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BMJ Open. 2018 Feb 28;8(2):e020738. doi: 10.1136/bmjopen-2017-020738.

Spatial distribution of clinical computer systems in primary care in England in 2016 and implications for primary care electronic medical record databases: a cross-sectional population study.

Author information

1
NIHR School for Primary Care Research, University of Manchester, Manchester, UK.
2
Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
3
Nuffield Department of Health Care Sciences, University of Oxford, Oxford, UK.
4
The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
5
Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
6
Department of Health Sciences, University of York, York, UK.
7
Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.

Abstract

OBJECTIVES:

UK primary care databases (PCDs) are used by researchers worldwide to inform clinical practice. These databases have been primarily tied to single clinical computer systems, but little is known about the adoption of these systems by primary care practices or their geographical representativeness. We explore the spatial distribution of clinical computing systems and discuss the implications for the longevity and regional representativeness of these resources.

DESIGN:

Cross-sectional study.

SETTING:

English primary care clinical computer systems.

PARTICIPANTS:

7526 general practices in August 2016.

METHODS:

Spatial mapping of family practices in England in 2016 by clinical computer system at two geographical levels, the lower Clinical Commissioning Group (CCG, 209 units) and the higher National Health Service regions (14 units). Data for practices included numbers of doctors, nurses and patients, and area deprivation.

RESULTS:

Of 7526 practices, Egton Medical Information Systems (EMIS) was used in 4199 (56%), SystmOne in 2552 (34%) and Vision in 636 (9%). Great regional variability was observed for all systems, with EMIS having a stronger presence in the West of England, London and the South; SystmOne in the East and some regions in the South; and Vision in London, the South, Greater Manchester and Birmingham.

CONCLUSIONS:

PCDs based on single clinical computer systems are geographically clustered in England. For example, Clinical Practice Research Datalink and The Health Improvement Network, the most popular primary care databases in terms of research outputs, are based on the Vision clinical computer system, used by <10% of practices and heavily concentrated in three major conurbations and the South. Researchers need to be aware of the analytical challenges posed by clustering, and barriers to accessing alternative PCDs need to be removed.

KEYWORDS:

clinical computer systems; cprd; electronic health records; emis; primary care databases; vision

PMID:
29490968
PMCID:
PMC5855245
DOI:
10.1136/bmjopen-2017-020738
[Indexed for MEDLINE]
Free PMC Article

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