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QOF performance ‘linked with choice of IT system’

The choice of clinical computing system has been linked with a larger effect on QOF performance than any other practice characteristic, conclude UK researchers.

The study of over 8,000 practices in England using the seven most popular GP clinical computing systems in use between 2008 and 2011 found differences in QOF performance - worth up to around £600 a year to the average practice - linked with the choice of computer system.

For the study, published in BMJ Open this month, researchers looked at QOF achievement, exception and prevalence data over the period 2008 to 2011 and then looked at the association of these with practice characteristics and the GP computer system used.

The researchers acknowledged absolute differences in QOF performance were ‘very small’, but said that the choice of clinical computing system had a bigger effect on QOF performance than any other practice characteristic.

‘The association between clinical computing system and QOF performance was stronger than for any other patient or practice characteristic, including list size, proportion of patients over the age of 65 and local area deprivation,’ the team wrote.

For example, performance differed by as much as 2.7% between computing systems, but only 0.14% at most per 1,000-patient increase in list size, and by up to 1.6% between the least and most deprived areas.

After adjusting for practice characteristics, such as list size, local area deprivation and rural location, the iSoft systems Synergy and Premiere were associated with the best QOF performance, with practices using Synergy predicted to achieve an average of £602 more a year, and those using Premiere £563 a year, compared with practices using EMIS’s PCS.

However, the researchers did point out that the PCS system had now been superseded by the EMIS Web system.

The team from the University of Manchester and University of York concluded: ‘In the UK, performance on the QOF, the world’s largest health-related pay-for-performance scheme, is partly dependent on the clinical computing system used by practices. The raises the question of whether particular characteristics of computing systems facilitate higher quality of care, better data recording or both.

‘This question is of interest to clinicians and to policy makers, for whom this work highlights an inconsistency across clinical computer systems which needs to be understood and addressed.’

Kathie Applebee, chair of the National Vision User Group, commented: ‘I think that the ability to tailor Vision and the late lamented Premiere and Synergy, and the fact that so many of their users were early adopters of GP IT (from VAMP and Abies respectively), may be influential. Both companies developed systems to ensure that high quality could be collected and this was good preparation for QOF.’

‘In my opinion, practices that exploit systems by being able to tailor them to meet their own needs probably benefit,’ she added.

Dr Grant Ingrams, GPC IT subcommittee member and a GP in Coventry, said the differences were small but the study was interesting and should get software suppliers looking at how they can improve things.

He said: ‘Often it’s about how well you’re able to capture the data and recognise missing data – the easier the system makes it with pop-up reminders the easier it will be. It would be interesting to do this sort of analysis to see which system allows people to pick up new indicators quicker.’ 

But Dr Shaun O’Hanlon, clinical and development Director for EMIS, said that the analysis was ‘flawed’

He said: ‘We therefore cannot be confident of its conclusions. It is disappointing that the figures do not include EMIS Web, which is now the most widely used GP clinical system and has a number of innovative tools to optimise QOF performance.’

Dr Paul Cundy, chair of the GPC’s IT subcommittee, said the differences uncovered in the study would have had little impact on practices’ relative incomes.

Dr Cundy said: ‘The spread of achievements said to be due to the systems the practices were using was 1% to 2% against an average achievement of 90%; if this variation is due to the computer systems it is very small and translates to very small sums of money.’

BMJ Open 2013; online 2 August