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Previous surveys suggested Australian GPs felt positive towards evidence-based medicine (EBM) but had reservations about practising it. Strategies to promote EBM in Australian general practice were implemented by the Royal Australian College of General Practitioners (RACGP) and published online in 1998. The aim of this study was to explore attitudes to and use of EBM in a population of Sydney GPs four years after publication of the strategies. A postal survey was conducted in 2003 among a group of GPs in Sydney (n = 135) with a response rate of 31%. The survey assessed: attitudes to and barriers to practising EBM; preferred methods in moving from opinion-based medicine to EBM; awareness and use of EBM resources; and ability to interpret research evidence. Two-thirds of respondents felt positive towards EBM. Time pressure was the most commonly perceived barrier to practising EBM and use of evidence-based guidelines was the most popular method in moving towards EBM. Among 70% of respondents, at least 40% of clinical practice was evidence-based. Awareness of the databases The Cochrane Library and Medline was high, but use of database information was rare. There was partial understanding of technical terms used in EBM. While overall these GPs had a positive attitude towards EBM, they indicated some reluctance to applying it. Thus it is probable that in this GP group EBM was used less than optimally. The evidence provided by this study suggests that the RACGP strategies to promote appropriate use of EBM in general practice need heightened emphasis among the GPs surveyed. The study's low response rate prevents any generalisation of findings to the Australian general practice workforce. [ABSTRACT FROM AUTHOR]

Study Objective: We identify and describe emergency physicians' and nurses' perceptions of the effect of an integrated emergency department (ED) information system on the quality of care delivered in the ED., Methods: A qualitative study was conducted in 4 urban EDs, with each site using the same ED information system. Participants (n=97) were physicians and nurses with data collected by 69 detailed interviews, 5 focus groups (28 participants), and 26 hours of structured observations., Results: Results revealed new perspectives on how an integrated ED information system was perceived to affect incentives for use, awareness of colleagues' activities, and workflow. A key incentive was related to the positive effect of the ED information system on clinical decisionmaking because of improved and quicker access to patient-specific and knowledge-base information compared with the previous stand-alone ED information system. Synchronous access to patient data was perceived to lead to enhanced awareness by individual physicians and nurses of what others were doing within and outside the ED, which participants claimed contributed to improved care coordination, communication, clinical documentation, and the consultation process. There was difficulty incorporating the use of the ED information system with clinicians' work, particularly in relation to increased task complexity; duplicate documentation, and computer issues related to system usability, hardware, and individuals' computer skills and knowledge., Conclusion: Physicians and nurses perceived that the integrated ED information system contributed to improvements in the delivery of patient care, enabling faster and better-informed decisionmaking and specialty consultations. The challenge of electronic clinical documentation and balancing data entry demands with system benefits necessitates that new methods of data capture, suited to busy clinical environments, be developed., (Copyright © 2012. Published by Mosby, Inc.)

Background: Hospital discharge summaries have traditionally been paper-based (handwritten or dictated), and deficiencies have often been reported. On the increase is the utilisation of electronic summaries, which are considered of higher quality than paper-based summaries. However, comparisons between electronic and paper-based summaries regarding documentation deficiencies have rarely been made and there have been none in recent years., Objectives: (1) To study the hospital discharge summaries, which were either handwritten or electronic, of a population of inpatients, with regard to documentation of information required for ongoing care; and (2) to compare the electronic with the handwritten summaries concerning documentation of this information., Methods: The discharge summaries of 245 inpatients were examined for documentation of the items: discharge date; additional diagnoses; summary of the patient's progress in hospital; investigations; discharge medications; and follow-up (instructions to the patient's general practitioner). One hundred and fifty-one (62%) discharge summaries were electronically created and 94 (38%) were handwritten. Odds ratios (ORs) with their confidence intervals (CI) were estimated to show strength of association between the electronic summary and documentation of individual study items., Results: Across all items studied, the electronic summaries contained a higher number of errors and/or omissions than the handwritten ones (OR 1.74, 95% CI 1.26-2.39, p<0.05). Electronic summaries more commonly documented a summary of the patient's progress in hospital (OR 18.3, 95% CI 3.33-100, p<0.05) and less commonly recorded date of discharge and additional diagnoses (respective ORs 0.17 (95% CI 0.09-0.31, p<0.05) and 0.33 (95% CI 0.15-0.89, p<0.05)., Conclusion: It is not necessarily the case that electronic discharge summaries are of higher quality than handwritten ones, but free text items such as summary of the patient's progress may less likely be omitted in electronic summaries. It is unknown what factors contributed to incompleteness in creating the electronic discharge summaries investigated in this study. Possible causes for deficiencies include: insufficient training; insufficient education of, and thus realisation by, doctors regarding the importance of accurate, complete discharge summaries; inadequate computer literacy; inadequate user interaction design, and insufficient integration into routine work processes. Research into these factors is recommended. This study suggests that not enough care is taken by doctors when creating discharge summaries, and that this is independent of the type of method used. The importance of the discharge summary as a chief means of transferring patient information from the hospital to the primary care provider needs to be strongly emphasised.

The aim of this multi-method study based at a microbiology department in a major Sydney metropolitan teaching hospital was to: i) identify the role that information and communication processes play in a paper-based test request system, and ii) examine how these processes may affect the implementation and design of Computerised Provider Order Entry (CPOE) systems. Participants in this study reported that clinical information can impact on the urgency and type of tests undertaken and affect the interpretation of test results. An audit of 1051 microbiology test request forms collected over a three-day period showed that 47% of request forms included clinical notes which provide a variety of information often vital to the test analysis and reporting process. This transfer of information plays an important role in the communication relationship between the ward and the laboratory. The introduction of new CPOE systems can help to increase the efficiency of this process but for that to be achieved research attention needs to be given to enhancing the provision and communication of clinical information.

The aim of this study was to assess general practitioners' (GPs') satisfaction with the quality of information in electronic discharge summaries and the timeliness of their receipt of the summaries. The study was conducted in a 75-bed Australian public metropolitan hospital which uses an electronic discharge summary which is mailed to the patients' nominated GP. Eighty-five GPs were surveyed regarding their satisfaction with the content of the electronic discharge summary and the timeliness of receipt. the majority of respondents indicated that they had received the electronic discharge summary within two weeks of the patients' discharge from hospital. The majority also indicated that they were satisfied with all eight documentation data elements. Some GPs indicated that they would prefer to receive the electronic discharge summary electronically by email rather than by conventional mail, and that they would like more information in the "follow-up and recommendations" content areas of the summary. It was concluded that the majority of GPs agreed that the electronic discharge summary was an improvement over the manual discharge summary. Further developments in the safe and secure electronic transfer of discharge summary information needs to be addressed to meet the information needs of GPs.

In this study 85 adult patients attending a Sydney general practice were asked for their views on computer-assisted consultations; 77 (91%) agreed to participate. In general, patients agreed they could still talk easily with their doctor, and felt listened to, while the doctor used the computer (87% & 75% respectively). More than half the patients felt the computer contributed to better treatment, although a quarter believed consultations were prolonged. About half the patients agreed that the doctor did not often explain the role of the computer. Given the national plans for increasing computerisation of health records (HealthConnect), this research suggests that more attention should be given to involving patients in e-health developments.

The profile of health information managers (HIMs) employed within one metropolitan area health service in New South Wales (NSW) was identified, together with which information technology and health informatics knowledge and skills they possess, and which ones they require in their workplace. The subjects worked in a variety of roles: 26% were employed in the area's Information Systems Division developing and implementing point-of-care clinical systems. Health information managers perceived they needed further continuing and formal education in point-of-care clinical systems, decision support systems, the electronic health record, privacy and security, health data collections, and database applications.

The aim of this study was to ascertain which competencies health information managers (HIMs) working in public hospital positions perceived were important for effective performance. A health information management competency model was developed based on the Boyatzis (1982) managerial competency model and modified to take into account previous health information management competency documents and competency studies in the Australian health service management literature. A questionnaire, administered between July 1995 and June 1996, asked a sample of 306 health information managers (HIMs) from 71 New South Wales and Victorian public hospitals to rate the importance of managerial competencies for effective performance in their current roles. The study sample was split, post survey, into two groups, 'managerial HIMs' and 'coder HIMs,' in order to reflect important role differences. The results showed that the Personal and interpersonal skills competency cluster, which included leadership, motivation, problem solving, managing change and negotiation skills, was ranked as most important by managerial HIMs in NSW, and the Clinical classification skills competency cluster was ranked as most important by Victorian managerial HIMs. This difference was thought to be due to the casemix-based funding environment in Victoria at the time of data collection. Nearly all the competencies listed were perceived to be of 'high' to 'medium' importance (on a scale of 'low', 'medium' and 'high') by managerial HIMs from both states. Coder HIMs from both states perceived fewer competencies included in the developed model to be important; this highlights the divergent roles undertaken by 'coder HIMs' and 'managerial HIMs'. Further work is required on competencies of HIMs in roles other than hospital-based positions.