The electronic locum record for general practitioners: outcome of an evaluation study in the Netherlands

Background: A locum practitioner is an out-of-hours general practitioner who needs access to the electronic health record of visiting patients. The electronic locum record is a summary of the electronic health record available to the locum practitioner and includes the most significant health problems, the most recent records of the patient's visits to the practice, current medication data and information on allergies and intolerances. The locum practitioner returns a locum medical note to the electronic health record at the general practitioner with his or her diagnosis, treatment or referral of the visiting patient. A pilot project of the electronic locum record was implemented in the Twente region of the Netherlands.

Objective: To obtain policy information for the nationwide implementation of the electronic locum record as a first component of the electronic health record in the Netherlands.

Methods: First, evaluation aspects were collected from parties involved in the pilot implementation process. Aspects were taken from the work flow to operationalise the electronic health record. Secondly, indicator questions were formulated and normative levels agreed for each indicator by a panel with experts from the medical and information technology domain. Third, the actual values were rated either by measurement (technical indicators) or by structured interviews (process indicators) with the general practitioners who joined the pilot study. Finally, a cross case analysis was performed by checking for (in-)consistencies among the respondents.

Results: Eight out of the 15 key indicators scored positive, three failed and four remained inconclusive. The indicators that failed the norms related to the guideline for electronic registration of patient information, the process of acquiring the healthcare professional identification card and card-related services. Indicators that remained inconclusive referred to storing and archiving of identification cards and codes, the use of the identification repository at the general practice post and the usefulness and ease-of-use of the electronic locum record.

Conclusions: The study demonstrates that many processes, systems, services and practices for nation-wide implementation of the electronic locum record for general practitioners in the Netherlands are in place. However, significant improvements are required on a number of aspects. For example general practitioners need to be trained more in applying the guideline for electronic registration of patient data. Also the process for general practitioners to acquire their unique healthcare professional identification cards should require less effort. We also recommend that a strong regional information technology support group should be in operation during roll-out.