Practice Management Systems Research Articles

Rethinking electronic health records implementation in Germany: a value-based health system approach

Abstract Problem The Digital Act (Digital-Gesetz) in Germany stipulates that electronic health records (elektronische Patientenakte; ePA) will be set up for all persons under the statutory health insurance (SHI) in 2025; those who do not wish to use ePA can object. This opt-out approach aims to increase the coverage of ePA among the SHI population to 80%, which has been ca. 1.5% since its launch in 2021. According to law, ePA is managed solely by the patient and does not replace the conventional patient file stored in the medical practice management system. Without appropriate measures, it is likely that multiple parallel patient files are created, with the risk of ePA being side-lined over time. Description The Ministry of Health aims to make ePA the central platform for patients’ healthcare provision throughout their life. With ePA, patients should receive useful information about their healthcare as well as reminders and tailor-made medical advice. For healthcare providers, ePA should become an essential part of the healthcare process with containing reliable information and supporting the treatment. However, understanding ePA as more than a digital health solution, factors beyond technical interoperability must be considered for its successful implementation. Results The full potential of ePA and its positive impact on healthcare to tackle the fragmentation issue can only be realised when it is viewed as a helpful tool of collaboration for all involved parties. The existing regulatory frameworks in Germany create disincentives for greater integration, coordination, and interconnection, with each sector following its own reimbursement system and reinforcing the division between them. This contradicts with the idea of ePA fostering patient-centredness and inter-sectoral collaboration. Lessons How a health system functions and how health services are governed and remunerated have a substantial impact on the healthcare providers’ acceptance of digital services. Key messages • Changes in the governance of health systems may be necessary when implementing electronic health records to bring person-centred care and overcome the separation of in-patient and out-patient sectors. • Rather than a paternalistic approach, the relationship between the patient and healthcare provider should move towards a partnership model, based on the motivation of keeping individuals healthy.

Perioperative anaesthetic complications in healthy cats undergoing anaesthesia for neutering in first opinion practice.

The aim of the present study was to identify the incidence of common perioperative anaesthetic complications in cats undergoing anaesthesia for neutering in three UK first opinion practices. A retrospective anaesthetic record analysis was performed on cats anaesthetised for neutering at practices 1 and 2 between 9 December 2017 and 2 February 2021 and practice 3 between 9 March 2020 and 7 January 2021. A search of the practice management system identified all cats that had undergone neutering in the selected timeframe. Data from 1019 cats were included in the study. Information relating to patient characteristics and data from the anaesthesia session were extracted from electronic patient records and anaesthesia record charts and entered into an Excel spreadsheet. A definition of the complications was created after reviewing the literature and their incidence determined from the data set. Comparisons between different groups of cats in the study were made using a χ2 test for homogeneity or Fisher's exact tests to identify factors associated with increased incidence of complications. The anaesthetic-related mortality was 1/1019 (0.10%). The most common complications were hypotension (22.6%), bradycardia (16.7%) and hypothermia (13.8%). Less common complications were hypocapnia (12.7%), hypercapnia (8.7%), tachycardia (6.6%), apnoea (3.1%), hyperthermia (1.7%), hypertension (1.4%), endotracheal tube obstruction (1.1%), hypoxia (0.3%), undesirable recovery (0.6%) and cardiac arrhythmia (0.2%). Factors associated with increased risk of hypotension were acepromazine pre-anaesthetic medication, higher maximum isoflurane dose, longer anaesthetic duration and lower body weight. Factors associated with increased risk of bradycardia were medetomidine pre-anaesthetic medication, longer anaesthetic duration and higher body weight. Factors associated with increased risk of hypothermia were higher maximum isoflurane dose, increased anaesthetic duration and lower body weight. This study showed that anaesthetic complications were frequently observed, with complications documented in 53.4% of the cats in the study. The information in this study may help to guide prioritisation of monitoring in feline anaesthesia.

Learning Health System to rapidly improve the implementation of a school physical activity policy

BackgroundLearning Health Systems (LHS) – characterised by cycles of evidence generation and application – are increasingly recognised for their potential to improve public health interventions and optimise health impacts; however there is little evidence of their application in the context of public health practice. Here, we describe how an Australian public health unit applied a LHS approach to successfully improve a model of support for implementation of a school-based physical activity policy.MethodsThis body of work was undertaken in the context of a strong research-practice partnership. Core LHS capabilities included: i) partnerships and stakeholder engagement; ii) workforce development and learning health communities; iii) multi-disciplinary scientific expertise; iv) practice data collection and management system; v) evidence surveillance and synthesis; and vi) governance and organisational processes of decision making. Three cycles of data generation and application were used. Within each cycle, randomised controlled trials conducted in NSW primary schools were used to generate data on the support model’s effectiveness for improving schools’ implementation of a government physical activity policy, its delivery costs, and process measures such as adoption and acceptability. Each type of data were analysed independently, synthesised, and then presented to a multi-disciplinary team of researchers and practitioners, in consult with stakeholders, leading to collaborative decisions for incremental improvements to the support model.ResultsCycle 1 tested the first version of the support model (composed of five implementation strategies targeting identified barriers of policy implementation) and showed the model’s feasibility and efficacy for improving schools’ policy implementation. Data-informed changes were made to enhance impact, including the addition of three implementation strategies to address outstanding barriers. Cycle 2 (now, testing a package of eight implementation strategies) established the model’s effectiveness and cost-effectiveness for improving school's policy implementation. Data-informed changes were made to reduce delivery costs, specifically adapting the costliest strategies to reduce in-person contact from external support personnel. Cycle 3 showed that the adaptations minimised the relative cost of delivery without adversely impacting on the effect.ConclusionsThrough this process, we identified an effective, cost-effective, acceptable and scalable policy implementation support model for service delivery. This provides important information to inform or support LHS approaches for other agencies seeking to optimise the health impact of evidence-based interventions.

Intervention Options for Enhancing Smallholder Compliance with Regulatory and Market Standards for High-Value Fruits and Vegetables in Rwanda and Zambia

Agriculture is vital for economic growth in sub-Saharan Africa. In Rwanda and Zambia, the sector drives economic output, particularly the horticulture sector, which has emerged as a significant contributor to export revenue and employment for resource-poor rural communities. As agri-food value chains become globally connected, there are increasing concerns about food safety and both the social and environmental sustainability benefits of production, which has underscored the need for producers to comply with certain regulatory standards. This paper uses a value chain analysis approach to assess the factors influencing compliance among smallholder fresh fruit and vegetable (FFV) producers in Zambia and Rwanda, and identify practices essential for achieving widespread compliance, to enhance the competitiveness of the sector. The data were gathered from 340 FFV farmers and key informants using structured questionnaires. The results reveal that the value chains for target FFVs are still traditional, predominantly targeting local markets. These markets pose low barriers to entry for smallholders, and often with few safety and quality requirements. As such, there remains a paucity of understanding of market needs and regarding quality and safety standards amongst smallholders, which, coupled with low-input, low-technology farming methods, and inadequate pre- and post-harvest handling, limit the market potential. To bridge these gaps, this study recommends organising farmers into legally recognised entities, to enable access to compliance information, reduce transaction costs, and provide access to high-quality niche markets through public–private partnerships. Countries also need to develop industry codes of practice and quality management systems and support farmers to adhere to them.

ReLink strategy in diagnosed-but-untreated hepatitis C-positive patients in Germany: report from a single center.

The ReLink project aims to reintegrate diagnosed-but-untreated hepatitis-C-positive patients into medical care and initiate a therapy. A retrospective search within the practice management system of a single center in Germany identified among 1965 hepatitis-C-positive patients 100untreated patients with available contact details and meeting all inclusion criteria. Patients were contacted by 2contact rounds. Out of 100patients, 64% were male. Most patients (81%) were aged between 30and59years. The patients belonged to high-risk groups for hepatitisC virus infections or had other comorbidities. The majority of patients injected drugs (21%) and/or were currently or had been on substitution therapy (44%); alcohol addiction was also frequent (21%). Out of 25patients who agreed to an appointment, 10patients (40%) started therapy and 5additional patients (20%) agreed to therapy but were not yet able to start or had not yet made a decision. One‑third of patients who agreed to an appointment did not show up. Diagnosed-but-untreated patients are an important subgroup of hepatitis-C-positive patients; their recall to the clinic for direct-acting antiviral therapy is possible. However, inaccurate contact information, unresponsiveness to outreach, and further reluctance to attend doctor appointments limited the overall impact of this program. Regular review of the patients' contact details may facilitate both follow-up and recall.

A practice management system that delivers dental AI.

A practice management system that delivers dental AI.

How software can save time in veterinary practice

The pace of change in software use in the veterinary industry is increasing and there are very few veterinary clinics that do not use multiple pieces of software on a daily basis. From practice management systems, to customer facing tools, apps and artificial intelligence, this article looks at how these work and how they can benefit veterinary professionals by saving time.

Water and nitrogen footprint assessment of integrated agronomic practice management in a summer maize cropping system

The footprints of water and nitrogen (WF and NF) provide a comprehensive overview of the type and quantity of water consumption and reactive nitrogen (Nr) loss in crop production. In this study, a field experiment over two years (2019 and 2020) compared three integrated agronomic practice management (IAPM) systems: An improved management system (T2), a high-yield production system (T3), and an integrated soil–crop management system (ISCM) using a local smallholder farmer's practice system (T1) as control, to investigate the responses of WF, Nr losses, water use efficiency (WUE), and nitrogen use efficiency (NUE) to IAPM. The results showed that IAPM optimized water distribution and promoted water use by summer maize. The evapotranspiration over the whole maize growth period of IAPM increased, but yield increased more, leading to a significant increase in WUE. The WUE of the T2, T3, and ISCM treatments was significantly greater than in the T1 treatment, in 2019 and 2020 respectively, by 19.8–21.5, 31.8–40.6, and 34.4–44.6%. The lowest WF was found in the ISCM treatment, which was 31.0% lower than that of the T1 treatment. In addition, the ISCM treatment optimized soil total nitrogen (TN) distribution and significantly increased TN in the cultivated layer. Excessive nitrogen fertilizer was applied in treatment T3, producing the highest maize yield, and resulting in the highest Nr losses. In contrast, the ISCM treatment used a reduced nitrogen fertilizer rate, sacrificing grain yield partly, which reduced Nr losses and eventually led to a significant increase in nitrogen use efficiency and nitrogen recovery. The Nr level in the ISCM treatment was 34.8% lower than in the T1 treatment while NUE was significantly higher than in the T1 treatment by 56.8–63.1% in 2019 and 2020, respectively. Considering yield, WUE, NUE, WF, and NF together, ISCM should be used as a more sustainable and clean system for sustainable production of summer maize.

German primary care data collection projects: a scoping review

BackgroundThe widespread use of electronic health records (EHRs) has led to a growing number of large routine primary care data collection projects globally, making these records a valuable resource for...

Novel linkage approach to join community-acquired and national data

BackgroundCommunity optometrists in Scotland have performed regular free-at-point-of-care eye examinations for all, for over 15 years. Eye examinations include retinal imaging but image storage is fragmented and they are not used for research. The Scottish Collaborative Optometry-Ophthalmology Network e-research project aimed to collect these images and create a repository linked to routinely collected healthcare data, supporting the development of pre-symptomatic diagnostic tools.MethodsAs the image record was usually separate from the patient record and contained minimal patient information, we developed an efficient matching algorithm using a combination of deterministic and probabilistic steps which minimised the risk of false positives, to facilitate national health record linkage. We visited two practices and assessed the data contained in their image device and Practice Management Systems. Practice activities were explored to understand the context of data collection processes. Iteratively, we tested a series of matching rules which captured a high proportion of true positive records compared to manual matches. The approach was validated by testing manual matching against automated steps in three further practices.ResultsA sequence of deterministic rules successfully matched 95% of records in the three test practices compared to manual matching. Adding two probabilistic rules to the algorithm successfully matched 99% of records.ConclusionsThe potential value of community-acquired retinal images can be harnessed only if they are linked to centrally-held healthcare care data. Despite the lack of interoperability between systems within optometry practices and inconsistent use of unique identifiers, data linkage is possible using robust, almost entirely automated processes.

Current Insights in The Barrier of Continuing Education for General Practitioners in China and Construction of A Novel Raining Model

Since 1997, China has been carrying out general practice education and has promulgated and implemented the “General Practitioner System”, conducting general practice job transfer training and “5+3” standardized training. However, the continuing education of general practitioners in China was the weakest. This study looked insights in the barrier of continuing education for General Practitioners in China: There was no unified mode and standard for continuing education for general practitioners, lacked of management system covering the entire practice cycle of general practitioners, the focus of post graduation training was unclear, the overall level of the teaching staff was not high, and the enthusiasm of general practitioners to participate in continuing education was poor. In response to these issues, the authors constructed and implemented a full cycle general practitioner continuing education model guided by job competence. Based on summarizing the 10 core job competencies of general practitioners, they constructed a general practitioner training faculty, established general practitioner related systems (continuing education system, practice management system, and professional title promotion system), designed training courses, and conducted hierarchical training, We organized multi-path scientific research training and conducted comprehensive quality management for the continuing education of general practitioners, achieving satisfactory results. Our raining model provided a useful reference for the current continuing education of general practitioners in China and is worth promoting and applying.

A framework for management of transportation infrastructure based on key performance indicators

AbstractTo facilitate decision‐making on optimal maintenance strategies for ageing traffic networks, a novel quantitative framework is presented. The framework comprises evaluation of the four KPI: reliability, safety for users and third parties, availability, and sustainability. The evolution of KPIs over time is subject to damaging processes and maintenance interventions. To characterize the impact of damaging processes and maintenance interventions, relevant performance indicators (PI) are selected that are used to estimate the key performance indicators (KPI). The native units of each KPI are normalized to a scale from 1‐5. Normalized KPI values are plotted on spider diagram for each time instance, rendering a 3D body with the volume which represents the network's quality over time, for considered maintenance strategies. The framework is aimed for medium to long‐term maintenance planning and can be further upgraded to account for risk & resilience analyses. The framework is implemented in a web‐based prototype to demonstrate its utilization in practice and future management systems.

The future of dental practice management systems.

The future of dental practice management systems.

Readiness Analysis of Politeknik STMI Jakarta Towards Implementation and Certification of ISO 21001:2018

Higher education has great demands and responsibilities to ensure their student graduates as highly competent human resources. Thus, effective and efficient management is required for higher education’s business process. To ensure their quality in process and result, compliance with national regulations and standards related to higher education is a must, and quality conformity with international standards is also one of the efforts of higher education institutions to improve their quality and competitiveness. ISO 21001:2018 is one of the international standards and best practice management systems for educational organizations that are widely used by various higher education institutions in the world. Considering Politeknik STMI Jakarta’s vision for resulting competent human resources, and that it is not yet certified by ISO 21001: 2018, this study is conducted to know the extent of readiness of Politeknik STMI Jakarta towards implementation and certification of ISO 21001:2018. The method used is the gap analysis method between conditions existing in Politeknik STMI Jakarta to ISO 21001:2018 standard. The results showed that the level of readiness of Politeknik STMI Jakarta is 88.85% which showed that the implementation of the clause requirements is mostly carried out but not consistently. The conclusion that can be drawn from the research is that Politeknik STMI Jakarta is ready to implement and carry out ISO 21001: 2018 certification.

Effects of a Primary Care-Based Intervention on the Identification and Management of Patients with Coronary Heart Disease and Mental or Cognitive Comorbidity-A Study Protocol.

Mental and cognitive disorders (MCD) negatively affect the incidence and prognosis of coronary heart disease (CHD). Medical guidelines recommend the appropriate management of comorbid MCD in patients with CHD, yet there is evidence that the implementation in primary care is not always adequate. We present the protocol for a pilot study that aims to develop a minimally invasive intervention and evaluate its feasibility in the primary care setting to improve the identification and management of comorbid MCD in patients with CHD. The study consists of two consecutive parts and will be carried out in Cologne, Germany. Part 1 comprises the development and tailoring of the intervention, which is guided by qualitative interviews with primary care physicians (PCPs, n = 10), patients with CHD and MCD and patient representatives (n = 10). Part II focuses on the implementation and evaluation of the intervention in n = 10 PCP offices. Changes in PCP behaviour will be analysed by comparing routine data in the practice management system six months before and six months after study participation. In addition, we will explore the influence of organisational characteristics and perform a socio-economic impact assessment. The outcomes of this mixed-method study will inform the feasibility of a PCP-based intervention to improve quality of care in patients with CHD and comorbid MCD.

Financial Controls in the Healthcare Practice: Using Emotional Intelligence to Trust and Verify

While a physician’s priority is always patient care, it is just as important to keep your finger on the pulse of the practice’s financial activities. There are benchmarks and key performance indicators to monitor and paying attention to the reports from the practice management system, will provide tools to assess the practice’s current and future success. Vulnerability results from too much trust. This article discusses the use of emotional intelligence for physicians and the administrative staff to help mitigate financial risk in the healthcare practice.

You Have Been Hacked!

On October 31, 2021, I learned the electronic health record in my independent, solo practice had been attacked by a Russian syndicate who was holding our data and our practice management system for "ransom." An encryption key could be given to our cloud provider once $5,100,000 was delivered in bitcoin to the hacking entity. After 3 long months of negotiations, with us going back to a completely paper-based system in the interim, our cloud provider paid the Russian syndicate and access was restored. There were many lessons to be learned from our experience. We were fortunate, and through the help of many of our business associates we were able to survive and live to see another day.

UK veterinary professionals' perceptions and experiences of adverse drug reaction reporting.

Spontaneous reporting of suspected adverse drug reactions (ADRs) is the cornerstone of pharmacovigilance. Despite this, it is believed that there is significant under-reporting in the veterinary setting. Low reporting rates delay marketing authorisation holders (MAHs) and regulators taking mitigating action in the case of safety concerns. We designed a survey to explore the perceptions, attitudes and experiences of UK veterinary professionals towards ADR reporting. The survey was advertised widely through conventional and social media and at several conferences. In total, 260 respondents completed the survey, including 210 veterinary surgeons, 49 veterinary nurses and one suitably qualified person. Respondents generally understood the need to report ADRs. The main barrier to reporting was the suspected ADR being well known, and the most popular potential facilitator identified was the ability to report via the practice management system. Facilitation via education in the form of a pharmacovigilance themed continuing professional development event was particularly popular among veterinary nurses, who reported time as being less of a barrier to reporting than their veterinary surgeon counterparts. Our findings suggest that technological interventions to facilitate reporting and empowerment of veterinary nurses to report through a tailored training event should be explored further.

Hospital Pharmacy Practice and Drug Management System of Khulna Division, Bangladesh: Results from a Cross-sectional Study

Hospital pharmacy and graduate pharmacists are part and parcel of a proper healthcare system. This study aims to assess Bangladesh's current hospital pharmacy practice and drug management system. A face-to-face interview-based survey was designed, and 15 hospitals of Khulna Division of Bangladesh were subjected to evaluation by a close-ended questionnaire containing 17 questions regarding hospital pharmacy practice and drug management system. Among 15 hospitals, 67% had hospital pharmacy services, whereas 47% had “C” grade pharmacists, and 53% of hospitals had no narcotic drug locker. Surprisingly, 87% of hospitals had no PTC (pharmacy and therapeutic committee), and 40% had no control over drug abuse. Besides, only 6.67% of hospitals had graduate pharmacists (A grade pharmacists), and 33% had no pharmacists. Furthermore, 67% of hospitals provided drug-using information, and 60% of hospitals provided no dosing information to their patients. Moreover, 40% did not maintain the record for expired products and had no “not for sale” tag for expired or damaged medicines. The current study findings suggest that the respective authorities must revisit the current healthcare system and take immediate initiatives to appoint graduate pharmacists in every hospital to improve the medical service with a proper drug management system. Bangladesh Pharmaceutical Journal 25(1): 44-53, 2022 (January)

Variability in non-core vaccination rates of dogs and cats in veterinary clinics across the United States

Vaccination guidelines for dogs and cats indicate that core vaccines (for dogs, rabies, distemper, adenovirus, parvovirus; for cats, feline parvovirus, herpes virus-1, calicivirus) are essential to maintain health, and that non-core vaccines be administered according to a clinician’s assessment of a pet’s risk of exposure and susceptibility to infection. A reliance on individual risk assessment introduces the potential for between-practice inconsistencies in non-core vaccine recommendations. A study was initiated to determine non-core vaccination rates of dogs (Leptospira, Borrelia burgdorferi, Bordetella bronchiseptica, canine influenza virus) and cats (feline leukemia virus) in patients current for core vaccines in veterinary practices across the United States. Transactional data for 5,531,866 dogs (1,670 practices) and 1,914,373 cats (1,661 practices) were retrieved from practice management systems for the period November 1, 2016 through January 1, 2020, deidentified and normalized. Non-core vaccination status was evaluated in 2,798,875 dogs and 788,772 cats that were core-vaccine current. Nationally, median clinic vaccination rates for dogs were highest for leptospirosis (70.5%) and B. bronchiseptica (68.7%), and much lower for canine influenza (4.8%). In Lyme-endemic states, the median clinic borreliosis vaccination rate was 51.8%. Feline leukemia median clinic vaccination rates were low for adult cats (34.6%) and for kittens and 1-year old cats (36.8%). Individual clinic vaccination rates ranged from 0 to 100% for leptospirosis, B. bronchiseptica and feline leukemia, 0–96% for canine influenza, and 0–94% for borreliosis. Wide variation in non-core vaccination rates between clinics in similar geographies indicates that factors other than disease risk are driving the use of non-core vaccines in pet dogs and cats, highlighting a need for veterinary practices to address gaps in patient protection. Failure to implement effective non-core vaccination strategies leaves susceptible dogs and cats unprotected against vaccine-preventable diseases.