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Objectives

Epidemiological data collection through the electronic medical record in general practice in Belgium: a feasibility study. Van Casteren Viviane (1), Van der Heyden J (1), Lafontaine MF (1) , Bastiaens H (1), Jonckheer P (1), De Clercq E(2), Mambourg F. (3)

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Objectives

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  1. Epidemiological data collection through the electronic medical record in general practice in Belgium: a feasibility study Van Casteren Viviane (1), Van der Heyden J (1), Lafontaine MF (1) , Bastiaens H (1), Jonckheer P (1), De Clercq E(2), Mambourg F. (3) 1 Scientific Institute of Public Health, Brussels 2 SESA, Catholic University of Louvain, Brussels 3 Ministry of Social Affairs, Public Health and Environment, Brussels

  2. Objectives • Study the feasibility of data collection by means of EMR in GP • Establishing a cardiovascular risk profile of the patients in the study • Providing information on the prevalence of diabetics, hypentensive and coronary patients in the practice • Study the technical possibility of automatic transfer of data from EMR to recording module and vice versa

  3. Partners in the study • Ministry of Social Affairs, Public Health and Environment • Scientific Institute of Public Health (IPH) • Scientific associations (SSMG and WVVH) • SESA (UCL) - Kindly Marked up Electronic Health Record (KMEHR) – working group • Software producers • Health Data Management Partners SA, Eudata SA, Socrate médical

  4. Participating GPs • 63 general practitioners - 3 software packages • GPs spread over Belgium

  5. Method • Pilot study (April 3 – May 31, 2000) • Eligible patients: aged between 50 and 74 • Active recording by means of data entry screen • Link between this screen and the EMR • Transcription of recorded items in a XML-KMEHR- format • Transfer of the file to SSMG/WVVH after encryption (PGP) • Assurance of confidentiality of data (GP, patient)

  6. Method • Items generated automatically: • Code of GP • Code of patient • Date of consultation • Demographic information to be added when absent from the EMR: • Sex • Year of birth

  7. Method • Parameters which could be added when absent from the EMR: • Smoking status • Hypertensive patient • Coronary patient • Diabetic patient

  8. Method • Parameters automatically taken from the EMR and impossible to add, when absent: • Most recent BP (incl. date) • Most recent cholesterol (incl. date) • Most recent HDL (incl. date) • Most recent hba1c (incl. date)

  9. Method • Parameters captured from the EMR or which could be added when absent: • Weight (incl. date of measure) • Length (incl. date of measure) • Parameters to be measured at the consultation: • Blood pressure • Information on treatment

  10. Output • Global and individual results • Prevalence • Cardiovascul. risk factors (smoking status, obesity, hypercholesterolemia, hypertension) • Chronic diseases (HTA, coronary, diab.2) • Follow up of patients • Last control (HTA, cholest., weight, Hba1c) • Treatment • Tool useful in future studies

  11. Results • Participation : 40 GPs (63%) variation between software packages (55% - 60% -100%) • Data from 3559 patients

  12. Results • Quality of data: • Demographic data: • Sex (96.4% OK) • Year of birth (99.2% OK) • Clinical parameters (day of consult): • Weight (92.8% OK) • Length (89.6% OK) • Systolic blood pressure (91.6% OK)

  13. Results • Quality of data: • Clinical parameters (in EMR): • Last systolic BP (58.5% OK) • Smoking status (79.5% OK) • Chronic diseases: • Known hypertensive pat. (89.0% OK)

  14. Results • Quality of data: • Treatment of chronic diseases: • For hypertension (75.0% OK) • Lab results: • HDL cholesterol (64.1% OK)

  15. Sample characteristics • 54.8% female patients • 24% 50-54 years old • 20% smokers • 22% obesity (BMI >30) • 14% coronary patients (11% treated) • 18% diabetics (9% treated)

  16. Evaluation: positive • Data collection from different software packages by means of XML-format is feasible • Many enthusiast participating GPs • Recording is useful for GP to improve own way of practicing • Recording is useful to improve use of EMR

  17. Evaluation: positive • Considerable commitment of producers • Opportunity for GPs to discuss problems with producers • User groups proved to be very useful • Quite successful procedure for transmission of anonymous data

  18. Evaluation: negative • Interference of recording module with EMR • Time spent on completion of module was too considerable • No time to test the registration module • Impossible to switch between module and EMR • The recording module was activated at the beginning of the consultation

  19. Evaluation: negative • Once the registration was done, it was impossible to return to the imput screen • Some GPs mentioned a problem with the validity of the registered data (e.g. cholesterol values) • There was no time to test the regis-tration module

  20. Evaluation: negative • GPs preferred not to use a specific registration module • GPs with limited computer experience had great difficulties in participating • The help desk could not be reached in the evening or during the weekend • The role of the scientific associations was not always clear

  21. Recommendations • Better elaborate the specific aims of the study and the expected output • Implicate the GPs and the scientific associations in the choice of the project theme • Voluntary participation, a fair compensation and anonymity of the data (at the level of doctor and patient) are essential

  22. Recommendations • The registration may not result in an instrument of control for the govern-ment • The registration module has to be ex-tensively tested in the field, before the start of the study • Need for adequate logistic support at a time convenient for a GP

  23. Future • Immediate future : preparation of a new project on appropriate use of NSAIDS • Involvement of more software developers • Involvement of more GPs (150) • Test phase in December 2000 • Recording in January-February 2001 • Afterwards ?

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