Use of Electronic Healthcare Records to Improve Primary Healthcare Services in the Greek Islands
A. Ginis, Public Surgery of Arkessini, Amorgos Island
S. Deftereos and D. Sotiriou, Medical Physics Laboratory, School of Medicine, University of Athens
(paper presented by D. Sotiriou, in the 13th International Congress on Medical Informatics, Copenhagen, August 19 - 22, 1996)
The Medical Physics Laboratory of the School of Medicine of the University of Athens has installed an Electronic Healthcare Record (HER)Software package at the island of Amorgos, in order to facilitate the extensive study of the local population and help the local doctors in enhancing the quality of the provided services.
Methods and Materials
The HEALTH.oneâ EHR software package has been used. HEALTH.one is a general purpose package, which can be customized to meet the needs of individual doctors or institutions. The records are structured and stored according to the GEHR architecture. Each record may contain multimedia objects (still or moving images, EKGs etc.). HEALTH.one allows the analysis of both individual healthcare records and the entire population recorded. Each record is stored in an individual file, which allows its easy exporting and further processing (e.g. transferring it to remote sites). HEALTH.one also allows the construction of drugs’ database from which prescribed drugs from the physician can automatically be entered in the healthcare record and printed.
The Medical Physics Laboratory (MPL) of the School of Medicine in the framework of its Telemedicine Services activities , in cooperation with the A’ Internal Medicine University Clinic at the Laikon General Hospital and the A’ Paediatric University Clinic at the Aghia Sofia Paediatric General Hospital have customized HEALTH.one in order to meet the needs of primary care phycisians. Prototype records (sequences) have been created for General Practice, Peadiatrics and Cardiology. Each prototype record is composed of a number of fields corresponding to the history of the patient, the systems review, the clinical examination and the basic laboratory tests. Each field has associated lists of the most common symptoms and signs respectively. In this way, the physician is presented with the parameters he should seek and record, while their most common values are displayed in order to guide the physician the handling of the case.
The personal and the family history, the way of life, the current medication as well as other parameters have been prototyped in a similar way. Sequences have also been created for ophthalmology and neurology, but are still under evaluation.
In order to facilitate the follow-up of chronic patient, sequences have been created for patient suffering for hypertension and diabetes mellitus, in cooperation with doctors of the Health Care Centre of Aliveri.
Although basic laboratory tests results have been included in the prototype records, the recording of the results of more specific examinations has been made possible, via a special software module created by HDMP.
MPL, in cooperation with HDMP, has modified HEALTH.one in order to allow the attachment of EKGs to the EHRs . The Cardio Controlä EKG machine and Cardio Perfectâ software package are used to acquire, view and process EKGs.
MPL has extended HEALTH.one, in order to allow exporting and importing of healthcare records together with selected attached objects (X-rays, EKGs, etc.). Proper modifications have been made in order to allow the transfer of exported records via PSTN lines with the use of modems and via VSAT and Internet links from rural sites to tertiary hospitals of support, in the context of the VSAT  Project.
MPL has also created a ‘summary’ software module, which processes healthcare records and displays only the positive signs, and other significant information and data concerning a patient. This has been insistently requested by doctors participating in the VSAT project and has been proved to be a very useful feature.
Concerning the analysis of the healthcare records, HEALTH.one has been customized in order to allow the detection of:
Persons falling into the above categories are identified and invitation notes for examinations are printed automatically by the software and then mailed.
Finally, a Decision Support System (DSS) is under development at MPL implementing the client/server architecture. The Decision Support Server uses the DDE protocol to communicate with the client (i.e. the EHR software). The latter provides the server with information related to the patient and uses the results of the processing of the DSS to intelligently guide the physician during the data entry procedure. The initial application uses an Expert System specialized in pneumonology cases.
Results and Discussion
The EHR software, as described above, has been installed at the island of Amorgos and all the primary and tertiary medical units of the Greek VSAT Project.
At Amorgos island in Cyclades in Central Aegean, the healthcare records of the 355 inhabitants of the municipalities of Arkesini and Vroutsi have already been recorded, while the creation of the records of all the 1600 inhabitants of the island is estimated to be completed by the end of summer 1996. The preliminary analysis of the population data shows an increased frequency of incidents of bronchic asthma and epileptic crisis. The population is searched for other frequently presenting diseases, while local factors possibly causing increasing frequency of occurrences of the diseases are also studied. It has been found that epileptic crisis are often present in members of two or three successive generations of the same families.
Primary physicians find that HEALTH.one facilitates their work significantly. In particular, they have pointed out that the General Practice, Cardiology and Peadiatrics sequences are those that are most frequently used in primary healthcare units.
At Naxos island also in Cyclades, the demographic data of the entire population of the capital of Naxos have been automatically imported from the database of the Municipal Registry. HEALTH.one operates on a network. Nurses are responsible for recording the family and personal history, the way of life and other related data. The physicians are only concerned with handling the cases and recording the history, the systems’ review and the results of the clinical examination. The laboratory tests and paraclinical examinations (EKGs, X-rays) are electronically ordered by the physicians and inserted as objects in the proper record only when the expert opinion is sought by the supporting hospitals. In all other cases only the results of the diagnostic examinations are recorder in the HER due to insufficient for the time being electronic storage facilities and capacity.
Server versions of HEALTH.one except of Naxos will be installed in the Healthcare Centres of Milos in Cyclades and of Plomari in the island of Lesvos in Eastern Aegean. In the context of the telecardiology programme TALOS , HER are expected to be introduced in the second phase due to start in the second half of 1996.
As a general conclusion, the introduction of the EHR technology in the rural areas of Greece has proved to be very beneficial. It allows better processing of the patient data, which may lead, to interesting conclusions about the healthcare conditions of the local populations. Furthermore, it can facilitate the implementation of proper Telemedicine services, which can be seen as the only real opportunity for improving locally offered primary healthare services of assured quality.
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