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Unlocking the Potential of EPR in Dutch Primary Care

Explore the impact, challenges, and advancements in medical data management and the pivotal role of IT in Dutch primary care. Discover how embracing electronic records can streamline healthcare processes and drive improvements in patient care. Empower yourself to lead the way in integrating technology for a more efficient and effective healthcare system.

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Unlocking the Potential of EPR in Dutch Primary Care

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Presentation Transcript

  1. Outline • Medical data • Nature • Challenges • Role of IT in Dutch primary care • Current status • Developments • Understanding change

  2. Computers • Boring …. • Dependent on technicians …. • Consume time …. • Re-organise your practice …. • Start coding …. • Cost money …. • Could somebody give me a REASON ???

  3. 100 90 number of installed systems 80 number of systems with CPR 70 60 50 Percentage of primary care practices 40 30 20 10 0 78 80 82 84 86 88 90 92 94 96 Year Growth of CPR systems in primary care

  4. Advantages • Paper records: • not accessible • not enough structure • Electronic records: • data available for many purposes • billing • patient care • quality • control costs • epidemiology • etc etc etc etc …….

  5. HOWEVER • J.F. Burnum • The misinformation era: The fall of the medical record. Annals of Internal Medicine, 1989;110:482-4 • “With the advent of the information era in medicine, we are pouring out a torrent of medical record misinformation.” • “All medical record information should be regarded as suspect; much of it is fiction.”

  6. Medical Data • Human Artefacts • Do not exist “an sich” • “Real-world entities” observed and described by humans

  7. Use of Data! • Registration has a purpose • Purpose determines • what • how

  8. Ignore Purpose: • Physicians hide information (Burnum 89) • Everybody optimises income (Hsia 88) • Control is exerted (Comm ACM 90) • Analysis difficult (Zwetsloot 90)

  9. FIRST QUESTION: • Why??? • Not what • Not how • Remember: • Data will be available for multiple purposes • To observe and code is a process of reduction • Purposes may collide

  10. EPR in Primary Care, present • Rule rather than exception • Electronic communication • Preventive medicine • Prescriptions • Post-marketing surveillance

  11. EPR in Primary Care, very soon • Regional networks • Collect data for studies • Shared care • Simple decision support

  12. EPR, soon • EPR infrastructure • Protocol-based care • Judging performance (C.M.E.) • Decision support

  13. Lessons from Dutch Primary Care • Physicians can type • Time consuming • Difficult • Changes how you work • Changes your future task

  14. BUT • Legacy systems • Building empires • Lack of standards

  15. and Whatever the challenges are, they are NOT of a technological nature

  16. EPR as Catalyst • Formal analysis • Interaction between providers • Responsibilities • described • redefined !!! • New approaches to collaboration

  17. Example: EDI • Stage 1: copies of paper • Stage 2: sharing a record • Stage 3: I'm drowning • Stage 4: let’s talk

  18. Example: drugs • pharmacist: send me the data • GP: send me the prescriptions • WHO is responsible

  19. Example: drugs (2) • Avoiding brandnames • Governmet: generic!!!! • Attempts: difficult • GPs: we will, $$$$$ • Government: $$$$ • GPs: deal! • GPs: software

  20. Example: preventive medicine • government: influenza vaccination! • pharmacists: we have the data • government: fine • registration board: no • GPs: if you pay us

  21. Ultimate challenge: You !!! • Why • What is your goal • What is your responsibility • If NOT: • frustration, communication problems, control, dependent, cost money, cost time, chasing, etc., etc., ……

  22. SO • Take control • Lead developments • Your task is at stake • Information technology is too important to be left only to the professionals!

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