title: Does Informatics Enable or Inhibit the Delivery of Patient-centred, Coordinated, and Quality-assured Care: a Delphi Study. A Contribution of the IMIA Primary Health Care Informatics Working Group.
abstract: BACKGROUND
  Primary care delivers patient-centred and coordinated care, which should be quality-assured. Much of family practice now routinely uses computerised medical record (CMR) systems, these systems being linked at varying levels to laboratories and other care providers. CMR systems have the potential to support care.
  
  
  OBJECTIVE
  To achieve a consensus among an international panel of health care professionals and informatics experts about the role of informatics in the delivery of patient-centred, coordinated, and quality-assured care.
  
  
  METHODS
  The consensus building exercise involved 20 individuals, five general practitioners and 15 informatics academics, members of the International Medical Informatics Association Primary Care Informatics Working Group. A thematic analysis of the literature was carried out according to the defined themes.
  
  
  RESULTS
  The first round of the analysis developed 27 statements on how the CMR, or any other information system, including paper-based medical records, supports care delivery. Round 2 aimed at achieving a consensus about the statements of round one. Round 3 stated that there was an agreement on informatics principles and structures that should be put in place. However, there was a disagreement about the processes involved in the implementation, and about the clinical interaction with the systems after the implementation.
  
  
  CONCLUSIONS
  The panel had a strong agreement about the core concepts and structures that should be put in place to support high quality care. However, this agreement evaporated over statements related to implementation. These findings reflect literature and personal experiences: whilst there is consensus about how informatics structures and processes support good quality care, implementation is difficult.
authors.forename: H
authors.initials: H
authors.lastname: Liyanage
authors.forename: A
authors.initials: A
authors.lastname: Correa
authors.forename: S-T
authors.initials: ST
authors.lastname: Liaw
authors.forename: C
authors.initials: C
authors.lastname: Kuziemsky
authors.forename: A L
authors.initials: AL
authors.lastname: Terry
authors.affiliation: Simon de Lusignan, Department of Health Care Management & Policy, University of Surrey, GUILDFORD, Surrey GU2 7XH, UK, E-mail: s.lusignan@surrey.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: de Lusignan
mesh_terms: D064229:Biological Ontologies; D032921:Consensus; D003697:Delphi Technique; D006801:Humans; D008490:Medical Informatics; D018802:Patient-Centered Care / Q000592:standards; D011785:Quality Assurance, Health Care; D012955:Societies, Medical
keywords: Patient-centred care; clinical informatics; computerised medical records; healthcare quality assurance; patient participation