Editorial - Collecting Data on Ambulatory Care

Welcome to the latest edition of Health Care and Informatics Review Online where we look at some key considerations in the collection of data on ambulatory care and take the opportunity to review a recent book on health informatics.

Effective data collection underpins the success of technology-enabled health care. This is of particular significance in New Zealand where the health sector has embraced information systems to support clinical care delivery to such an extent that it recognised internationally as a world leader in this field.

Our first two papers touch on two specific considerations in the area of collection of ambulatory care data in New Zealand.

A comparison of data collection methods between a pilot electronic survey and a paper-based survey is the focus of our first paper “Comparative study of electronic pilot and paper data collection methods in a survey of general practice consultations” from Peter Crampton, Department of Public Health, School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand, Roy Lay-Yee, Daniel Patrick and Peter Davis, Department of Sociology, The University of Auckland, Auckland, New Zealand, and Antony Raymont, Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand.

The study analysed a subset of data from a pilot sub-study of data collection methods in the National Primary Medical Care Survey (NatMedCa), carried out over 2001/2002, which was a nationally representative, multistage, probability sample of general practitioners (GPs) and patient visits in New Zealand.

Focusing on data from 10 community-governed, non-profit practices, the study compared data captured in the course of consultations using practice management software enhanced with supplementary electronic forms with data from the main NatMedCa survey collected using paper collection methods.

Patient visits data showed differences in practitioner data reporting despite similar patient characteristics. Reasons-for-visit and problems-per-visit data from the electronic arm of the study appeared to be less complete than data from the paper arm. In contrast, practitioners using electronic data collection methods had comparatively high rates of recording prescription items per 100 problems.

The findings are relevant for researchers undertaking general practice-based surveys in that survey data generated routinely via practice management systems may differ considerably from survey data collected using tailored paper collection instruments.

“Data salvage” in hospital emergency departments (EDs) was the focus of the paper from Martin von Randow, Peter Davis and Roy Lay-Yee, Department of Sociology, The University of Auckland, Auckland, New Zealand, Antony Raymont, Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand, and Daniel Patrick, Social Statistics Research Group, The University of Auckland, Auckland New Zealand.

This study also utilised the findings of NatMedCa which, along with a nationally representative sample of general practitioners (GPs) and their patients, included a sample of EDs throughout New Zealand.

The paper reports on the steps that were required to extract usable operational information from the electronic data capture systems of four hospital EDs and draws attention to the considerable difficulties in comparing data across EDs, and between EDs and community-based ambulatory care.

The paper highlights the lack of a common, usable template across EDs for the capture of data on core clinical and related variables and issues with the coding of such data. The resulting difficulty in extracting meaningful and comparable information from ED data capture systems impacts on the quality of information available for management purposes, both internally for ED operations and for the wider health system.

The hospital ED is vital to New Zealand’s health system as the entry point to care for a proportion of inpatients and within the broader system of ambulatory and first-contact (primary) care. This critical role in the wider health system not been matched by quality of data capture and there is an argument  for uniform requirements to be applied to ED data capture systems; the development of a minimum data set, common variable formats and standardised coding schemes.

The third paper in this edition provides a valuable overview of the health informatics text: “Health Informatics: A Socio-Technical Perspective” by Sue Whetton, published by Oxford University Press, Melbourne, Australia, in August 2005.

The socio-technical perspective taken in the text is described in the book’s preface as one which “explores technical aspects of health informatics while focusing on the interplay between the health care environment and the systems used to manage information in that environment”. Such a perspective enables analysis of the complex health care environment and its many different service systems and professional groups, “each with their own ideas and views about health matters, including health informatics”. A health informatics professional seeks to identify and accommodate these different views and the socio-technical focus of the book facilitates this approach.

In his review of the book, Alec Holt, Director of the Health Informatics Program and Senior Lecturer, Department of Information Science, University of Otago, Dunedin, New Zealand, highlights that the book is timely and fills a niche, in particular for an Australasian audience.

Holt highlights strengths of the book including a straightforward structure and comprehensive coverage. He notes that Whetton has maintained the book within the stated introductory brief: introducing the field to health professionals and consumer groups and developing the skills and knowledge of health informatics professionals. However, Holt cautions that Whetton has overstated the case for health informatics as a discipline in its own right, highlighting that health informatics is, in fact, a multi-disciplinary domain inhabited by a diverse workforce with diverse needs.