Marleen de Mul

Improving the quality of eye care with tele-ophthalmology: shared-care glaucoma screening

We evaluated a shared-care tele-ophthalmology service initiated by the Rotterdam Eye Hospital and 10 optometrists working in retail optician stores. The optometrists screened their clients with a nerve fibre analyser and the resulting images were then further assessed by trained technicians at the hospital. We analysed data from 1729 patients and measured several indicators of the quality of the work as well as its efficiency and effectiveness. The quality of the images was at least satisfactory in most cases (89%), and the agreement between the optometrists and the hospital about normal or suspect test results was high (81%). Only 27% of the patients were called for additional testing at the hospital department and 11% consulted an ophthalmologist. Eighty new cases of glaucoma were detected. The combination of task redesign and telemedicine accounted for the success of the screening service. Task redesign was needed to transfer screening from the hospital to primary care in a safe and responsible way. Telemedicine was crucial for assuring quality, facilitating information exchange and for coordination.

Development of a clinical data warehouse from an intensive care clinical information system

There are relatively few institutions that have developed clinical data warehouses, containing patient data from the point of care. Because of the various care practices, data types and definitions, and the perceived incompleteness of clinical information systems, the development of a clinical data warehouse is a challenge. In order to deal with managerial and clinical information needs, as well as educational and research aims that are important in the setting of a university hospital, Erasmus Medical Center Rotterdam, The Netherlands, developed a data warehouse incrementally. In this paper we report on the in-house development of an integral part of the data warehouse specifically for the intensive care units (ICU-DWH). It was modeled using Atos Origin Metadata Frame method. The paper describes the methodology, the development process and the content of the ICU-DWH, and discusses the need for (clinical) data warehouses in intensive care.

Developing patient portals in a fragmented healthcare system.

BACKGROUND Use of patient portals may contribute to improved patient health and experiences and better organizational performance. In the Netherlands, patient portals have gained considerable attention in recent years, as evidenced by various policy initiatives and practical efforts directed at developing portals. Due to the fragmented setup of the Dutch healthcare system patient portals that give patients access to information and services from across their providers are developed in inter-organizational collaboration. OBJECTIVE The objective of this paper is to identify and describe the types of collaborations, or networks, that have been established to develop patient portals in the Netherlands. Understanding the characteristics of these networks as well as the development of their respective portals enables us to assess the enabling and constraining effects of different network types on patient portal initiatives. METHODS We used qualitative methods including interview and documents analysis. In a first step, we interviewed eighteen experts and reviewed relevant national policy and strategy documents. Based on this orientation, we selected three networks we deemed to be representative of inter-organizational efforts to develop Dutch patient portals in 2012. In a second step, we interviewed twelve representatives of these patient portal networks and collected documents related to the portals. We applied content analytic techniques to analyze data from the three cases. RESULTS The three studied networks differed in their number and diversity of actors, the degree to which these actors were mutually dependent, the degree to which network governance was decentralized, and the dynamics of the network structures. We observed that the portals developed in networks displaying the highest degree of these characteristics experienced most difficulties associated with developing patient portals - such as achieving interoperability, successful implementation, regulatory complaisance, and financial sustainability. Yet, at the same time, the portals developed in these networks may hold the highest functionality to patients, since they can consolidate information and services from a broad array of health service providers. CONCLUSIONS The early empirical evidence provided here indicates that effective development of patient portals begs a tradeoff between envisioned functionality and ease of development.