Informatics 97nov3

Journal of Informatics in Primary Care 1997 (November):5-8


Papers


Information Technology in General Practice: current use and views on future development

M Arfan Ahmed MBChB, MRCGP, DRCOG*, Anita Berlin MRCGP†

* Currently working under a LIZEI "Recent graduate scheme" as an Academic Trainee in General Practice at the Department of Primary Health Care & General Practice, Imperial College School of Medicine at St Mary’s, previously GP Registrar at Central Milton Keynes Medical Centre, Milton Keynes, Bucks.   † Senior Lecturer, Imperial College School of Medicine at St Mary’s

Correspondence: Dr M Arfan Ahmed, Dept. of Primary Health Care & General Practice, Imperial College School of Medicine at St Mary’s, Norfolk Place, London, W2 1PG.  Tel. 0171-725 1075.

This project was funded by LIZEI.


Abstract

Objective: To ascertain general practitioners current use of computers and their views on future development of information technology in general practice. Design: Postal questionnaire sent to general practitioners. Setting and subjects: 189 general practitioners working within the Kensington, Chelsea & Westminster (KCW) Health Authority area in London. Results: Three-quarters of computerised general practitioners recorded some or all consultation details on computer. 70% used the computer to generate prescriptions during consultations, and 98% for repeat prescriptions. 91% of all (computerised and non-computerised) general practitioners were in favour of electronic links between hospital and surgery computers, with the majority wanting access to text-based reports and letters from hospital. 45% wanted access to X-rays, and only a third wanted access to MRI and CT scans. Conclusion: The majority of general practitioners use their computers during routine consultations. Most general practitioners want links to hospital computers to access text-based hospital reports and letters and these links should be introduced. They are less enthusiastic about accessing radiological images.


Introduction

80% of general practitioners are computerised[1] and further advances in information technology (IT) have led general practice to the brink of a new revolution. Computer links between surgeries and hospitals have already been introduced as pilot studies[2] and have been proven to be a feasible option for improving communication between primary and secondary care[3]. The main functionalities introduced so far have included the transmission of text-based laboratory and radiology reports. However, it is now possible to digitally store, retrieve and transmit radiological images such as X-rays, CT and MRI scans across networked computers (teleradiology) using picture archiving and communication systems (PACS)[4,5].

The NHS Executive’s Information Management & Technology (IM&T) strategy[6] includes the NHS-wide networking programme that aims to "establish an infrastructure that will improve the flow of information on which patient care depends". These networked links are possible both on national and local levels and the number of functionalities possible via these links is enormous.

The views of general practitioners on the functionalities they would benefit most from are important, to enable them to drive the technology rather than vice versa. Although the views of general practitioners on text based electronic communication have been sought[1], little is known about their views regarding access to actual radiological images. These views will depend upon a number of factors, including the current use of computers in practice, perceived usefulness of the new technology and the motivation to use it. It is known that 63% of general practitioners use their computer to view clinical data[1], and studies have shown that motivated doctors record data adequately on their computers[7,8].

This study aimed to ascertain general practitioners' current use of computers and their views on future development of IT in general practice. The current level of computer use was assessed to put into perspective their views on future development.

Method

A postal questionnaire was sent to all 189 general practitioner principals working in the Kensington & Chelsea and Westminster Health Authority area, which was followed by a reminder sent to non-responders three weeks after the initial mailing.

The questionnaire was designed to assess the current use of computers regarding the recording of patients’ notes and the generation of prescriptions for both routine and repeat prescribing amongst general practitioners. Their views on the introduction of computer links between hospitals and surgeries were also sought. This was achieved by using a five-point Likert scale to score the usefulness of specific functionalities such as access to discharge summaries, laboratory and radiology reports, actual X-rays, CT and MRI scans. Questions were also included to gauge whether general practitioners wanted the facility of arranging out-patients appointments, and requesting laboratory and radiology investigations from their surgeries.

Results

128/189 (68%) questionnaires were returned, of which 74 (58%) were from men and 54 (42%) were from women. There were 61 non-responders and these included a number who had moved away, for whom demographic data was unavailable. However, of the remaining non-responders there was no significant difference in their partnership size, fundholding or computerisation status when compared to the responders. The only difference was that females were better responders, but this was not statistically significant.

Current use of computers

  • 108/128 (84%) of the general practitioners were computerised
  • 80/108 (74%) of computerised general practitioners recorded some or all aspects of the consultation on the computer
  • 28/108 (26%) of computerised general practitioners did not use their computers to record any consultation details (see Table 1)
  • 15/108 (14%) were paperless
  • 76/108 (70%) used the computer to generate prescriptions routinely (see Table 2)
  • 106/108 (98%) used the computer to generate repeat prescriptions

Table 1: Recording of notes

 

No. of GPs

(%)

Written notes only

28

(26)

Partially computer plus written notes

51

(47)

Fully computer plus written notes

14

(13)

Computer only

15

(14)

Table 2: Printing prescriptions

 

No. of GPs

(%)

During routine consultations

76

(70)

Repeat prescriptions

106

(98)

Future IT Links (see Tables 3 and 4)

  • 117 (91.0%) were generally in favour of linking surgery computers to hospital computers
  • 125 (97.8%) wanted access to discharge summaries
  • 121 (96.9%) were in favour of text-based laboratory and radiology reports
  • 121 (94.5%) thought that letters from out-patients’ departments were useful
  • 117 (91.0%) wanted the facility of requesting laboratory and radiology investigations
  • 95 (74.2%) wanted to arrange out-patients’ appointments from their surgeries.
  • 58 (45.3 %) wanted access to X-rays
  • 52 (40.7%) were actually against access to X-rays
  • 18 (14.1%) were uncertain about access to X-rays
  • 46 (35.9%) were in favour of access to CT scans
  • 62 (48.5 %) against access to CT scans
  • 20 (15.6%) were undecided about access to CT scans
  • 43 (33.6%) thought access to MRI scans was useful
  • 63 (49.2%) were against access to MRI scans
  • 22 (17.2%) were undecided about access to MRI scans

Table 3: Links between hospital and surgery computers are generally a good idea (95% confidence intervals)

Agree

Disagree

Uncertain

No. of GPs

(%)

No. of GPs

(%)

No. of GPs

(%)

117

(91.4)

5

(3.9)

6

(4.7)

Range 86.5% to 96.2%

Range 0.5% to 7.3%

Range 1.0% to 8.3%

Table 4: Services to which you would want access (95% confidence intervals)

 

Agree

Disagree

Uncertain

 

No. of GPs

(%)

No. of GPs

(%)

No. of GPs

(%)

Patient discharge summaries from hospital

125

(97.7)

3

(2.4)

0

(0)

Range

(96.3 to 99.0)

(-0.3 to 5.0)

Letters from out-patients’ departments

121

(94.5)

6

(4.7)

1

(0.8)

Range

91.6% to 97.4%

1.0% to 8.3%

-0.7% to 2.3%

Requesting lab/ radi-ology investigations

117

(91.4)

6

(4.7)

5

(3.9)

Range

86.5% to 96.2%

1.0% to 8.3%

0.5% to 7.3%

Results from labs/ histopath/radiology

124

(96.9)

4

(3.1)

0

(0)

Range

93.9% to 99.9%

0.1% to 6.1%

Arranging out-patient appointments

95

(74.2)

27

(21.1)

6

(4.7)

Range

66.6% to 81.8%

14.0% to 28.1%

1.0% to 8.3%

Actual X-ray images

58

(45.3)

52

(40.7)

18

(14.1)

Range

36.6% to 53.9%

32.1% to 49.1%

8.0% to 20.0%

Actual CT scans

46

(35.9)

62

(48.5)

20

(15.6)

Range

31.7% to 40.1%

39.7% to 57.1%

12.4% to 8.8%

Actual MRI scans

43

(33.6)

63

(49.2)

22

(17.2)

Range

25.4% to 41.8%

40.1% to 57.8%

10.7% to 23.7%

Discussion

Current use

Three-quarters of the computerised doctors in this study recorded some or all aspects of the consultation on computer and a surprisingly high proportion (14%) were paperless when compared to a figure of 8% nationally[9]. However, one in four general practitioners did not use their computer to record any consultation details. This may represent a reluctance to use existing technology which has already been installed in surgeries or a lack of adequate training.

70 % used their computer to prescribe routinely for acute illness, representing an increase from a previous national figure of 58%[10]. Almost all used the computer for repeat prescribing, which is significant when one considers that repeat prescribing accounts for 75% of all items prescribed[11]. The limitations of the above findings are that they are based on subjective, self-reported use of computers by doctors. This may have led to misleading evidence of high usage.

Future IT links

The concept of access to text-based information from hospitals via computer links was thought to be useful by nine out of ten doctors, with a specific preference for access to discharge summaries and text-based laboratory and radiology reports. This compares favourably to a previous national study that showed 80% in favour of access to discharge summaries and pathology reports[1]. The ability to arrange out-patients’ appointments was thought useful by 74 %, which exactly matches the finding of another study[12].

Access to actual radiological images was met with ambivalence overall, although 45.3% were in favour of access to X-rays. The observed ambivalence towards accessing images (only one-third wanted access to CT and MRI scans) may have been due to the perceived difficulty in interpreting the actual images or the perceived high costs of the technology. The introduction of images to general practice would require sophisticated software and hardware equipment at a considerable expense when compared to providing only text-based information.

The total number of general practitioners involved in this study was relatively small, and the enthusiasm for text-based electronic communication may not be a representative view of general practitioners nationwide. However, it is worth considering that the KCW Health Authority is known to have a higher percentage of single-handed practitioners when compared to the national figure, and single-handed practitioners are less likely to be computerised than group practices[12]. This could have led to the results indicating a resistance to potential IT introduction, because of the nature of single-handed practice in terms of the resources available. Surprisingly, the attitude towards IT links allowing access to text-based reports was overwhelmingly enthusiastic.

Conclusions

Computers in surgeries should be linked to hospital computers with particular emphasis on text-based laboratory and radiology reports, discharge summaries and letters from out-patients’ departments. The facility of booking out-patients’ appointments and requesting laboratory and radiology investigations should also be made available. At present general practitioners are not enthusiastic towards accessing radiological images.

Before implementation of IT links, health authorities should gain local consensus from their general practitioners as to the services they would like to be provided with, followed by a pilot project to evaluate reliability. This could be achieved by offering a few services initially to pilot surgeries, accompanied by adequate training. These services could then be provided to the remaining surgeries if found satisfactory on evaluation of the pilot sites.

References

  1. Social Surveys (Gallup Poll) Limited. Computerisation in GP practices 1993 survey. Department of Health (NHS Management Executive), London, 1993:40
  2. McVittie J, Kay J. Communication of structured medical information by computers: the Oxford experience. In: De Moor J (ed.). Progress in standardisation in health care informatics. IOS Press, London, 1993
  3. Branger PJ, van der Wouden JC, Schudel BR et al. Br Med J 1992; 305:1068–1070
  4. Huang HK, Taira RK, Lou SL, et al. Implementation of a large-scale picture archiving and communication system. Comput Med Imaging Graph 1993; 17:1–11
  5. Wright R, Loughrey C. Teleradiology. Br Med J 1995; 310:1392–1393
  6. An Information Management and Technology Strategy for the NHS in England. Handbook for IM&T specialists. NHS Executive Information Management Group, London, 1992.
  7. Nazareth I, King M, Haines A et al. Accuracy of diagnosis of psychosis on a general practice computer system. Br Med J 1993; 307:32–34
  8. Pringle M, Ward P, Chilvers C. Assessment of the completeness and accuracy of computer medical records in four practices committed to recording data on computer. Br J Gen Pract 1995; 45:537–541.
  9. Purves IN. The paperless general practice. Br Med J 1996; 312:1112–1113
  10. Harris CM, Dajda R. The scale of repeat prescribing. Br J Gen Pract 1995; 46:649–653
  11. Daniels A. GP survey on electronic communication. Oxford IM&T Consulting, 1991
  12. Bosanquet N, Leese B. Change in general practice and its effects on service provision in areas with different socioeconomic characteristics. Br Med J 1995; 311:546–550

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