Abstract
Purpose:
Specific requirements for electronic health records (EHRs) in ophthalmology are recognised but there is no consensus on EHR requirements for managing glaucoma. This study aimed to establish whether the Rand/UCLA appropriateness method could establish consensus on aspects of importance to implementing EHRs in the current healthcare landscape.
Methods:
57 attendees at the 2011 UK & Eire Glaucoma Society meeting agreed to be contacted to participate in an online study using a Delphi process, 66% of these participated. Two Delphi rounds were conducted with 75% completing both rounds. The sample included staff at University and district general hospitals with a normally distributed range of attitudes to the ease of use and usefulness of EHRs, different levels of experience of EHR use and self-rated IT proficiency.
Results:
Participants agreed that several strategies for migrating to an EHR from paper records exist, all of which may be appropriate but could not agree on training requirements to summarise clinical records. Twenty one core data fields to be extracted from paper records were defined; six fields were disputed even after round two. Thirty- four clinical decision support tools were prioritised, with drug alerts, documentation aids and risk assessment tools regarded as top priorities. Patient Reported Outcome Measures (PROMs) were agreed to have a role in assessing the outcomes of all glaucoma procedures and all glaucoma patients in routine glaucoma care. Patient Reported Experience Measures (PREMS) were considered an important measure of service quality. Collecting this type of data was felt to be appropriate in the clinic but there was debate about collecting such data at patients' homes. There was no strong preference for any questionnaire format. Measurement should ideally be conducted on a random sample of patients on an annual basis. The role of personal health records for glaucoma was disputed but email communication was felt to be unlikely to be useful for most patients although there was disagreement about its role in patients with complex glaucoma.
Conclusions:
This method successfully established consensus on a range of issues. The need to develop a working PROM for routine care was established in addition to priorities for the development of clinical decision support tools and minimum data fields required from historic paper records for effective on-going care with an EHR.
Keywords: 669 quality of life •
465 clinical (human) or epidemiologic studies: systems/equipment/techniques •
460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower