Knight Andrew W, Szucs Craig, Dhillon Mia, Lembke Tony, Mitchell Chris
University of NSW, Fairfield, NSW, Australia The Improvement Foundation, Adelaide, South Australia, Australia.
National eHealth Transition Authority, Sydney, New South Wales, Australia.
Int J Qual Health Care. 2014 Aug;26(4):411-7. doi: 10.1093/intqhc/mzu059. Epub 2014 Jun 12.
The new national patient-controlled electronic health record is an important quality improvement, and there was a pressing need to pilot its use in Australian primary care practices. Implementation of electronic health records in other countries has met with mixed success.
New work was required in general practices participating in the national electronic health record. National implementers needed to engage with small private general practices to test the changes before general introduction.
The National E-health Transition Authority contracted the Improvement Foundation Australia to conduct a quality improvement collaborative based on 9 years of experience with the Australian Primary Care Collaborative Program.
Aims, measures and change ideas were addressed in a collaborative programme of workshops and supported activity periods. Data quality measures and numbers of health summaries uploaded were collected monthly. Challenges such as the delay in implementation of the electronic health summary were met.
Fifty-six practices participated. Nine hundred and twenty-nine patients registered to participate, and 650 shared health summaries were uploaded. Five hundred and nineteen patient views occurred. Four hundred and twenty-one plan/do/study/act cycles were submitted by participating practices.
The collaborative methodology was adapted for implementing innovation and proved useful for engaging with multiple small practices, facilitating low-risk testing of processes, sharing ideas among participants, development of clinical champions and development of resources to support wider use. Email discussion between participants and system designers facilitated improvements. Data quality was a key challenge for this innovation, and quality measures chosen require development. Patient participants were partners in improvement.
新的全国患者自控电子健康记录是一项重要的质量改进措施，迫切需要在澳大利亚基层医疗实践中进行试点使用。电子健康记录在其他国家的实施成效不一。
参与全国电子健康记录的基层医疗实践需要开展新的工作。国家实施者需要与小型私人基层医疗实践合作，在全面推广之前测试这些变化。
国家电子健康转型管理局与澳大利亚改进基金会签约，基于其在澳大利亚基层医疗合作项目9年的经验开展一项质量改进合作项目。
在一系列协作式研讨会及配套活动期间讨论了目标、措施和变革想法。每月收集数据质量指标以及上传的健康总结数量。应对了诸如电子健康总结实施延迟等挑战。
56家医疗实践参与其中。929名患者登记参与，上传了650份共享健康总结。收集到519条患者意见。参与的医疗实践提交了421个计划/执行/研究/行动循环。
协作方法适用于实施创新，事实证明有助于与多个小型医疗实践合作，促进流程的低风险测试，在参与者之间分享想法，培养临床倡导者以及开发支持更广泛使用的资源。参与者与系统设计师之间的电子邮件讨论推动了改进。数据质量是这项创新的关键挑战，所选的质量指标需要进一步完善。患者参与者是改进工作的合作伙伴。
