The research by Torloni et al. (2009, p. 599) “Ultrasound in Obstetrics and Gynaecology” is integrative or secondary research that tries to draw conclusions from studies in various electronic databases, unpublished literature and reference lists. The studies from which conclusions were drawn were observational and clinical trials, which evaluated short-term and long-term impacts of exposure to ultrasonography by women during pregnancy. Meta-analysis was applied to integrate the numerical findings from 11cohorts, 16 clinical trials, and 11 case controls. The research has a pre-determined methodology and as such qualifies under systematic review. According to Greenhalgh (1997, p. 2) this type of research falls under clinical trials because it analyses the results of the intervention and in this case, ultrasonography, on a group of pregnant women. The research is ranked first in the hierarchy of evidence because it involves both systematic reviews and Meta-analyses (Greenhalgh 1997, p. 36).
The second research by Scherer, Gupta, Caine and Panda (2009, p. 1161), “differential diagnosis and management of a recurrent hepatic cyst” is a type of secondary research that reviews the testing of a medical condition on a patient. The research falls under a case report. It gives a detailed medical history of a single patient who was suffering from a recurrent hepatic cyst and attempts to evaluate the effectiveness of testing procedures from the case with those of other patients gathered from a review of the literature (Greenhalgh 1997, p. 34). Researchers are interested in the testing of the disease rather than the treatment. In the hierarchy of evidence, case reports are ranked last because it is done in a quick and shallow way. However, it does provide useful information to primary care physicians dealing with a recurring type of hepatic cysts (Greenhalgh 1997, p. 36).
Physician Order Entry is a system that allows the physician to make orders electronically. Clinical decision Support Systems is based on the guidelines and the research conducted by doctors. In this system, a physician can suggest possible diagnoses and treatments that he may consider. Electronic Pharmacy System contains systems that permit the physicians to electronically enter prescriptions, which can later be checked for drug interactions. The key concept in a health information system is interoperability; “this is a standard process whereby the health information systems are able to communicate with each other to enable physicians in separate and different health organizations to assess patient’s information even if the patient uses the services different health organization” (Bray 2010, p. 1).
The article by Torloni et al. (2009) is more likely to have clinical significance and impact on practice. The authors undertook a systematic and exhaustive review of the literature addressing a clearly defined thesis- ultrasound in gynaecology and obstetrics. Authors have equally employed an explicit and systematic methodology in identifying and evaluating 11cohorts, 16 clinical trials, and 11 case controls, and in collecting and analyzing the data that emerged from the studies.
Furthermore, a statistical analysis tool -Meta-analysis is used in analysing and summarizing the results of all studies included in the review. The use of Meta-analysis technique is recognized beforehand and reported in the methodology section of the report. Through the use of Meta-analysis, authors have managed to integrate the results of the studies included. Through the systematic reviews, the authors found consistencies in the clinical trials literature and these findings can, therefore, be generalized to different populations. The use of 38 studies (11cohorts, 16 clinical trials, and 11 case controls) limited the possibility of bias and increased. In their results, authors found out that Ultrasonography during pregnancy is not linked with serious maternal effects, increased risk for malignancies during childhood, neurological development and impaired physically. The purpose of a systematic review in medical research is to interpret results, determine validity, and evaluate the applicability of the research to public health, clinical practice, and its contributions toward future studies. By analysing the results statistically, and proving that it is safe for pregnant women to be exposed to ultrasonography, the authors have achieved their objective (Sportsci.org 2002, p. 1).
The modern medical records are still dominated by paperwork and it is only estimated that approximately four per cent of physicians have fully operational electronic health records whereas close to 13 percent of the physicians have basic electronic health records. The strong advocacy for electronic health records is largely due to the problems that are associated with paperwork. Paperwork has several disadvantages, which include limited sharing, analysis and evaluation of medical information; they lack uniformity and are isolated and inert: they can only be read and cannot be processed through other healthcare applications. These limitations of paperwork have made it hard to coordinate patients care across all multiple health care organizations. Paperwork also hinders efficiency and evaluation by the medical professionals (Miles 2009, p. 108). Through the use of Meta analysis, authors have managed to integrate the results of the studies included.
Physicians often join the medical practice with deeply acquired skills and knowledge. However, with the changing medicine environment, sometimes physicians are confronted with uncertainty and ambiguity during patient visits. A number of examples highlight the areas where highlight situations when physicians seek addition information to support them in medical practice. Physicians often receive a large number of patients each week (approximately 100 patient visits per week). Because of the large number of patient visits, new clinical questions are likely to arise during patient care necessitating the need to seek extra information. In most cases, these new questions relate to drug interactions and therapies. Example of situations that physicians face in practice that call for additional information are given below:
Use of sonographer is one example where a physician may need to seek additional information. A sonographer uses ultra sound to yield clear visual images of tissues, organs, or blood flow in the body. Sonography can be used in examining many body parts including the reproductive system, heart and prostate, abdomen and blood vessels. The field of sonography has various specializations such as breast, abdomen, gynecology, Echocardiography, Vascular Technology, Neurosonology, and Ophthalmology. A physician may not be fully acquainted with all the areas of specialization making it necessary to seek additional information.
Whenever physicians are confronted with difficult situations or questions in practice, they formulate a hypothesis on how they can solve it based on their skills, knowledge and experience. Afterwards, they research on the specific aspects of the case by seeking fresh information that will permit them to deal with the situation better, if it arises next time. There are many sources of information for practicing physicians. The most notable of them is health care information systems
Health information system quality can be understood practically, empirically, literature based and theoretically. Health information system can store and process information concerning the health care delivery of a patient. They are commonly used in confirming the eligibility and billing for medical insurance and government programs like Medicaid and Medicare. Nevertheless, they are not clinical support systems hence they are not used to track and evaluate health care progress. Health information systems are capable of supporting, tracking and evaluation of health care delivery and both are build on Electronic Medical Record (EMR). The information contained includes the patient’s history, all tests, diagnoses and the results, the comments of the physician and medical images like X-rays. The unique feature about EMR is that it can be shared and can be analyzed by different physicians in different health institution in its simplest form. The difficulty of having single electronic health records (EHR) spanning across various health organizations together with interoperability and regional health information networks often allow health organizations to share EMR when required, they also allow for the sharing of patients information when required. EMRs should have confidentiality and privacy for security purposes; this can be achieved through fixing access controls like passwords, digital signatures and encryptions (Braiy 2010, p. 4).
There are seven types of health information systems. These types are the Electronic Medical Record, which is the same as the electronic equivalent of patient’s record in paper. Electronic Health Record involves complete set of records that contain all the patient’s information in many different health care institutions. Personal Health Records are obtained, controlled and maintained by the patient or any third party and not health care institutions. Patient-based Health Record is the electronic patient information that is controlled and maintained by the players like insurance companies and it includes the procedure, the cost and the payment information. Computerized Physician Order Entry is a system that allows the physician to make orders electronically. Clinical decision Support Systems is based on the guidelines and the research conducted by doctors. In this system, a physician can suggest possible diagnoses and treatments that he may consider. Electronic Pharmacy System contains systems that permit the physicians to electronically enter prescriptions, which can later be checked for drug interactions. The key concept in health information system is interoperability; “this is a standard process whereby the health information systems are able to communicate with each other to enable physicians in separate and different health organizations to assess patient’s information even if the patient uses the services different health organization” (Bray 2010, p. 1).
Health information system can be improved through the following ways: Involving all levels in changes to health information management system- this concerns the involvement of people at all levels of the data chain in order to determine what is needed and how it will be used. Improving the paper-based system is critical in improving health information system; stakeholders are placing a lot of attention on the IT aspect of the information system when the reality is that the basics of diagnosis, coding and the reporting should be first in place (Hillestad, et al 2005, p. 7).
List of References
Bray, O 2010, Health care information technology: A key to quality and cost issues, lwv.org, Web.
Greenhalgh, T 1997, How to read a paper: getting your bearings (deciding what the paper is about), UNISA, Web.
Hillestad, R, Bigeiow, J, Bower, A, Girosi, F, Meiii, R, Scoviile, R & Tayior, R 2005, Can electronic medical record systems transform health care? Potential health benefits, savings, and costs, Harvard Education, Web.
Miles, P 2009, ‘Health information system and physician quality: role if the American Board of Pediatrics maintenance of certification in improving children’s health care’, Pediatrics, vol.123, no.2, pp. 108-109.
Scherer, K, Gupta, N, Caine, W & Panda, M 2009, ‘Differential diagnosis and management of a recurrent hepatic cyst: a case report and review of literature’, Journal of General Internal Medicine, vol. 24, no. 10, pp. 1161-1165.
Sportsci.org 2002, New view of statistics: p values, Web.
Torloni, MR, Vedmedovska, N, Merialdi, M, Bertran, AP, Allen, T, Gonsalez, R & Platt, LD 2009, ‘Safety of ultrasonography in pregnancy: WHO systematic review of the literature and meta-analysis’, Ultrasound in Obstetrics and Gynaecology, vol. 33, pp. 599-608.