Patient registries are poorly interoperable and as a result data exchange or aggregation across organizations, regions and countries for secondary purposes (i.e. research and public health) is ...difficult to perform. PARENT Joint Action aims to provide EU Member States with a set of guidelines, recommendations and tools to support setting-up, management and governance of interoperable patient registries, thus helping EU Member States to drive down cost and interoperability risks of patient registries as well as improving secondary us-age of registry data in a cross-border setting.
Slovenia's national eHealth strategy aims to develop an efficient, flexible and modern health care informatics framework that would be comparable to the most successful EU countries. To achieve this ...goal, the gap between availability and usage of information and communication technology by primary care physicians needs to be reduced.As recent efforts show, consensus on information and communication technology purpose and usage in primary care needs to be established before any national information and communication technology solutions are developed.The aim of this study was to identify the most appropriate measures in implementation of Slovene national eHealth strategy and to suggest an appropriate model for success by using the three round Delphi study.
An e-mail based, three-round Delphi study was undertaken to achieve consensus from a selected sample of nationally recognized experts from the fields of primary health care and medical informatics. The aim of this study was to identify the most appropriate measures and key obstacles in implementation of eHealth in Slovene primary health care by using the Delphi study.
High levels of consensus on the majority of suggested measures were achieved among all study participants, as well as between the subgroups of experts from primary health care and medical informatics. All aims of the three-round Delphi study on eHealth implementation in Slovenian primary health care were achieved.
The three round decision Delphi process has proven to be effective for developing outcomes, ranking key priorities in primary care eHealth development, and achieving consensus among the most influential experts in that field. This consensus is an important contribution to future national eHealth strategies in the field of primary health care.
Cancer is a major European public health issue and represents the second most important cause of death and morbidity in Europe. Moreover, as a result of constant advances in medicine, medical ...technology and other sciences, and due to improvements in economic circumstances, cancer survival rates are increasing in Europe and prevalent cases (i.e. number of subjects who have experienced cancer) represent a growing proportion of the population. In order to tackle cancer efficiently throughout the European Member states, the European Commission launched the Joint Action (JA) 'European Partnership for Action Against Cancer' (EPAAC) facilitated by the Community Health Programme, in September 2009. EPAAC is designed to fill a gap in cooperation, collaboration and shared experiences for countries with similar needs and diverse experience in the area of their national cancer control policies. Activities and studies are tackling the main challenges of cancer control in Europe as a whole and in the Member states, including the provision of services and health system responses, human resources and research. In contrast with previous European actions in the field of cancer, EPAAC joins different partners and stakeholders at various levels ranging from Member states (including Iceland and Norway) and Regions to patient representatives.
Background: Information and communication technology (ICT) and paperless practices have been shown to improve “existing processes in the workplace” “as well as being an important component of modern ...primary healthcare”. The aim of our study was to analyse the attitudes of health-care professionals and patients with regard to paperless practice and the most frequently used information and communication technology tools in Slovenian primary healthcare.
Qualitative methodology using focus groups of 22 primary care physicians, 14 nurses and 18 patients.
The areas recognised by all participants as important for further information and communication technology development were: computer-supported decision making, accessibility and completeness of personal e-health data, emergency cases, support for chronic disease management, ICT related time savings, e-prescriptions and e-discharge letters. The most important identified barriers impeding the use of ICT were: the heavy workload of primary care physicians and nurses, health insurance reimbursement rules and duplication of work using both paper and electronic health records.
This study highlighted a number of strengths of ICT use in primary care as well as numerous areas where changes in procedures and improvement of ICT tools to support them are needed.
Izhodišča: Informacijsko-komunikacijska tehnologija (IKT) in brezpapirno delo lahko izboljšata obstoječe delovne procese in so pomembna sestavina sodobnega osnovnega zdravstva. Namen študije je bil analizirati stališča zdravstvenega osebja in pacientov glede brezpapirne ambulante in najpogostejše uporabljene informacijskokomunikacijske tehnologije v slovenskem osnovnem zdravstvu.
Kvalitativna metodologija fokusnih skupin z 22 zdravniki iz osnovnega zdravstva, s 14 ambulantnimi sestrami in z 18 bolniki.
Področja, ki so jih vsi udeleženci prepoznali kot pomembna za nadaljnji razvoj IKT, so: računalniško podprto odločanje, dostopnost in popolnost osebnih zdravstvenih podatkov, nujni primeri, podpora pri obravnavi kroničnih bolezni, prihranki časa z uporabo IKT, e-recept in e-odpustno pismo. Najpomembnejše ovire za uporabo IKT so: velike delovne obremenitve zdravnikov in sester v osnovnem zdravstvu, pravila zdravstvene zavarovalnice, podvajanje dela z uporabo papirnatih in elektronskih zdravstvenih kartotek.
Študija je poudarila številne prednosti uporabe IKT v osnovnem zdravstvu in tudi številna področja, na katerih so potrebni spremembe v procesih in izboljšanje podpornih orodij IKT.
Information technology has the potential to improve and support the treatment of depression. Use of clinical guidelines can improve outcome of treatment, but implementation of guidelines is a ...demanding process and the resulting user compliance is often poor. Electronic health records, clinical decision support systems and other information technology tools seem at first glance to be a preferable way to implement clinical guidelines since they require user's active and problem oriented participation. This article reviews attempts made so far at use of information tools for implementation of clinical guidelines for depression treatment and discusses their effects. It turns out that there are few existing solutions, ambiguous effects and that usage is often limited. In future the factors determining development of successful electronic tools for clinical guidelines implementation will need to be further specified. Further research projects are underway in Slovenia to investigate these issues.
Evropa Združeno V Boju Proti Raku: Projekt Evropsko Partnerstvo Za Boj Proti Raku - EPAAC
In 2011 Slovenia has taken over the role of the leading partner of the biggest European project in the field ...of cancer so far, the European Partnership for Action Against Cancer - EPAAC. The project will last three years. All European member states, Norway and Iceland will participate in the project. Slovenia has been actively involved in the project from its beginning and respecting the decision of the European Commission Slovenia has taken over the role of the project coordinator. Slovenian Ministry of Health authorized the National Institute of Public Health (NIPH) to lead the project.
Abstract
Background/Aims
On average, there is a delay of 6.7 years between symptom onset and diagnosis of axial spondyloarthritis (axSpA). Since traditional approaches to improving early axSpA ...identification have had limited success, predictive automated analyses using patient records may help alleviate the burden on healthcare providers. We report results from a machine learning (ML) algorithm developed with UK electronic health records (EHRs) Clinical Practice Research Datalink (CPRD) data to estimate the probability or likelihood of a patient being diagnosed with axSpA based on prior clinical indicators and patient history.
Methods
Primary care UK EHR data - CPRD GOLD was used to identify patients with axSpA and healthy controls (HC). Patients aged ≥18 years with first diagnosis date of axSpA within the identification period (01-Jan-2005 to 31-Dec-2018) and fulfilling CPRD research acceptability criteria were included. Data pertaining to clinical presentation, consultation, referral, test, and therapy history were extracted for individual patients prior to diagnosis of axSpA. A total of 5,090 patients with axSpA satisfied the acceptability criteria. HC were randomly sampled to create a subset of one unique HC matched to each patient with axSpA, resulting in 5,089 HC. ML usable features derived from the total population (patients with axSpA and HC) numbered 820. After using a further exclusion criterion for the patients with axSpA and HC who had ≥1 of 820 usable features, the final dataset included 7,813 patients (3,902 with axSpA and 3,911 HC). This combined dataset was randomly split (67:33) into a train (n = 5237) and a test (n = 2576) dataset. A random forest (RF) model was trained on the train dataset. Cross-validation was performed for hyper-parameter tuning of the RF classifier. Once the model was trained, accuracy, precision, and F-1 scores were obtained with the test dataset.
Results
The RF-based algorithm resulted in a high level of accuracy (88.12%), with precision of 0.95 for patients with axSpA and 0.83 for HC. The RF algorithm identified 89 best clinical predictors (out of 820 used as inputs) that differentiated between patient and HC such as: total number of tests, total number of referrals, first age of consultation, first symptom age, and number of low back pain symptoms. The model sensitivity was 0.75 and positive predictive value was 80.88%. The model specificity was 0.96 and negative predictive value was 82.56%.
Conclusion
The ML algorithm demonstrated a high level of accuracy and precision in the identification of possible cases of axSpA, which may be useful in reducing the delay in diagnosis. Previous studies have successfully demonstrated automated cohort identification of axSpA in large datasets, with only a few using ML-based approaches for diagnosis from patient medical history. While our model supports previous work in axSpA, it needs further validation in routine clinical practice (exploration ongoing).
Disclosure
R. Sengupta: Honoraria; AbbVie, Biogen, Celgene, Lilly, MSD, Novartis, Roche, UCB. Grants/research support; AbbVie, Celgene, Novartis, UCB. S. Narasimham: Shareholder/stock ownership; Novartis. Other; Employee of Novartis. B.S. Mato: Shareholder/stock ownership; Novartis. Other; Employee of Novartis. M. Meglic: Other; Employee of Novartis. C. Perella: Other; Employee of Novartis. P. Pamies: Other; Employee of Novartis. P. Emery: Consultancies; AbbVie, Astra-Zeneca, BMS, Boehringer Ingelheim, Celltrion, Gilead, Janssen, MSD, Lilly, Novartis, Pfizer, Roche, Samsung, UCB. Grants/research support; AbbVie, BMS, Lilly, Novartis, Pfizer, Roche, Samsung.
Izhodišča: Informacijsko-komunikacijska tehnologija (IKT) in brezpapirno delo lahko izboljšata obstoječe delovne procese in so pomembna sestavina sodobnega osnovnega zdravstva. Namen študije je bil ...analizirati stališča zdravstvenega osebja in pacientov glede brezpapirne ambulante in najpogostejše uporabljene informacijskokomunikacijske tehnologije v slovenskem osnovnem zdravstvu.
Treatments and organizational changes supported by eHealth are beginning to play an important role in improving disease treatment outcome and providing cost-efficient care management. ..."Improvehealth.eu" is a novel eHealth service to support the treatment of patients with depressive disorder. It offers active patient engagement and collaborative care management by combining Web- and mobile-based information and communication technology systems and access to care managers.
Our objective was to assess the feasibility of a novel eHealth service.
The intervention--the "Improvehealth.eu" service--was explored in the course of a pilot study comparing two groups of patients receiving treatment as usual and treatment as usual with eHealth intervention. We compared patients' medication adherence and outcome measures between both groups and additionally explored usage and overall perceptions of the intervention in intervention group.
The intervention was successfully implemented in a pilot with 46 patients, of whom 40 were female. Of the 46 patients, 25 received treatment as usual, and 21 received the intervention in addition to treatment as usual. A total of 55% (12/25) of patients in the former group and 45% (10/21) in the latter group finished the 6-month pilot. Available case analysis indicated an improvement of adherence in the intervention group (odds ratio OR = 10.0, P = .03). Intention-to-treat analysis indicated an improvement of outcome in the intervention group (ORs ranging from 0.35 to 18; P values ranging from .003 to .20), but confidence intervals were large due to small sample sizes. Average duration of use of the intervention was 107 days. The intervention was well received by 81% (17/21) of patients who reported feeling actively engaged, in control of their disease, and that they had access to a high level of information. In all, 33% (7/21) of the patients also described drawbacks of the intervention, mostly related to usability issues.
The results of this pilot study indicate that the intervention was well accepted and helped the patients in the course of treatment. The results also suggest the potential of the intervention to improve both medication adherence and outcome measures of treatment, including reduction of depression severity and patients becoming "healthy."
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