Information standards for recording alcohol use in electronic health records: findings from a national consultation
Abstract Background Alcohol misuse is an important cause of premature disability and death. While clinicians are recommended to ask patients about alcohol use and provide brief interventions and specialist referral, this is poorly implemented in routine practice. We undertook a national consultation...
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| Format: | Article |
| Language: | English |
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BMC
2018-06-01
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| Series: | BMC Medical Informatics and Decision Making |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12911-018-0612-z |
| _version_ | 1818695730732204032 |
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| author | Shamil Haroon Darren Wooldridge Jan Hoogewerf Krishnarajah Nirantharakumar John Williams Lina Martino Neeraj Bhala |
| author_facet | Shamil Haroon Darren Wooldridge Jan Hoogewerf Krishnarajah Nirantharakumar John Williams Lina Martino Neeraj Bhala |
| author_sort | Shamil Haroon |
| collection | DOAJ |
| description | Abstract Background Alcohol misuse is an important cause of premature disability and death. While clinicians are recommended to ask patients about alcohol use and provide brief interventions and specialist referral, this is poorly implemented in routine practice. We undertook a national consultation to ascertain the appropriateness of proposed standards for recording information about alcohol use in electronic health records (EHRs) in the UK and to identify potential barriers and facilitators to their implementation in practice. Methods A wide range of stakeholders in the UK were consulted about the appropriateness of proposed information standards for recording alcohol use in EHRs via a multi-disciplinary stakeholder workshop and online survey. Responses to the survey were thematically analysed using the Consolidated Framework for Implementation Research. Results Thirty-one stakeholders participated in the workshop and 100 in the online survey. This included patients and carers, healthcare professionals, researchers, public health specialists, informaticians, and clinical information system suppliers. There was broad consensus that the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-Consumption (AUDIT-C) questionnaires were appropriate standards for recording alcohol use in EHRs but that the standards should also address interventions for alcohol misuse. Stakeholders reported a number of factors that might influence implementation of the standards, including having clear care pathways and an implementation guide, sharing information about alcohol use between health service providers, adequately resourcing the implementation process, integrating alcohol screening with existing clinical pathways, having good clinical information systems and IT infrastructure, providing financial incentives, having sufficient training for healthcare workers, and clinical leadership and engagement. Implementation of the standards would need to ensure patients are not stigmatised and that patient confidentiality is robustly maintained. Conclusions A wide range of stakeholders agreed that use of AUDIT-C and AUDIT are appropriate standards for recording alcohol use in EHRs in addition to recording interventions for alcohol misuse. The findings of this consultation will be used to develop an appropriate information model and implementation guide. Further research is needed to pilot the standards in primary and secondary care. |
| first_indexed | 2024-12-17T13:50:07Z |
| format | Article |
| id | doaj.art-c0f27a9d179f45f6a967782bb1d3aa65 |
| institution | Directory Open Access Journal |
| issn | 1472-6947 |
| language | English |
| last_indexed | 2024-12-17T13:50:07Z |
| publishDate | 2018-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj.art-c0f27a9d179f45f6a967782bb1d3aa652022-12-21T21:46:04ZengBMCBMC Medical Informatics and Decision Making1472-69472018-06-0118111110.1186/s12911-018-0612-zInformation standards for recording alcohol use in electronic health records: findings from a national consultationShamil Haroon0Darren Wooldridge1Jan Hoogewerf2Krishnarajah Nirantharakumar3John Williams4Lina Martino5Neeraj Bhala6Institute of Applied Health Research, College of Medical and Dental Sciences, University of BirminghamHealth Informatics Unit, Royal College of PhysiciansHealth Informatics Unit, Royal College of PhysiciansInstitute of Applied Health Research, College of Medical and Dental Sciences, University of BirminghamHealth Informatics Unit, Royal College of PhysiciansPublic Health Specialty RegistrarQueen Elizabeth Hospital BirminghamAbstract Background Alcohol misuse is an important cause of premature disability and death. While clinicians are recommended to ask patients about alcohol use and provide brief interventions and specialist referral, this is poorly implemented in routine practice. We undertook a national consultation to ascertain the appropriateness of proposed standards for recording information about alcohol use in electronic health records (EHRs) in the UK and to identify potential barriers and facilitators to their implementation in practice. Methods A wide range of stakeholders in the UK were consulted about the appropriateness of proposed information standards for recording alcohol use in EHRs via a multi-disciplinary stakeholder workshop and online survey. Responses to the survey were thematically analysed using the Consolidated Framework for Implementation Research. Results Thirty-one stakeholders participated in the workshop and 100 in the online survey. This included patients and carers, healthcare professionals, researchers, public health specialists, informaticians, and clinical information system suppliers. There was broad consensus that the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-Consumption (AUDIT-C) questionnaires were appropriate standards for recording alcohol use in EHRs but that the standards should also address interventions for alcohol misuse. Stakeholders reported a number of factors that might influence implementation of the standards, including having clear care pathways and an implementation guide, sharing information about alcohol use between health service providers, adequately resourcing the implementation process, integrating alcohol screening with existing clinical pathways, having good clinical information systems and IT infrastructure, providing financial incentives, having sufficient training for healthcare workers, and clinical leadership and engagement. Implementation of the standards would need to ensure patients are not stigmatised and that patient confidentiality is robustly maintained. Conclusions A wide range of stakeholders agreed that use of AUDIT-C and AUDIT are appropriate standards for recording alcohol use in EHRs in addition to recording interventions for alcohol misuse. The findings of this consultation will be used to develop an appropriate information model and implementation guide. Further research is needed to pilot the standards in primary and secondary care.http://link.springer.com/article/10.1186/s12911-018-0612-zAlcoholElectronic health recordsInformation standardsConsolidated framework for implementation researchConsultation |
| spellingShingle | Shamil Haroon Darren Wooldridge Jan Hoogewerf Krishnarajah Nirantharakumar John Williams Lina Martino Neeraj Bhala Information standards for recording alcohol use in electronic health records: findings from a national consultation BMC Medical Informatics and Decision Making Alcohol Electronic health records Information standards Consolidated framework for implementation research Consultation |
| title | Information standards for recording alcohol use in electronic health records: findings from a national consultation |
| title_full | Information standards for recording alcohol use in electronic health records: findings from a national consultation |
| title_fullStr | Information standards for recording alcohol use in electronic health records: findings from a national consultation |
| title_full_unstemmed | Information standards for recording alcohol use in electronic health records: findings from a national consultation |
| title_short | Information standards for recording alcohol use in electronic health records: findings from a national consultation |
| title_sort | information standards for recording alcohol use in electronic health records findings from a national consultation |
| topic | Alcohol Electronic health records Information standards Consolidated framework for implementation research Consultation |
| url | http://link.springer.com/article/10.1186/s12911-018-0612-z |
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