The computerized medical record as a tool for clinical governance in Australian primary care.
BACKGROUND
Computerized medical records (CMR) are used in most Australian general practices. Although CMRs have the capacity to amalgamate and provide data to the clinician about their standard of care, there is little research on the way in which they may be used to support clinical governance: the process of ensuring quality and accountability that incorporates the obligation that patients are treated according to best evidence.


OBJECTIVE
The objective of this study was to explore the capability, capacity, and acceptability of CMRs to support clinical governance.


METHODS
We conducted a realist review of the role of seven CMR systems in implementing clinical governance, developing a four-level maturity model for the CMR. We took Australian primary care as the context, CMR to be the mechanism, and looked at outcomes for individual patients, localities, and for the population in terms of known evidence-based surrogates or true outcome measures.


RESULTS
The lack of standardization of CMRs makes national and international benchmarking challenging. The use of the CMR was largely at level two of our maturity model, indicating a relatively simple system in which most of the process takes place outside of the CMR, and which has little capacity to support benchmarking, practice comparisons, and population-level activities. Although national standards for coding and projects for record access are proposed, they are not operationalized.


CONCLUSIONS
The current CMR systems can support clinical governance activities; however, unless the standardization and data quality issues are addressed, it will not be possible for current systems to work at higher levels.
Inner East Melbourne Medicare Local, Burwood East, Australia. chris.pearce@monash.edu.
Christopher Martin
0000-0001-5371-8196
CM
Pearce
Simon
S
de Lusignan
Christine
C
Phillips
Sally
S
Hall
Joanne
J
Travaglia
clinical governance; electronic health records; general practice; health care; quality assurance; realist evaluation