Primary care physician networks a better way of access to information in candidate countries

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Primary care physician networks- a better way of
access to information in candidate countries
Dr. Andrea Abaitancei Dr. Marius Marginean Dr.
Cristina Isar National Centre for Studies in
Family Medicine, Bucharest, ROMANIA
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WHO

• Provide access to and sharing of the worlds
  store of global health knowledge
• Improve and expand use of electronic access to
  that knowledge
• Creation of Knowledge Communities to bring
  together those working on a common set of
  activities or mission

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Identification of knowledge needs
1. Discovery of existing knowledge
2. Aquisition of knowledge
3. Creation of new knowledge
4. Storage and organization of knowledge
5. Sharing of knowledge
6. Use and application of knowledge
After Understanding knowledge management and
information management. F. Bouthillier, K.Shearer
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The way to knowledge in primary care

• 3. Knowledge
• Gaining.
• Apprehending
• reasoning
• understanding
• applying.

1. Data as factual information
2. Information as the communication or reception
of knowledge or intelligence
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Arising questions

• How can primary care physicians contribute to the
  acquirement of health knowledge?
• How can we use information and knowledge to
  develop our specialty?
• What are the needs of the health care system that
  can be addressed through information and
  knowledge?

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A Romanian project
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Traditionally

• All 12.000 Ro family doctors register and report
  data related to patient care and services
• Weekly
• Monthly
• Biannualy
• Annualy
• Local Public Health Departments
• National Health Statistic Centre MoH

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GP-Medinet Project 2001-2004
Sentinel Station Program Morbidity Pilot Study
1997-1998 ICPC 2000 Project 1999-2000 GP
Medinet Project 2001 - 2004

• Sentinel network
• 100 GPs over all the country - Using 100 PC
• ? sample around 200.000 people (1)
• software Medins
• data was sent monthly to the central database at
  the National Centre for Studies in Family
  Medicine

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Goals of the project

• Obtaining a global image about morbidity patterns
  in the general population of Romania
• Incidence and prevalence of diseases by sex, age
  groups
• Obtaining data about patterns of care provided by
  GPs in the network regarding
• diagnostic and therapeutically procedures
• referrals

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Romania - Population 22 mil. - 42
counties - 8 euro-regions (PHARE)

• Bucharest Ilfov
• Center
• North-East
• North-West
• South
• South-East
• South-West
• West

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3
2
8
7
1
6
5
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Distribution of population in GP MEDINET
Sentinel Stations
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MedINS brief presentation
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MedINS assets

• Uses the SOAP concept
• Registers reasons for encounter
• Registers episodes of care
• Codification using ICPC-2 developed for primary
  care
• Sending data using Internet

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Closed problem
Open problem

• Data registration software is episode based using
  SOAP concept
• Subjective (RFE, subjective symptoms)
• Objective (objective symptoms from clinical
  examination)
• Assessment (evaluation of the problem, diagnosis
  and treatments)
• Procedures (pre and post-diagnosis)
• RFEs are codified only using ICPC-2
• Diagnosis are codified using ICPC-2-e and ICD-10
  classification systems
• Procedures are coded with an extension of ICPC-2
  codes

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ICPC ICD10
ICD-10
ICPC-2
ICD-10 has a bigger granularity
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Registered data

• Personal data of patients ( those asked by the
  IH)
• Personal and familial history
• Reasons for encounters
• Simptoms and objective findings
• diagnosis
• Diagnostics and therapeutical procedures in
  dispensary
• Referalls from interdisciplinary examinations
  for diagnosis or treatment
• Receipts, periodic examination, tests, results etc

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Main concept

• Usefull for GPs day to day practice
• GP dont need to make anything special for data
  collection, just register the usual information
  in the electronic medical record
• The system takes from doctors database the
  needed information (in respect of patient
  confidentiality)

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Patients list
Selected patient
Open the patient file
Squedule
New file
Reports
Advanced search
Different criterias for select patients
Patients list
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Patients record
Next patients from the squedule
File exit
Erase patients from active list
Delete patient from hard disk
Print the patient file
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Alarms patients problems at a glance
The list with selected alarms
Risk factors
Chronic diseases
Other alarms
Accept the modification
Cancel
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The list of consultations

• All consultations presented in a tabular list
  like in a register on paper
• GP can start a new consultation or can set a
  future meeting for the patient

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Register the consultationusing SOAP concept
Subjective(Reason for encounter)
Select from a alphabetic list
Objective(Simptomes)
Assessment(Diagnosis)
Procedures (in dispensary or with referrals)
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Select the symptoms and diagnosis
Graphical sensitive interface (sensitive human
body)
List of selected symptoms
List of symptoms (codified using ICPC-2)
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ICPC-2 - ICD-10 transcoding
ICPC-2 code for diagnosis
Inclusion criteria
List of corresponding ICD-10 codes
Exclusion criteria
Other information concerning ICPC code
Accept the ICD-10 selected code
Cancel
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Patients investigations

• Results from the paraclinic investigations could
  be visualized in a chronological table. Also,
  there are mentioned the normal intervals for each
  investigation.

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Visualizing the episodes of care
Closed episode
Open episode
The list of all episodes of care of the selected
patien (opend and closed episodes)
The list of all running episodes of care The tree
contain all consultations and all registered
items.
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Recording biological parameters

• Could be introduced and visualized
• Blood pressure
• frequency
• weight
• height
• temperature
• glicemia

List of values
Graphical representation
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Consultation registry

• Time, date
• Name
• Sex
• Age
• Diagnosis

Accept
Select the step (week, month)
Backward / forward
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Sending data using INTERNET
Server
Server WEB

• Two ways to send data to server
• directly from MedINS (ftp)
• via WEB browser (MediNET)

• The system is able to
• Command the structure of the database to be send
  to server using a file that contain the
  instructions
• Generate a database using the sent instruction
  file
• Send the generated database using 2 ways
  directly by ftp or via a web page

Cabinete medicale individuale
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• Results from data analysis
• MEDINET network

http//www.medfam.ro/medinet
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The reasons for encounter on ICPC chapters
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Top 20 the most frequent reasons for encounter
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New episodes on age groups and ICPC chapter

Respiratory
Locomotory
Cardiovascular
Digestif
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All episodes on age groups and ICPC chapter (old
and news)

Respiratory
Cardiovascular
Locomotory
Digestif
Digestif
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Top 20 new diagnosis
per 100cons
New diagnosis
Nr

ICPC
Hypertension uncomplicated
5588
11,21
1
9,63
No disease
4107
8,24
2
7,08
Upper respiratory infection acute
2655
5,33
3
4,58
Acute bronchitis/ bronchiolitis
1828
3,67
4
3,15
Tonsillitis acute
1329
2,67
5
2,29
Ischaemic heart disease without angina
1223
2,45
6
2,11
Cystitis/ urinary infection other
1120
2,25
7
1,93
1021
2,05
8
1,76
Ischaemic heart disease with angina
990
1,99
9
1,71
Osteoarthrosis other
989
1,98
10
1,70
Back syndrome with radiating pain
Pneumonia
893
1,79
11
1,54
Cholecystitis, cholelithiasis
829
1,66
12
1,43
Stomach function disorder
745
1,49
13
1,28
678
1,36
14
1,17
Diabetes mellitus type II
Strep throat
647
1,30
15
1,12
645
1,29
16
1,11
Iron deficiency anaemia
Pregnancy
600
1,20
17
1,03
Lipid disorder
577
1,16
18
0,99
Urinary calculus
542
1,09
19
0,93
Dermatitis contact/ allergic
541
1,09
20
0,93
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Top 20 new diagnosis
per 100cons
New diagnosis
Nr

ICPC
Hypertension uncomplicated
5588
11,21
1
9,63
No disease
4107
8,24
2
7,08
Upper respiratory infection acute
2655
5,33
3
4,58
Acute bronchitis/ bronchiolitis
1828
3,67
4
3,15
Tonsillitis acute
1329
2,67
5
2,29
Ischaemic heart disease without angina
1223
2,45
6
2,11
Cystitis/ urinary infection other
1120
2,25
7
1,93
1021
2,05
8
1,76
Ischaemic heart disease with angina
990
1,99
9
1,71
Osteoarthrosis other
989
1,98
10
1,70
Back syndrome with radiating pain
Pneumonia
893
1,79
11
1,54
Cholecystitis, cholelithiasis
829
1,66
12
1,43
Stomach function disorder
745
1,49
13
1,28
678
1,36
14
1,17
Diabetes mellitus type II
Strep throat
647
1,30
15
1,12
645
1,29
16
1,11
Iron deficiency anaemia
Pregnancy
600
1,20
17
1,03
Lipid disorder
577
1,16
18
0,99
Urinary calculus
542
1,09
19
0,93
Dermatitis contact/ allergic
541
1,09
20
0,93
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Top 20 new diagnosis
per 100cons
New diagnosis
Nr

ICPC
Hypertension uncomplicated
5588
11,21
1
9,63
No disease
4107
8,24
2
7,08
Upper respiratory infection acute
2655
5,33
3
4,58
Acute bronchitis/ bronchiolitis
1828
3,67
4
3,15
Tonsillitis acute
1329
2,67
5
2,29
Ischaemic heart disease without angina
1223
2,45
6
2,11
Cystitis/ urinary infection other
1120
2,25
7
1,93
1021
2,05
8
1,76
Ischaemic heart disease with angina
990
1,99
9
1,71
Osteoarthrosis other
989
1,98
10
1,70
Back syndrome with radiating pain
Pneumonia
893
1,79
11
1,54
Cholecystitis, cholelithiasis
829
1,66
12
1,43
Stomach function disorder
745
1,49
13
1,28
678
1,36
14
1,17
Diabetes mellitus type II
Strep throat
647
1,30
15
1,12
645
1,29
16
1,11
Iron deficiency anaemia
Pregnancy
600
1,20
17
1,03
Lipid disorder
577
1,16
18
0,99
Urinary calculus
542
1,09
19
0,93
Dermatitis contact/ allergic
541
1,09
20
0,93
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Top 10 specialities for which the GP gives
referrals
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Referrals according to age groups
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• The percentage of different patients sent to
  interdisciplinary consultations
• (n 7.509)

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What was the importance of the project?

• It gave us the first valid data on the incidence
  and prevalence of diseases
• It showed the problems why patients address
  primary care
• It showed the ability of primary care workers to
  solve patients problems
• It showed the educational needs of family
  physicians
• It showed the burden of work

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What can we do with this results?

• Data collected illustrates health needs
  implement adequate health policies
• The pattern of work of family physicians improve
  the quality of the services and to raise
  efficiency

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Interface between FM and PH
Phare Project "Improvement of Health Status
Monitoring and Evaluation Capacity in the
Framework of Health Care System Reform"
PHARE
Ministry ofHealth
FM
NGO
INTERFACE (ISP)
PHARE
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Identification of knowledge needs
1. Discovery of existing knowledge
2. Aquisition of knowledge
3. Creation of new knowledge
4. Storage and organization of knowledge
5. Sharing of knowledge
6. Use and application of knowledge
After Understanding knowledge management and
information management. F. Bouthillier, K.Shearer
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WHO initiatives

• FluNET a surveillance system linking 100
  National influenza Centers in 82 countries
• Anti-microbial Resistance Network use of a
  software for training and support for the
  management of anti-microbial efforts.
• Action Programme on Essential Drugs to support
  the programme, Internet is used to exchange
  expert knowledge worldwide

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Future directions

• Developing and strengthening the sentinel network
  (enlarging it in order to gain significance on
  data related to doctors)
• Adding new assets
• quality of care indicators collection
• Joining international networks

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!!! FP7 opportunity

• EU research Building Knowledge Europe The
  EUs new Research Framework Programme 2007-2013
• The proposal provides new impetus to increase
  Europes growth and competitiveness, recognizing
  that knowledge is Europes greatest resource

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• Thank you !