Volume 41 Number 2: >>  


Are General Practitioners getting the information they need from hospitals to manage their lung cancer patients? A qualitative approach
Stella Rowlands, Joanne Callen and Johanna Westbrook  p4    [ FULL TEXT AVAILABLE AFTER 6 MONTHS OF PUBLICATION ]

The delivery of cancer services is primarily hospital-based; however, General Practitioners (GPs) have a key role to play within the context of a multidisciplinary model of care. In order to fulfill their role in cancer care GPs must receive complete and timely information from appropriate members of the hospital team. The aim of this study was to investigate perceptions of the quality, format and timeliness of the patient information GPs receive from a multidisciplinary hospital-based lung cancer team, and elicit how communication between the team and the GP could be improved. Data were collected using semi-structured interviews with a representative sample (n=22) of members of the hospital team and a sample of GPs (n=8). A grounded theory approach was used to categorise the data. Most communications with GPs were from medical officers; however, GPs desired information from all health professional groups in the hospital-based lung cancer team. Most GPs were dissatisfied with the timing of communication. A multidisciplinary discharge summary was suggested as a means of providing both clinical and social information from the team to the GP. Further developments in electronic health records could improve access to patient information by GPs. Results from this study illustrate the need for GPs to receive information from all members of the multidisciplinary hospital team so that they may fulfill their diverse role in supporting patients through all phases of the cancer journey.

Simulation Studies for the evaluation of health information technologies: experiences and results
Elske Ammenwerth, Werner O. Hackl, Kristine Binzer, Tue E. H. Christoffersen, Sanne Jensen, Kitta Lawton, Peter Skjoet & Christian Nohr  p14    

It is essential for new health information technologies (IT) to undergo rigorous evaluations to ensure they are effective and safe for use in real-world situations. However, evaluation of new health IT is challenging, as field studies are often not feasible when the technology being evaluated is not 
sufficiently mature. Laboratory-based evaluations have also been shown to have insufficient external validity. Simulation studies seem to be a way to bridge this gap. The aim of this study was to evaluate, using a simulation methodology, the impact of a new prototype of an electronic medication management system on the appropriateness of prescriptions and drug-related activities, including laboratory test ordering or medication changes. This article presents the results of a controlled simulation study with 50 simulation runs, including ten doctors and five simulation patients, and discusses experiences and lessons learnt while conducting the study. Although the new electronic medication management system showed tendencies to improve medication safety when compared with the standard system, this tendency was not significant. Altogether, five distinct situations were identified where the new medication management system did help to improve medication safety. This simulation study provided a good compromise between internal validity and external validity. However, several challenges need to be addressed when undertaking simulation evaluations including: preparation of adequate test cases; training of participants before using unfamiliar applications; consideration of time, effort and costs of conducting the simulation; technical maturity of the evaluated system; and allowing adequate preparation of simulation scenarios and simulation setting. Simulation studies are an interesting but time-consuming approach, which can be used to evaluate newly developed health IT systems, particularly those systems that are not yet sufficiently mature to undergo field evaluation studies.

Application of case classification in healthcare quality assessment in China
Ping Xu, Meina Li (co-fi rst author), Lulu Zhang*, Qingwen Sun, Shiwei Lv, Bin Lian, Min Wei & Zhang Kan  p22 


The purpose of this study was to build a healthcare quality assessment system with disease category as the basic unit of assessment based on the principles of case classification, and to assess the quality of care in a large hospital in Shanghai. Using the Delphi method, four quality indicators were selected. The data of 124,125 patients discharged from a large general hospital in Shanghai, from October 1, 2004 to September 30, 2007, were used to establish quality indicators estimates for each disease. The data of 51,760 discharged patients from October 1, 2007 to September 30, 2008 were used as the testing sample, and the standard scores of each quality indicator for each clinical department were calculated. Then the total score of various clinical departments in the hospital was calculated based on the differences between the practical scores and the standard. Based on quality assessment scores, we found that the quality of healthcare in departments of thyroid and mammary gland surgery, obstetrics and gynaecology, stomatology, dermatology, and paediatrics was better than in other departments. Implementation of the case classification for healthcare quality assessment permitted the comparison of quality among different healthcare departments.

Social media in health - what are the safety concerns for health consumers? 

Annie Y.S. Lau, Elia Gabarron, Luis Fernandez-Luque and Manuel Armayones  p30

Recent literature has discussed the unintended consequences of clinical information technologies (IT) on patient safety, yet there has been little discussion about the safety concerns in the area of consumer health IT. This paper presents a range of safety concerns for consumers in social media, with a case study on YouTube. We conducted a scan of abstracts on ‘quality criteria’ related to YouTube. Five areas regarding the safety of YouTube for consumers were identified: (a) harmful health material targeted at consumers (such as inappropriate marketing of tobacco or direct-to-consumer drug advertising); (b) public display of unhealthy behaviour (such as people displaying self-injury behaviours or hurting others); (c) tainted public health messages (i.e. the rise of negative voices against public health messages); (d) psychological impact from accessing inappropriate, offensive or biased social media content; and (e) using social media to distort policy and research funding agendas. The examples presented should contribute to a better understanding about how to promote a safe consumption and production of social media for consumers, and an evidence-based approach to designing social media interventions for health. The potential harm associated with the use of unsafe social media content on the Internet is a major concern. More empirical and theoretical studies are needed to examine how social media influences consumer health decisions, behaviours and outcomes, and devise ways to deter the dissemination of harmful influences in social media.

Damages claim for wrongful birth due to a systems failure

Judith Mair  p36

Health professionals are well versed in the need to have systems in place which avoid mishaps happening to patients due to human error or breakdown in communications: for example, legal actions for damages for operations wrongfully performed on patients due to a failure in the identification process; surgery involving the wrong limb or organ; medications being given to the wrong patient. Hospitals set in place systems by which a patient’s name and procedures to be performed are checked multiple times throughout the patient’s stay. This process is particularly vital when a patient is undergoing a surgical procedure which will be performed under anaesthesia. Nevertheless, systems failures continue to occur resulting in claims for damages by affected patients.

© 2012 Health Information Management Journal of the Health Information Management Association of Australia Ltd