health services delivered via telehealth between March 2020 and November 2021; 2) determine the types of mental health consultations most frequently delivered via telehealth; and 3) model the sociodemographic characteristics of patients using telehealth mental health consultations, including consultation type. STUDY TYPE: Retrospective observational study. METHODS: We used Medicare Benefits Schedule service item numbers to distinguish mental health consultations in de-identified electronic general practice data. We stratified the proportions of face-to-face, video, and telephone mental health consultations by state and consultation type. We used two mixed-effects logistic models to assess the variation in the likelihood of i) a telehealth (video/telephone) compared to a face-to-face consultation and ii) a video compared to telephone consultation; by sociodemographic characteristics. RESULTS: The study comprised 874 249 mental health consultations. Telehealth use peaked in Victoria (61.6%) during July 2020 and in NSW during August 2021 (52.5%). Telehealth use continued throughout 2021 with an increase in video consultations from July 2021 onwards in both states. Proportions of mental health treatment plan consultations via telephone decreased from July 2021 with a concomitant increase in video. Telehealth was more likely to be used by females, in Victoria, in regional/remote regions and during 2020. Video was more likely to be used than telephone for mental health treatment plans/reviews compared with mental health consultations. Compared with people aged 25-29, video was most likely to be used by ages 20-24 and least by those aged 80 and over. There was no evidence for sex differences when comparing telephone and video. CONCLUSIONS: This study presents a comprehensive understanding of the important role telehealth played in the delivery of mental health consultations during the first 21 months of the pandemic, including sociodemographics of patients utilising telehealth. The findings can assist general practices with future planning for the delivery of mental health services via telehealth.

Patient and practice factors associated with HbA1c testing frequency in patients with type 2 diabetes: a retrospective cohort study in Australian general practice.

BACKGROUND: Better adherence to guideline-recommended glycated haemoglobin A1c (HbA1c) testing frequency is associated with better glycaemic control and lower risk of complications such as chronic kidney disease in patients with type 2 diabetes. This study investigates patient and practice factors associated with adherence to guideline-recommended HbA1c testing frequency. METHODS: A cohort of type 2 diabetes patients who regularly visited general practices from 2012 to 2018 was identified from 225 Australian general practices. With the goal of ≤53mmol/mol, Australian guidelines recommend HbA1c testing at least 6-monthly. Patient history of HbA1c tests from 2017 to 2018 was used to define adherence to guidelines, and the associations with patient and practice factors were examined by regression models. RESULTS: Of the 6881 patients, 2186 patients (31.8%) had 6-monthly HbA1c testing. Patient age and anti-diabetic medications were associated with adherence to 6-monthly testing. When financial incentives are available to practices, a larger practice was associated with better adherence to 6-monthly testing. CONCLUSIONS: The identified key factors such as age, practice size, medication, and incentive payments can be used to target initiatives aimed at improving guideline-recommended monitoring care for patients with type 2 diabetes to enhance their health outcomes.

Sociodemographic determinants of telehealth utilisation in general practice during the COVID-19 pandemic in Australia.

This analysis assessed the sociodemographic characteristics of telehealth utilisation during the coronavirus disease 2019 (COVID-19) pandemic from March 2020 to August 2021 in Australia. Drawing on 860 general practice providers among 3 161 868 patients, 24 527 274 consultations were recorded. Telehealth accounted for 37.6% of the consultations, with 2.4% through videoconferencing and 35.2% through phone consultations. Our multivariate regression analyses indicated low utilisation of videoconferencing compared with phone consultations among older adults, those living in rural communities and migrants from non-English speaking countries.

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.

General practice perspective on the use of telehealth during the COVID-19 pandemic in Australia using an Action Research approach: a qualitative study.

OBJECTIVES: Telehealth has emerged as a viable and safe mode of care delivery in Australia during the COVID-19 pandemic. However, electronic general practice data reveal differences in uptake and consultation mode, which we hypothesise may be due to potential barriers impacting on quality of care. We aimed to identify the benefits and barriers of telehealth use in general practice, using an 'Action Research' approach involving general practitioners (GPs) and general practice stakeholders. DESIGN: Qualitative focus group performed within a broader Action Research methodology. SETTING: A focus group was held in August 2021, with general practice participants from Victoria, Australia. PARTICIPANTS: The study consisted of a purposive sample of 11 participants, including GPs (n=4), representatives from three primary health networks (n=4) and data custodian representatives (n=3) who were part of a project stakeholder group guided by an Action Research approach. METHODS: Semistructured interview questions were used to guide focus group discussions via videoconference, which were recorded and transcribed verbatim for analysis. The transcript was analysed using an inductive thematic approach. RESULTS: Emerging themes included evolution of telehealth, barriers to telehealth (privacy, eligibility, technology, quality of care, sociodemographic and residential aged care barriers) and benefits of telehealth (practice, quality of care, sociodemographic and residential aged care benefits). CONCLUSION: The findings highlight a range of barriers to telehealth that impact general practice, but also provide justification for the continuation and development of telehealth. These results provide important context to support data-driven population-based findings on telehealth uptake. They also highlight areas of quality improvement for the enhancement of telehealth as a valuable tool for routine general practice patient care.

Telehealth use in patients with type 2 diabetes in Australian general practice during the COVID-19 pandemic: a retrospective cohort study.

BACKGROUND: The Australian government introduced temporary government-subsidised telehealth service items (phone and video-conference) in mid-March 2020 in response to the COVID-19 pandemic. The uptake of telehealth by patients with type 2 diabetes (T2DM) for consulting with GPs is unknown. AIM: To evaluate the uptake of telehealth consultations and associated patient characteristics in Australian general practice, including the frequency of haemoglobin A1c (HbA1c) tests and change in HbA1c levels by telehealth use, compared with guideline recommendations. DESIGN & SETTING: This exploratory study used electronic patient data from approximately 800 general practices in Victoria and New South Wales (NSW), Australia. A pre-COVID-19 period from March 2019-February 2020 was compared with a pandemic period from March 2020-February 2021. Patients diagnosed with T2DM before March 2018 were included. METHOD: Telehealth uptake patterns were examined overall and by patient characteristics. Generalised estimating equation models were used to examine patient probability of 6-monthly HbA1c testing and change in HbA1c levels, comparing between patients who did and patients who did not use telehealth. RESULTS: Of 57 916 patients, 80.8% had telehealth consultations during the pandemic period. Telehealth consultations were positively associated with patients with T2DM who were older, female, had chronic kidney disease (CKD), prescribed antidiabetic medications, and living in remote areas. No significant difference was found in 6-monthly HbA1c testing and HbA1c levels between telehealth users and patients who had face-to-face consultations only. CONCLUSION: Telehealth GP consultations were well utilised by patients with T2DM. Diabetes monitoring care via telehealth is as effective as face-to-face consultations.

Telehealth-based diagnostic testing in general practice during the COVID-19 pandemic: an observational study.

BACKGROUND: Since the World Health Organization declared COVID-19 a pandemic on 11 March 2020, health technologies have been rapidly scaled up to ensure access to care. A significant innovation has been telehealth in general practice. Now widespread, it remains unknown how this shift to virtual care has impacted on quality-of-care indicators such as pathology testing and diagnosis. AIM: To undertake a comparison of telehealth and face-to-face general practice consultations to: identify if there were differences in the proportion of pathology test referrals from 2019-2020; and quantify any change in pathology test collection and follow-up patterns. DESIGN & SETTING: Retrospective observational study of routinely collected electronic patient data from 807 general practices across New South Wales (NSW) and Victoria, Australia. METHOD: Multivariate generalised estimating equation models were used to estimate the proportion of pathology test referrals for overall, face-to-face, and telehealth consultations. Pathology test follow-up was described through median (and interquartile range [IQR]) time. RESULTS: Pathology test referrals declined during periods of high COVID-19 cases, falling from 10.8% in February 2020 to a low of 4.5% during the first peak in April. Overall, pathology test referrals were lower for telehealth than face-to-face consultations. Median time between referral and test collection was 3 days (IQR 1-14) for telehealth and 1 day (IQR 0-7) for face to face. CONCLUSION: For telehealth to become part of routine care, it is crucial that gaps in functionality, including difficulty in test referral processes, be addressed. Quality improvements supporting care practices will ensure clinicians' workflows are supported and patients receive diagnostic testing.

Diagnostic Informatics-The Role of Digital Health in Diagnostic Stewardship and the Achievement of Excellence, Safety, and Value.

Diagnostic investigations (pathology laboratory and medical imaging) aim to: increase certainty of the presence or absence of disease by supporting the process of differential diagnosis; support clinical management; and monitor a patient's trajectory (e. g., disease progression or response to treatment). Digital health can be defined as the collection, storage, retrieval, transmission, and utilization of data, information, and knowledge to support healthcare. Digital health has become an essential component of the diagnostic process, helping to facilitate the accuracy and timeliness of information transfer and enhance the effectiveness of decision-making processes. Digital health is also important to diagnostic stewardship, which involves coordinated guidance and interventions to ensure the appropriate utilization of diagnostic tests for therapeutic decision-making. Diagnostic stewardship and informatics are thus important in efforts to establish shared decision-making. This is because they contribute to the establishment of shared information platforms (enabling patients to read, comment on, and share in decisions about their care) based on timely and meaningful communication. This paper will outline key diagnostic informatics and stewardship initiatives across three interrelated fields: (1) diagnostic error and the establishment of outcomes-based diagnostic research; (2) the safety and effectiveness of test result management and follow-up; and (3) digitally enhanced decision support systems.

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.

Adherence to guideline-recommended HbA1c testing frequency and better outcomes in patients with type 2 diabetes: a 5-year retrospective cohort study in Australian general practice.

BACKGROUND: Clinical practice guidelines emphasise the role of regular monitoring of glycated haemoglobin A1c (HbA1c) for patients with type 2 diabetes, with most recommending 6-monthly testing. Nonetheless, there are few in-depth studies evaluating the clinical impact of the recommended testing frequency for patients to underpin the significance of guideline adherence. OBJECTIVE: This study aimed to examine associations between patient outcomes and adherence to HbA1c testing frequencies recommended by Australian guidelines (6-monthly for patients with adequate glycaemic control and 3-monthly for patients with inadequate glycaemic control). The primary and secondary outcomes of interest were longitudinal changes in HbA1c values and development of ischaemic heart disease (IHD) and chronic kidney disease (CKD). METHODS: This 5-year retrospective cohort study (July 2013-June 2018) evaluated HbA1c testing frequency in a subset of patients with type 2 diabetes identified within data collected from approximately 250 Australian general practices. The study included patients who were aged ≥18 in 2013 and had a record of HbA1c testing in study practices during the study period. Each patient's adherence rate was defined by the proportion of HbA1c tests performed within the testing intervals recommended by Australian guidelines. Based on the adherence rate, adherence level was categorised into low (≤33%), moderate (34%-66%) and high (>66%). Generalised additive mixed models were used to examine associations between adherence to the recommended HbA1c testing frequency and patient outcomes. RESULTS: In the 6424 patients with diabetes, the overall median HbA1c testing frequency was 1.6 tests per year with an adherence rate of 50%. The estimated HbA1c levels among patients with low adherence gradually increased or remained inadequately controlled, while HbA1c values in patients with high adherence remained controlled or improved over time. The risk of developing CKD for patients with high adherence was significantly lower than for patients with low adherence (OR: 0.42, 95% CI 0.18 to 0.99). No association between IHD and adherence to the recommended HbA1c frequency was observed. CONCLUSION: Better adherence to guideline-recommended HbA1c testing frequency was associated with better glycaemic control and lower risk of CKD. These findings may provide valuable evidence to support the use of clinical guidelines for better patient outcomes in patients with type 2 diabetes.

Potentially redundant repeat liver function test ordering practices in australian hospitals: A 5-year multicentre retrospective observational study.

BACKGROUND: Repeat Liver Function Tests (LFTs) are often necessary for monitoring purposes, but retesting within a short time interval may suggest potentially redundant repeat test (PRRT) ordering practices. We aimed to determine the proportion of potentially redundant repeat LFT ordering and identify associated factors in hospitals. METHODS: A 5-year (2014-2018) retrospective cohort study in six hospitals in New South Wales, Australia. A total of 131 885 patient admissions with repeat LFTs in the general ward (n = 102 852) and intensive care unit (ICU) (n = 29 033) met the inclusion criteria. Existing guidelines do not support retesting LFT for at least 48-72 hours. We used 24 hours as a conservative minimum retesting interval to examine PRRT ordering. We fit binary logistic regression to identify factors associated with PRRT ordering in two conditions with the highest repeat LFTs. RESULTS: There were a total of 298 567 repeat LFTs (medians of 2 repeats/admission and retesting interval of 25.6 hours) in the general ward and 205 929 (medians of 4 repeats/admission and retesting interval of 24.1 hours) in the ICU. The proportions of PRRT ordering were 35.2% (105 227/298 567) and 47.7% (98 307/205 929) in the general ward and ICU, respectively. The proportions of patients who received at least one PRRT were 52.3% (53 766/102 852) and 83.9% (24 365/29 033) in the general ward and ICU, respectively. Age, gender and the number of comorbidities and procedures were associated with the likelihood of ordering PRRT depending on the settings. CONCLUSION: Repeat LFT testing is common in Australian hospitals, often within 24 hours, despite guidelines not supporting too-early repeat testing. Further research should be conducted to understand whether better adherence to existing guidelines is required, or if there is any case for guidelines to be updated based on certain patient subpopulations.

How effective are electronic medication systems in reducing medication error rates and associated harm among hospital inpatients? A systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review and meta-analysis to assess: 1) changes in medication error rates and associated patient harm following electronic medication system (EMS) implementation; and 2) evidence of system-related medication errors facilitated by the use of an EMS. MATERIALS AND METHODS: We searched Medline, Scopus, Embase, and CINAHL for studies published between January 2005 and March 2019, comparing medication errors rates with or without assessments of related harm (actual or potential) before and after EMS implementation. EMS was defined as a computer-based system enabling the prescribing, supply, and/or administration of medicines. Study quality was assessed. RESULTS: There was substantial heterogeneity in outcomes of the 18 included studies. Only 2 were strong quality. Meta-analysis of 5 studies reporting change in actual harm post-EMS showed no reduced risk (RR: 1.22, 95% CI: 0.18-8.38, P = .8) and meta-analysis of 3 studies reporting change in administration errors found a significant reduction in error rates (RR: 0.77, 95% CI: 0.72-0.83, P = .004). Of 10 studies of prescribing error rates, 9 reported a reduction but variable denominators precluded meta-analysis. Twelve studies provided specific examples of system-related medication errors; 5 quantified their occurrence. DISCUSSION AND CONCLUSION: Despite the wide-scale adoption of EMS in hospitals around the world, the quality of evidence about their effectiveness in medication error and associated harm reduction is variable. Some confidence can be placed in the ability of systems to reduce prescribing error rates. However, much is still unknown about mechanisms which may be most effective in improving medication safety and design features which facilitate new error risks.

The General Practice and Residential Aged Care Facility Concordance of Medication (GRACEMED) study.

BACKGROUND: The lack of interoperable IT systems between residential aged care facilities (RACF) and general practitioners (GP) in primary care settings in Australia introduces the potential for medication discrepancies and other medication errors. The aim of the GRACEMED study is to determine the extent and potential severity of medication discrepancies between general practice and RACFs, and identify factors associated with medication discrepancies. METHODS: A cross sectional study of medication discrepancies between RACF medication orders and GP medication lists was conducted in the Sydney North Health Network, Australia. A random sample of RACF residents was included from practice lists provided by the general practices. RACF medication orders and GP medication lists for the included residents were compared, and medication discrepancies between the two sources were identified and characterised in terms of discrepancy type, potential for harm and associated factors. RESULTS: 31 GPs and 203 residents were included in the study. A total of 1777 discrepancies were identified giving an overall discrepancy rate of 72.6 discrepancies for every 100 medications. Omissions were the most common discrepancy type (35.2%,) followed by dose discrepancies (34.4%) and additions (30.4%). 48.5% of residents had a discrepancy with the potential to result in moderate harm and 9.8% had a discrepancy with the potential for severe harm. Number of medications prescribed was the only factor associated with medication discrepancies. CONCLUSION: Increased use of systems that allow information sharing and improved interoperability of clinical information is urgently needed to address medication safety issues experienced by RACF residents.

Harnessing the potential of electronic general practice pathology data in Australia: An examination of the quality use of pathology for type 2 diabetes patients.

BACKGROUND: Despite the importance of pathology testing in diagnosis and disease monitoring, there is little in-depth research about pathology test ordering in general practice and how it impacts patient outcomes. This is in part due to the limited availability of high-quality data. With the now-widespread use of electronic software in general practice comes the potential for electronic patient data to be used for research leading to better understanding of general practice activities, including pathology testing. OBJECTIVES: This study aimed to examine the usefulness of electronic general practice pathology data to: (1) identify patients' characteristics, (2) monitor quality of care, (3) evaluate intervention effects, (4) identify variations in patient care, and (5) measure patient outcomes. An exemplar study evaluating kidney function testing in type 2 diabetes mellitus (type 2 diabetes) compared to guidelines was used to demonstrate the value of pathology data. MATERIALS AND METHODS: De-identified electronic data from approximately 200 general practices in Victoria were extracted using Outcome Health's Population Level Analysis & Reporting (POLAR) Aurora research platform. Our study population included patients ≥18 diagnosed with type 2 diabetes before July 2016. Data from July 2016 to June 2018 were used to i) determine frequency of kidney function tests (KFT), and ii) identify whether antihypertensive medications were prescribed for abnormal KFT results. RESULTS: There were 20,514 active patients with type 2 diabetes identified from the data. The age and gender standardised estimate of diabetes prevalence was 4.9%, consistent with Australian estimates (5.2%). Sociodemographic features of prevalence, including higher prevalence in older males, were also consistent with previous Australian estimates. Kidney function testing was performed annually, as recommended by guidelines, in 75.7% of patients, with higher annual testing observed in patients managed under general practice incentive programs (80.1%) than those who were not (72.2%). Antihypertensive medications were prescribed as recommended in 77.4% of patients with suspected microalbuminuria or macroalbuminuria based on KFT results. DISCUSSION: Evaluations using data from diabetes patients in this study illustrate the value of electronic data for identifying patients with the condition of interest (e.g. type 2 diabetes) along with sociodemographic characteristics. This allows for the ability to undertake analyses on pathology testing factors and the identification of variation compared to guidelines, which has a potential to ensure quality of care. Its potential to identify associations with incentive programs further demonstrates the advantages of the data's longitudinal nature. These include the ability to assess temporal order and time interval of tests as a marker of quality of monitoring and evaluate intervention effects on a cohort over time. Finally, analyses on antihypertensive medication prescribing in patients with suspected micro/macroalbuminuria exemplified the electronic data's usefulness in monitoring patient outcomes, such as appropriate prescribing based on pathology test results. CONCLUSIONS: Electronic general practice data is an important resource which can provide valuable insights about the quality use of pathology. There are clear benefits to patients for better monitoring, and consequent better outcomes, and to inform policymakers about the best ways to channel resources to enhance the quality of care.

Interaction and innovation: practical strategies for inclusive consumer-driven research in health services.

INTRODUCTION: Despite advances in the co-creation of clinical research involving consumers in the last few decades, consumer engagement in health services research generally remains inconsistent and is too often treated as a perfunctory exercise. OBJECTIVE: Drawing on a health services study on diagnostic test result management, communication and follow-up, we: (1) outline practical strategies used to enhance the contribution of health consumer representatives across all stages of health services research, including active involvement in prioritising objectives for data analysis and participating in data analysis and the dissemination of findings; and (2) describe the impact of continued engagement of consumers on the programme of research, the interpretation of findings and their translational potential. KEY INNOVATIONS: Key enabling innovations for engagement included: (1) planned opportunities for long-term consumer involvement across all stages of the research process from conception to dissemination; (2) enhanced consumer engagement capacity; (3) purposeful recruitment of appropriately trained consumers; (4) provision of support structures for active consumer involvement in research design, analysis and write-up; and (5) financial support for consumer involvement. IMPACT/CONCLUSION: Enhancing consumer contribution and establishing inclusive research design requires a negotiated, interactive, meaningful and transparent process. As a collaborative approach, consumer-driven research involvement offers opportunities for new, often unexpected or unexplored perspectives to feature across the whole research process. In a move away from tokenistic consumer involvement, consumers and researchers who participated in this novel and immersive research project identified inclusive research as a powerful tool to enhance health services research and its translation into effective policy.

Diagnostic Informatics: Its Role in Enhancing Clinical Excellence, Patient Safety and the Value of Care.

Diagnostic informatics encompasses the role of information technology in key areas of the diagnostic testing (pathology and medical imaging) process, including the selection of appropriate tests and interpretation and follow-up of test results. We present three case studies employing diagnostic informatics methodologies to demonstrate their potential use and value in health services research: (1) Data analytics applied to diagnostic data linked with patient outcome data as a means of enhanancing the monitoring of the quality and appropriateness of diagnostic test choices; (2) Business process modelling which can help to highlight healthcare processes in the diagnostic pathway as a means of improving safety and performance, and (3) Consumer involvement in the diagnostic research process to assist in the establishment of person-centred test result management systems. The case studies provide evidence of the role that diagnostic informatics can have in improving the quality and safety of patient care.