Women's Health Informatics in the Primary Care Setting

Women's Health Informatics in the Primary Care Setting

Gareth Parry (Horsmans Place Partnership, UK)
Copyright: © 2009 |Pages: 12
DOI: 10.4018/978-1-60566-078-3.ch004
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Women’s health in primary care is a large part of the generalist’s practice. Information technology (IT) is now an integral part of the generalist’s office, often more so than in secondary care and therefore this chapter is a key starting point in the book. Initially there is an introduction of the role of IT in primary health and the many areas it may encompass. We then move onto organizing clinical information and the ways that this maybe represented electronically in the “cradle to grave” electronic health record. In addition to recording information, can IT help the primary care doctor? The area of IT in screening, prevention and alerts is discussed. The role of the computer in the clinician’s office and the impact it has on the consultation is explored. Can computer help clinicians perform better? Areas of discussion include the role of computers in audit and systems using artificial intelligence to improve patient care. IT is increasingly important in scheduling both within the practice and at the local hospital. This can be done by the primary care doctor and in some instances by the patient his or herself. The ideal situation is the primary care doctor having a system which can “talk” to external systems (e.g. local hospital notes, with a secure portal). In some countries such as the United Kingdom, this is becoming a reality, though there are problems which are discussed.
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Introduction Information Technology And The Generalist

The generalist medical function occupies an important role in most models of health service provision. The terminology may vary (Primary Care, Family Medicine General Medical Practice) however there are a number of consistent themes which characterise this role and impact on the information requirements.

  • 1.

    Generalists have long term, relationships with patients covering the whole spectrum of medical, psychological and social functioning.

  • 2.

    Successive generalists looking after a patient should inherit the entire existing record and its summary, add to it appropriately and pass it on in a coherent state to the succeeding clinician.

  • 3.

    Generalists manage many of the day to day issues of patient care in house and refer and accept back patients from episodes of specialist or increasingly multidisciplinary care and need to record these events and their outcomes, both for the coherence of the record and to retain information pertinent to further requests for specialist advice or intervention

Hence clinicians, patients and administrators demand much of our medical record systems.

Different elements of the record (datasets) are required for different clinical situations, such as the recording of allergies, the past obstetric history, the most recent blood pressure measurement. Each element of the history assumes a different importance at different times.

  • Some conditions may be recurrent; recording post natal depression in the past may alter and direct the care offered in a further pregnancy and change the index of suspicion for the obstetrician.

  • Some conditions change the subsequent risk profile. Gestational diabetes though resolved postnatally remains a risk factor for Type 2 diabetes in later life.

  • Some elements of the record become highly relevant only in very specific situation – a difficult endotracheal intubation has little relevance to a generalists care but is critical information to an anaesthetist. This information may not transfer in a hospital to hospital situation an argument for patient held records in the form of an accessible alert.

Medical decisions are often dependent on observing trends in a specific test or measurement or recognising a constellation of features of the medical history which point to a recognised pathological process. Recording and presenting data to highlight these trends aids correct management of the clinical situation. The maintenance of accurate, comprehensive and up to date records supports this process

Communication with other health care professionals often requires specific datasets of information to be mutually agreed and easily transferred and integrated into the appropriate record. Standardisation of the method of recording, transferring and distribution data is central to the effectiveness of multidisciplinary medical care.

Organised proactive care of patient subgroups in the form of screening, vaccination and analysis of combined risk factors requires a recall or reminder system which has to be updated in real time. Missed recalls need to be recorded and acted on while the patient choice to cease or postpone recall need to be respected. Opportunities to remind patients opportunistically allows further explorations of the patient’s choice and the presentation of personalised explanation and encouragement – backed up by specific literature explaining why engagement with the service is in the patient’s interest.

Increasingly the quality and the outcomes of medical activity need to be fed back to the central authorities for payment, audit, public health (or sometimes disciplinary or medico-legal) reasons. The aggregated records of patients and those specific subgroups of interest have to be organised with this requirement in mind.

A further and very topical theme related to the recording of medical information relates to the contrasting pressure to share and combine information about patients for a number of very worthy administrative or policy making aims including the analysis of gaps in service provision and tailoring better quality services. This can be in conflict with an overriding need for confidentiality of the patient/clinician relationship and the records content.

Complete Chapter List

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Editorial Advisory Board
Table of Contents
Neil Pattison
Emma Parry, David Parry
Emma Parry, David Parry
Chapter 1
Peter Stone
Improving women’s health is a vital task for the world. The consequences of obstetric and gynecological disease are serious both for the women... Sample PDF
An Introduction to Women's Health and Informatics
Chapter 2
Premila Fade
Principlism (derived from common sense morality) is the most common theory used within the healthcare sphere. The elements of this theory are... Sample PDF
Women's Health Informatics: The Ethical and Legal Issues
Chapter 3
David Parry
Recording information about symptoms, observations, actions, and outcomes is a key task of health informatics. Standardization of records is vital... Sample PDF
Coding and Messaging Systems for Women's Health Informatics
Chapter 4
Gareth Parry
Women’s health in primary care is a large part of the generalist’s practice. Information technology (IT) is now an integral part of the generalist’s... Sample PDF
Women's Health Informatics in the Primary Care Setting
Chapter 5
Emma Parry
The seamless electronic health record is often hailed as the holy grail of health informatics. What is an electronic health record? This question is... Sample PDF
The Electronic Health Record to Support Women's Health
Chapter 6
Graham Parry
Information technology and communication systems have made imaging in women’s health easier at many levels. There are now many commercial systems on... Sample PDF
Imaging and Communication Systems in Obstetrics and Gynecology
Chapter 7
Emma Parry
Pregnancy is unique in medicine in providing a discrete event with a fixed end. It is well suited to data collection and statistical assessment.... Sample PDF
Statistical Measures in Maternity Care
Chapter 8
Kiran Massey, Tara Morris, Robert M. Liston
Our ultimate goal as obstetric and neonatal care providers is to optimize care for mothers and their babies. As such, we need to identify practices... Sample PDF
Building Knowledge in Maternal and Infant Care
Chapter 9
Malcolm Battin, David Knight, Carl Kuschel
Neonatal care is an extremely data-intensive activity. Physiological monitoring equipment is used extensively along with web-based information tools... Sample PDF
Informatics Applications in Neonatology
Chapter 10
Jenny Westgate
During pregnancy the fetus requires an adequate supply of oxygen and clearance of carbon dioxide which is a waste product of metabolism. In fetal... Sample PDF
Computerizing the Cardiotocogram (CTG)
Chapter 11
Liron Pantanowitz
Automation and emerging information technologies are being adopted by cytology laboratories around the world to augment Pap test screening and... Sample PDF
Computer Assisted Cervical Cytology
Chapter 12
Laurie Elit, Susan Bondy, Michael Fung-Kee-Fung, Prafull Ghatage, Tien Le, Barry Rosen, Bohdan Sadovy
Ovarian cancer affects 2,400 women annually in Canada with a case fatality ratio of 0.70. There are several practice guidelines that indicate women... Sample PDF
Informatics and Ovarian Cancer Care
Chapter 13
Jamila Abuidhail
Information and communication technologies include computers, telecommunication, digital networks, and television. Using informatics in healthcare... Sample PDF
Women's Health and Health Informatics: Perinatal Care Health Education
Chapter 14
Shona Kirtley
In an age where health professionals lead very busy working lives, electronic information sources provide ease of access to vast amounts of health... Sample PDF
Electronic Information Sources for Women's Health Knowledge for Professionals
Chapter 15
David Parry
Decision analysis techniques attempt to utilize mathematical data about outcomes and preferences to help people make optimal decisions. The... Sample PDF
Computerised Decision Support for Women's Health Informatics
Chapter 16
Michelle Brear
The influence of organizational factors on the success of informatics interventions in healthcare has been clearly demonstrated. This health... Sample PDF
Organizational Factors: Their Role in Health Informatics Implementation
Chapter 17
Josipa Kern
When things go well then often it is because they conform to standards (ISO, 2005). According to the Oxford Dictionary of Modern English, there is a... Sample PDF
Standardization in Health and Medical Informatics
Chapter 18
Elske Ammenwerth, Stefan Gräber, Thomas Bürkle, Carola Iller
This chapter summarizes the problems and challenges which occur when health information systems are evaluated. The main problem areas presented are... Sample PDF
Evaluation of Health Information Systems: Challenges and Approaches
Chapter 19
Pirkko Nykänen
eHealth refers to use of information and communication technologies to improve or enable health and healthcare. eHealth broadens the scope of health... Sample PDF
eHealth Systems, Their Use and Visions for the Future
Chapter 20
Nilmini Wickramasinghe, Santosh Misra, Arnold Jenkins, Douglas R. Vogel
Superior access, quality and value of healthcare services has become a national priority for healthcare to combat the exponentially increasing costs... Sample PDF
The Competitive Forces Facing E-Health
About the Contributors