Implementation of an integrated preoperative care pathway and regional electronic clinical portal for preoperative assessment

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• 作者：Matt-Mouley Bouamrane ; Frances S Mair
• 关键词：(Mesh) ; Medical informatics applications ; Information systems ; Integrated advanced information management systems
• 刊名：BMC Medical Informatics and Decision Making
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：2,140 KB
• 参考文献：1. Bouamrane MM, Mair F: A study of clinical and information management processes in the surgical pre-assessment clinic . / BMC Med Inform Decis Making 2014.,14(22): http://www.biomedcentral.com/1472-947/14/22/citation
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• 刊物主题：Health Informatics; Information Systems and Communication Service; Management of Computing and Information Systems;
• 出版者：BioMed Central
• ISSN：1472-6947

文摘

Background Effective surgical pre-assessment will depend upon the collection of relevant medical information, good data management and communication between the members of the preoperative multi-disciplinary team. NHS Greater Glasgow and Clyde has implemented an electronic preoperative integrated care pathway (eForm) allowing all hospitals to access a comprehensive patient medical history via a clinical portal on the health-board intranet. Methods We conducted six face-to-face semi-structured interviews and participated in one focus group and two workshops with key stakeholders involved in the Planned Care Improvement (PCIP) and Electronic Patient Record programmes. We used qualitative methods and Normalisation Process Theory in order to identify the key factors which led to the successful deployment of the preoperative eForm in the health-board. Results In January 2013, more than 90,000 patient preoperative assessments had been completed via the electronic portal. Two complementary strategic efforts were instrumental in the successful deployment of the preoperative eForm. At the local health-board level: the PCIP led to the rationalisation of surgical pre-assessment clinics and the standardisation of preoperative processes. At the national level: the eHealth programme selected portal technology as an iterative strategic technology solution towards a virtual electronic patient record. Our study has highlighted clear synergies between these two standardisation efforts. Conclusion The adoption of the eForm into routine preoperative work practices can be attributed to: (i) a policy context -including performance targets -promoting the rationalisation of surgical pre-assessment pathways, (ii) financial and organisational resources to support service redesign and the use of information technology for operationalising the standardisation of preoperative processes, (iii) a sustained engagement with stakeholders throughout the iterative phases of the preoperative clinics redesign, guidelines standardisation and the eForm development, (iv) the use of a pragmatic and domain-agnostic technology solution and finally: (v) a consensual and contextualised implementation.