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. 2021 Aug;30(1):44-55.
doi: 10.1055/s-0041-1726489. Epub 2021 Apr 21.

Primary Care Informatics Response to Covid-19 Pandemic: Adaptation, Progress, and Lessons from Four Countries with High ICT Development

Siaw-Teng Liaw  1 , Craig Kuziemsky  2 , Richard Schreiber  3 , Jitendra Jonnagaddala  1 , Harshana Liyanage  4 , Aliasgar Chittalia  5 , Ravninder Bahniwal  6 , Jennifer W He  7 , Bridget L Ryan  8 , Daniel J Lizotte  9 , Jacqueline K Kueper  7 , Amanda L Terry  8 , Simon de Lusignan  4
Affiliations

Primary Care Informatics Response to Covid-19 Pandemic: Adaptation, Progress, and Lessons from Four Countries with High ICT Development

Siaw-Teng Liaw et al. Yearb Med Inform. 2021 Aug.

Abstract

Objective: Internationally, primary care practice had to transform in response to the COVID pandemic. Informatics issues included access, privacy, and security, as well as patient concerns of equity, safety, quality, and trust. This paper describes progress and lessons learned.

Methods: IMIA Primary Care Informatics Working Group members from Australia, Canada, United Kingdom and United States developed a standardised template for collection of information. The template guided a rapid literature review. We also included experiential learning from primary care and public health perspectives.

Results: All countries responded rapidly. Common themes included rapid reductions then transformation to virtual visits, pausing of non-COVID related informatics projects, all against a background of non-standardized digital development and disparate territory or state regulations and guidance. Common barriers in these four and in less-resourced countries included disparities in internet access and availability including bandwidth limitations when internet access was available, initial lack of coding standards, and fears of primary care clinicians that patients were delaying care despite the availability of televisits.

Conclusions: Primary care clinicians were able to respond to the COVID crisis through telehealth and electronic record enabled change. However, the lack of coordinated national strategies and regulation, assurance of financial viability, and working in silos remained limitations. The potential for primary care informatics to transform current practice was highlighted. More research is needed to confirm preliminary observations and trends noted.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Box. 1
Box. 1
Quotes from health system leaders about the shift towards digital health
Fig. 1
Fig. 1
Daily charting of mode of consultations by GPs in South Eastern Australia. In person consultations declined and phone consultations increased; both after the initial surge. The low levels of telehealth (videoconsultation) remained stable. Source: Pearce C et al. The GP Insights Series no 7. 26 Oct 2020 (www.polargp.org.au) [ 12 ]
Fig. 2
Fig. 2
Weekly consultations by GPs in UK primary care, week 40 of 2018 to week 47 of 2020. In week 12 of 2020, (202012) lockdown was announced and there was a drop in overall consulting. Home visit rates and face to face in surgery declined, clinical administration (including text and email) and telephone consulting increased.
Fig. 3
Fig. 3
Rate of failed encounters/did not attend in UK primary care. Week 12 of 2020 was the highest ever recorded for not attending. The rates of non-attendance have not changed with lockdown.
Fig. 4
Fig. 4
Mortality in week 49 of 2019 (2019-48), to week 08 of 2021 (2021-08) in people 75 years old and older. The light blue line represents this year, with the peak coinciding with the first wave of COVID-19, the dark blue line the 5-year mortality average.
Fig. 5
Fig. 5
At its peak in the spring of 2020, telemedicine accounted for 62% of all outpatient encounters in the Geisinger Health System.
See this image and copyright information in PMC

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