Josephine McMurray

Navigation roles support chronically ill older adults through healthcare transitions: a systematic review of the literature.

Transitions between various healthcare services are potential points for fragmented care and can be confusing and complicated for patients, formal and informal caregivers. These challenges are compounded for older adults with chronic disease, as they receive care from many providers in multiple care settings. System navigation has been suggested as an innovative strategy to address these challenges. While a number of navigation models have been developed, there is a lack of consensus on the desired characteristics and effectiveness of this role. We conducted a systematic literature review to describe existing navigator models relevant to chronic disease management for older adults and to investigate the potential impact of each model. Relevant literature was identified using five electronic databases - Medline, CINAHL, the Cochrane database, Embase and PsycINFO between January 1999 and April 2011. Following a recommended process for health services research literature reviews, exclusion and inclusion criteria were applied to retrieved articles; 15 articles documenting nine discrete studies were selected. This review suggests that the role of a navigator for the chronically ill older person is a relatively new one. It provides some evidence that integrated and coordinated care guided by a navigator, using a variety of interventions such as care plans and treatment goals, is beneficial for chronically ill older adults transitioning across care settings. There is a need to further clarify and standardise the definition of navigation, as well as a need for additional research to assess the effectiveness and cost of different approaches to the health system.

Quality of Communication Between Primary Health Care and Mental Health Care: An Examination of Referral and Discharge Letters

In managing treatment for persons with mental illness, the primary care physician (PCP) needs to communicate with mental health (MH) professionals in various settings over time to provide appropriate management and continuity of care. However, effective communication between PCPs and MH specialists is often poor. The present study reviewed evidence on the quality of information transfer between PCPs and specialist MH providers for referral requests and after inpatient discharge. Twenty-three audit studies were identified that assessed the quality of content and nine that assessed strategies to improve quality. Results indicated that rates of item reporting were variable. Within the limited evidence on interventions to improve quality, use of structured forms showed positive results. Follow-up work can identify a minimum set of items to include in information transfers, along with item definitions and structures for holding this information. Then, methodologies for measuring data quality, including electronically generated performance metrics, can be developed.

‘Trying to find information is like hating yourself every day’: The collision of electronic information systems in transition with patients in transition

The consequences of parallel paper and electronic medical records (EMR) and their impact on informational continuity are examined. An interdisciplinary team conducted a multi-site, ethnographic field study and retrospective documentation review from January 2010 to December 2010. Three case studies from the sample of older patients with hip fractures who were transitioning across care settings were selected for examination. Analysis of data from interviews with care providers in each setting, field observation notes, and reviews of medical records yielded two themes. First, the lack of interoperability between electronic information systems has complicated, not eased providers’ ability to communicate with others. Second, rather than transforming the system, digital records have sustained health care’s ‘culture of documentation’. While some information is more accessible and communications streamlined, parallel paper and electronic systems have added to front line providers’ burden, not lessened it. Implementation of truly interoperable electronic health information systems need to be expedited to improve care continuity for patients with complex health-care needs, such as older patients with hip fractures.

Enter at your own risk: government changes to comprehensive care for newly arrived Canadian refugees

On June 30, 2012, most refugees to Canada, including those who arrive seeking asylum, had major cuts to health insurance coverage provided by the Interim Federal Health Program. Coverage for many is now limited to conditions deemed a public health or public security concern. At the eleventh hour,

Ontological modeling of electronic health information exchange

INTRODUCTION Investments of resources to purposively improve the movement of information between health system providers are currently made with imperfect information. No inventories of system-level electronic health information flows currently exist, nor do measures of inter-organizational electronic information exchange. METHODS Using Protégé 4, an open-source OWL Web ontology language editor and knowledge-based framework, we formalized a model that decomposes inter-organizational electronic health information flow into derivative concepts such as diversity, breadth, volume, structure, standardization and connectivity. RESULTS The ontology was populated with data from a regional health system and the flows were measured. Individual instances properties were inferred from their class associations as determined by their data and object property rules. It was also possible to visualize interoperability activity for regional analysis and planning purposes. A property called Impact was created from the total number of patients or clients that a health entity in the region served in a year, and the total number of health service providers or organizations with whom it exchanged information in support of clinical decision-making, diagnosis or treatment. Identifying providers with a high Impact but low Interoperability score could assist planners and policy-makers to optimize technology investments intended to electronically share patient information across the continuum of care. Finally, we demonstrated how linked ontologies were used to identify logical inconsistencies in self-reported data for the study.

“Eye-T”: Information technology adoption and use in Canada’s optometry practices

BACKGROUND While information technology (IT) is playing an increasing role in the delivery of optometric services, little specific information is available about how IT is changing the practice of optometry in Canada or whether optometry schools are adequately preparing their students to use this technology when they graduate. METHODS Quantitative data on how IT is being used, as well as related barriers and potential benefits, were obtained in a survey of Canadian optometrists (N = 474). Three site visits were made to geographically dispersed Canadian optometry practices identified as exemplars of IT adoption. RESULTS More than 96% of Canadian optometrists use computers in their practices, but fewer have integrated computers into their examination rooms. Optometrists are regularly using computers to manage their practices and medical record keeping. The automated perimeter is the clinical assessment technology most used (88.4%), followed by the autorefractor (83.9%) and the autokeratometer (72.2%). The anterior segment camera is the technology most likely to be acquired within the next 5 years (36.9%), followed by the scanning laser ophthalmoscope (26.8%). Major benefits of IT for optometrists include being better able to provide patients with images and information to explain results and to inspire greater patient confidence that the practice is state of the art. Perceived barriers include the need for frequent updates, lack of resources for training, and cost. There is support for increased exposure to IT as part of training in optometry. CONCLUSIONS Use of IT in optometry practices is widespread and likely to continue to increase in the years ahead. IT may be a key element in the future success of optometry practices in an increasingly competitive marketplace. Perceptions of high investment and training costs are barriers to further adoption. Optometrists may benefit from increased exposure to IT as part of their training.