A major initiative to modernise the NHS is to make more effective use of information technology, and the quality of the information is seen as the key to improving patient care and public health.
'The most valuable repository about the current health of the population may well be GP records and it is ironic that these are virtually unused for local health surveillance and service audit.' 1
The quality and reliability of clinical data stored on practice computer systems is variable.
Information extracted from computerised health records can be invaluablemin assessment of the health needs of practice populations or larger populations using aggregated data. This can only be achieved if data are recorded on electronic patient records (EPRs) and the quality of that data is consistent and of a high standard.
In April 2000, the NHS Information Authority (NHSIA) launched a new no-charge training and support service specifically to help primary care organisations take full advantage of their clinical computer systems.
This service, known as Primary Care Information Services (PRIMIS), is a national programme to help primary care organisations improve the quality of patient care through the effective use of practice clinical computer systems.
The training and support provided by PRIMIS will help GPs make the best use of their clinical computer systems and significantly improve the quality of clinical data recordeds in primary care.
PRIMIS is funded by the NHSIA and is based in the Division of General Practice at the University of Nottingham Medical School. The national team work with locally funded information facilitators.
The PRIMIS team provides:
- Guidance on making the most effective use of clinical computer systems
- Training and support in information management skills, data recording, extraction and analysis
- Analysis: Direct help with analysis of data quality, plus a comparative analysis service focused on key clinical topics
- Feedback and interpretation of the results of data quality and comparative analyses.
The local information facilitators are employed by primary care groups and trusts (PCG/Ts) and cascade their knowledge and skills to GPs and practice staff in their local health communities, to improve patient care through the effective use of quality clinical information.
Why PRIMIS is needed
Primary care organisations, which include PCTs, PCGs and practices, need high quality data to support:
- Greater integration of patient care
- The national service frameworks
- The process of clinical governance
- Evidence-based medicine
- Performance targets that focus on the quality and outcome of care.
PCG/Ts will be expected to monitor and compare the performance of practices within their organisation.
The PCT/Gs will also require robust clinical data to support their commissioning role and to monitor the effectiveness and value for money of the services they commission. This will involve aggregating data from clinical systems used by practices within their organisation.
The need to ensure accurate and comprehensive recording of health events on computer systems, as well as the ability to extract relevant and useful information from them, forms the basis of the service that PRIMIS offers.
Benefits for PCG/Ts
- Free resources for analysis and facilitation.
- Training and support for local information facilitators, whose role it is to assist practices in evaluating and improving data quality and information management skills.
- Encouragement for all members of the primary healthcare team to record clinical data in a uniform manner, and to seek help where necessary. Also, to demonstrate the benefits of EPRs.
- Tools and techniques to help PCTs feed back comparative analysis. Together with consistent data quality across a PCT, this will help provide benchmarks as a basis for addressing issues of inequity. In addition, it will enable the establishment of local standards and targets to help improve quality and efficiency.
GPs do not respond well to being told what to do, but are extremely good at addressing issues if they are shown to be performing to a lower standard than their peers.
- Savings in cost and effort – why reinvent the wheel?
- Information on best practice can be identified and shared, as can information on how to make the most of relevant national initiatives, products and services.
- Better patient care.
How will PRIMIS facilitators help practices?
Working effectively on data quality and information management is going to become increasingly important to all practices as the NHS moves toward EPRs. Many practices could get far more from their clinical computer systems if shown what can be done and the benefits of doing it.
A standard way of recording data is vital to data quality; PRIMIS facilitators will share their knowledge with practices. Many practices have MIQUEST* on the practice clinical computer system, but have no knowledge of how to use this powerful 'data interrogator'.
(*MIQUEST is a tool for enquirers to express queries and extract data from different types of clinical computer systems using a common query language)
Is PRIMIS a threat to general practice?
All healthcare professions have a duty and obligation to provide the best possible service to their patients within the resources that are available. There is now overwhelming evidence that computerised health data of good quality will help healthcare professionals and health service managers improve the service offered to all patients.
PRIMIS is voluntary and allows comparison of anonymised data within a PCT, which will be of use to both the practice and clinical governance leads. PRIMIS is not 'big brother', extracting data to report the practice to a performance review panel.
If misused, MIQUEST could be used to performance manage GPs, but PRIMIS has gone to great lengths to ensure that MIQUEST is used correctly in its schemes.
Care must be taken when entering into any agreement, and clarity is needed when reaching agreements with PCTs as to what can and cannot be done with extracted data.
Although the process of data extraction is completely within the control of the practice, the practice must exercise those controls properly to ensure the correct use of data and preservation of confidentiality.
Clinical governance is not a threat but an opportunity to develop and improve healthcare professionals' knowledge, organisation and care of their patients. PRIMIS should be viewed in exactly the same way.
PCTs must help and support practices to improve data quality; PRIMIS is one means of doing this, but additional resources will also be required to assist practices in achieving this goal.
Figure 1 (below) lists key facts about PRIMIS. For further information, including details of how to access the services, visit the website at www.primis.nottingham.ac.uk
Figure 1: PRIMIS – key facts
|Set up||April 2000|
|Funding||NHS Information Authority|
|Aims||To help primary care organisations improve the quality of patient care through the effective use of practice clinical computer systems|
|Address||Primary Care Information Services, 14th Floor, Tower Building, University Park, University of Nottingham, Nottingham NG7 2RD|
|Telephone||0115 846 6420|
|Home page of the PRIMIS website|
- Information for Health. NHS Executive, 1998.