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Professor Simon de Lusignan

Chair in Health Care Management

Qualifications: BSc, MB BS, MSc, MD(Res), FHEA, FBCS CITP, FRCGP

Email:
Phone: Work: 01483 68 3089
Room no: 76 AP 02

Office hours

My usual days at University are:

Tuesday, Friday and alternate Monday and Thursday

Further information

Biography

I am an academic GP with a research interest in informatics and quality improvement (QI) and lead my own research group; from February 2011 I am Professor of Primary Care and Clinical Informatics and Chair in Health Care Management at University of Surrey.

I am trained as an educator and have developed innovative new courses including the UK’s first full time undergraduate informatics degree; I also have a long experience of supervising undergraduate and post graduate students.  

I have been a partner in my practice (Woodbridge Hill Surgery) for over twenty years and have been active in the local health community.  My practice has always been innovative and active in the local health community.  We were first wave Fundholders (a scheme where practice took partial financial responsibility for patient care), I have been PEC (Professional Executive Committee) chair – chair of the senior medical committee in the local health community; my practice was one of six to form the countries first pilot ICO (Integrated Care Organisation), and previously vice-chair of the Practice Based Commissioning group.  

Research Interests

The Clinical Informatics research group I lead has raised over £4 million in funding and published over 150 peer reviewed papers and articles.   I am currently completing a large cluster randomised trial (QICKD study); writing-up an evaluation based on linked hospital, clinic and practice data; and also the world’s largest series of multi-channel consultation videos using the ALFA toolkit.  My research focuses on how routinely collected data can be used for quality improvement and how IT is best used at the point of care.  My quality improvement work has been in: cardiovascular disease, chronic kidney disease, diabetes, mental health and osteoporosis.  I have led the development of on-line information sources for primary care but latterly focussed more on the evaluation of how these and electronic patient record (EPR) systems might best be incorporated into clinical practice.  I have been active in developing metrics for improving the quality of management of chronic kidney disease, diabetes and mental health.

Publications

Highlights

  • De Lusignan S, Michalakidis G, Vicente MT, Pearce C, Shaw NT, Liaw S-T, Michalakidis G, Vicente MT, Bainbridge M. (2011) 'What are the barriers to conducting international research using routinely collected primary care data?'. Studies in Health Technology and Informatics, 165, pp. 135-140.
    doi: 10.3233/978-1-60750-735-2-135
  • de Lusignan S, Tomson C, Harris K, van Vlymen J, Gallagher H. (2011) 'Creatinine fluctuation has a greater effect than the formula to estimate glomerular filtration rate on the prevalence of chronic kidney disease.'. Karger Nephron Clinical Practice, Switzerland: 117 (3), pp. c213-c224.
    doi: 10.1159/000320341
    Full text is available at: http://epubs.surrey.ac.uk/186033/

    Abstract

    Cases of chronic kidney disease (CKD) are defined by the estimated glomerular filtration rate (eGFR), calculated using the Modified Diet in Renal Disease (MDRD) or, more recently, the CKD Epidemiology Collaboration (CKD-EPI) formula. This study set out to promote a systematic approach to reporting CKD prevalence. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: The study explores the impact of the way in which eGFR is calculated on the prevalence of CKD. We took into account whether including (1) ethnicity, (2) using a single eGFR, (3) using more than 1 eGFR value or (4) using the CKD-EPI formula affected the estimates of prevalence.

  • Phillips CB, Pearce CM, Hall S, Travaglia J, de Lusignan S, Love T, Kljakovic M. (2010) 'Can clinical governance deliver quality improvement in Australian general practice and primary care? A systematic review of the evidence'. AUSTRALASIAN MED PUBL CO LTD MEDICAL JOURNAL OF AUSTRALIA, 193 (10), pp. 602-607.
  • Debar S, Kumarapeli P, Kaski JC, de Lusignan S. (2010) 'Addressing modifiable risk factors for coronary heart disease in primary care: an evidence-base lost in translation.'. Fam Pract, England: 27 (4), pp. 370-378.
    doi: 10.1093/fampra/cmq025
  • de Lusignan S, Khunti K, Belsey J, Hattersley A, van Vlymen J, Gallagher H, Millett C, Hague NJ, Tomson C, Harris K, Majeed A. (2010) 'A method of identifying and correcting miscoding, misclassification and misdiagnosis in diabetes: a pilot and validation study of routinely collected data.'. Diabet Med, England: 27 (2), pp. 203-209.
    doi: 10.1111/j.1464-5491.2009.02917.x
  • de Lusignan S, Krause P. (2010) 'The Hayes principles: learning from the national pilot of information technology and core generalisable theory in informatics.'. Inform Prim Care, England: 18 (2), pp. 73-77.
  • de Lusignan S, Gallagher H, Chan T, Thomas N, van Vlymen J, Nation M, Jain N, Tahir A, du Bois E, Crinson I, Hague N, Reid F, Harris K. (2009) 'The QICKD study protocol: a cluster randomised trial to compare quality improvement interventions to lower systolic BP in chronic kidney disease (CKD) in primary care.'. BioMed Central Implementation Science, England: 4 (39)
    doi: 10.1186/1748-5908-4-39
    Full text is available at: http://epubs.surrey.ac.uk/191650/

    Abstract

    BACKGROUND: Chronic kidney disease (CKD) is a relatively newly recognised but common long-term condition affecting 5 to 10% of the population. Effective management of CKD, with emphasis on strict blood pressure (BP) control, reduces cardiovascular risk and slows the progression of CKD. There is currently an unprecedented rise in referral to specialist renal services, which are often located in tertiary centres, inconvenient for patients, and wasteful of resources. National and international CKD guidelines include quality targets for primary care. However, there have been no rigorous evaluations of strategies to implement these guidelines. This study aims to test whether quality improvement interventions improve primary care management of elevated BP in CKD, reduce cardiovascular risk, and slow renal disease progression DESIGN: Cluster randomised controlled trial (CRT) METHODS: This three-armed CRT compares two well-established quality improvement interventions with usual practice. The two interventions comprise: provision of clinical practice guidelines with prompts and audit-based education. The study population will be all individuals with CKD from general practices in eight localities across England. Randomisation will take place at the level of the general practices. The intended sample (three arms of 25 practices) powers the study to detect a 3 mmHg difference in systolic BP between the different quality improvement interventions. An additional 10 practices per arm will receive a questionnaire to measure any change in confidence in managing CKD. Follow up will take place over two years. Outcomes will be measured using anonymised routinely collected data extracted from practice computer systems. Our primary outcome measure will be reduction of systolic BP in people with CKD and hypertension at two years. Secondary outcomes will include biomedical outcomes and markers of quality, including practitioner confidence in managing CKD. A small group of practices (n = 4) will take part in an in-depth process evaluation. We will use time series data to examine the natural history of CKD in the community. Finally, we will conduct an economic evaluation based on a comparison of the cost effectiveness of each intervention. CLINICAL TRIALS REGISTRATION: ISRCTN56023731. ClinicalTrials.gov identifier.

Journal articles

  • Liaw ST, Rahimi A, Ray P, Jalaludin B, Liaw ST, Taggart J, Dennis S, Liaw ST, Rahimi A, Ray P, Talaei-Khoei A, Rahimi A, de Lusignan S, Jalaludin B, Yeo AET. (2013) 'Towards an ontology for data quality in integrated chronic disease management: A realist review of the literature'. International Journal of Medical Informatics, 82 (1), pp. 10-24.
    doi: 10.1016/j.ijmedinf.2012.10.001
  • Kumarapeli P, de Lusignan S. (2012) 'Using the computer in the clinical consultation; setting the stage, reviewing, recording, and taking actions: multi-channel video study.'. J Am Med Inform Assoc,
    doi: 10.1136/amiajnl-2012-001081
  • Woodman J, Freemantle N, Allister J, de Lusignan S, Gilbert R, Petersen I. (2012) 'Variation in Recorded Child Maltreatment Concerns in UK Primary Care Records: A Cohort Study Using The Health Improvement Network (THIN) Database'. Public Library of Science PLoS One, 7 (11)
    doi: 10.1371/journal.pone.0049808
    Full text is available at: http://epubs.surrey.ac.uk/741954/
  • Liaw ST, Rahimi A, Ray P, Taggart J, Dennis S, de Lusignan S, Jalaludin B, Yeo AE, Talaei-Khoei A. (2012) 'Towards an ontology for data quality in integrated chronic disease management: A realist review of the literature.'. Int J Med Inform,
    doi: 10.1016/j.ijmedinf.2012.10.001
  • Sadek K, Khunti K, de Lusignan S. (2012) 'Classification of Diabetes for Primary Care: A Practical Approach'. SB Communications Group Diabetes & Primary Care, 14 (5, 2012)
  • Stevens PE, de Lusignan S, Farmer CK, Tomson CR. (2012) 'Engaging primary care in CKD initiatives: the UK experience.'. Nephrol Dial Transplant, England: 27 Suppl 3, pp. iii5-iii11.
    doi: 10.1093/ndt/gfs103
  • De Lusignan S, Allister J, Rafi I. (2012) 'How do we identify and support maltreated children?'. British Journal of General Practice, 62 (602), pp. 458-459.
    doi: 10.3399/bjgp12X654461
  • de Lusignan S, Krause P, Michalakidis G, Tristan Vicente M, Thompson S, Gilchrist M, Sullivan F, van Royen P, Agreus L, Desombre T, Taweel A, Delaney B. (2012) 'Business Process Modelling is an Essential Part of a Requirements Analysis.'. IMIA Yearbook of Medical Informatics 2012,
  • Woodman J, de Lusignan S, Rafi I, Allister J, Gilbert R. (2012) 'GPs' role in safeguarding children'. B M J PUBLISHING GROUP BRITISH MEDICAL JOURNAL, 345 Article number ARTN e4758
    doi: 10.1136/bmj.e4758
    Full text is available at: http://epubs.surrey.ac.uk/713655/
  • Woodman J, Allister J, Rafi I, de Lusignan S, Belsey J, Petersen I, Gilbert R. (2012) 'A simple approach to improve recording of concerns about child maltreatment in primary care records: developing a quality improvement intervention.'. e478 Edition. British Journal of General Practice,
    doi: 10.3399/bjgp12X652346
  • Hassan Sadek N, Sadek AR, Tahir A, Khunti K, Desombre T, de Lusignan S. (2012) 'Evaluating tools to support a new practical classification of diabetes: excellent control may represent misdiagnosis and omission from disease registers is associated with worse control.'. Blackwell Publishing Ltd The International Journal of Clinical Practice,
    doi: 10.1111/j.1742-1241.2012.02979.x
  • de Lusignan S, Woodhams V, Desombre T, Mughal S, Head G, Debar S, Hilton S, Al-Sharifi H. (2012) 'Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network'. BioMed Central BMC Health Services Research, 12
    doi: 10.1186/1472-6963-12-153
    Full text is available at: http://epubs.surrey.ac.uk/659224/
  • Dawson I, Senior V, de Lusignan S. (2012) 'Perceptions of risk may explain the discrepancy between patient and clinician-recorded symptoms'. Elsevier Primary Care Respiratory Journal, 21 (2), pp. 124-126.
    doi: 10.4104/pcrj.2012.00024
  • Drennan VM, Chattopadhyay K, Halter M, Brearley S, de Lusignan S, Gabe J, Gage H. (2012) 'Physician assistants in English primary care teams: A survey.'. J Interprof Care,
    doi: 10.3109/13561820.2012.686538
  • De Lusignan S. (2012) 'Informatics research, practice, theory and history'. Informatics in Primary Care, 19 (3), pp. 125-126.
  • De Lusignan S, Van Vlymen J, Tomson C, Harris K, Gallagher H. (2012) 'Erratum: UK prevalence of chronic kidney disease for the adult population is 6.76% based on two creatinine readings (Nephron - Clinical Practice)'. Nephron - Clinical Practice, 120 (2), pp. 107-107.
    doi: 10.1159/000337124
  • de Lusignan S, Tomson C, Harris K, van Vlymen J, Gallagher H. (2012) 'UK Prevalence of Chronic Kidney Disease for the Adult Population Is 6.76% Based on Two Creatinine Readings.'. Nephron Clin Pract, 120 (2)
    doi: 10.1159/000337124
  • Sadek AR, van Vlymen J, Khunti K, de Lusignan S. (2012) 'Automated identification of miscoded and misclassified cases of diabetes from computer records.'. Wiley Diabet Med, 29 (3), pp. 410-414.
    doi: 10.1111/j.1464-5491.2011.03457.x
    Full text is available at: http://epubs.surrey.ac.uk/7263/

    Abstract

    Aims:  To develop a computer processable algorithm, capable of running automated searches of routine data that flag miscoded and misclassified cases of diabetes for subsequent clinical review. Method: Anonymized computer data from the Quality Improvement in Chronic Kidney Disease (QICKD) trial (n = 942 031) were analysed using a binary method to assess the accuracy of data on diabetes diagnosis. Diagnostic codes were processed and stratified into: definite, probable and possible diagnosis of Type 1 or Type 2 diabetes. Diagnostic accuracy was improved by using prescription compatibility and temporally sequenced anthropomorphic and biochemical data. Bayesian false detection rate analysis was used to compare findings with those of an entirely independent and more complex manual sort of the first round QICKD study data (n = 760 588). Results:  The prevalence of definite diagnosis of Type 1 diabetes and Type 2 diabetes were 0.32% and 3.27% respectively when using the binary search method. Up to 35% of Type 1 diabetes and 0.1% of Type 2 diabetes were miscoded or misclassified on the basis of age/BMI and coding. False detection rate analysis demonstrated a close correlation between the new method and the published hand-crafted sort. Both methods had the highest false detection rate values when coding, therapeutic, anthropomorphic and biochemical filters were used (up to 90% for the new and 75% for the hand-crafted search method). Conclusions:  A simple computerized algorithm achieves very similar results to more complex search strategies to identify miscoded and misclassified cases of both Type 1 diabetes and Type 2 diabetes. It has the potential to be used as an automated audit instrument to improve quality of diabetes diagnosis.

  • Gibbings-Isaac D, Iqbal M, Tahir MA, Kumarapeli P, de Lusignan S. (2012) 'The pattern of silent time in the clinical consultation: an observational multichannel video study.'. Fam Pract,
    doi: 10.1093/fampra/cms001
  • Alsanjari ON, de Lusignan S, van Vlymen J, Gallagher H, Millett C, Harris K, Majeed A. (2012) 'Trends and transient change in end-digit preference in blood pressure recording: studies of sequential and longitudinal collected primary care data.'. Int J Clin Pract, England: 66 (1), pp. 37-43.
    doi: 10.1111/j.1742-1241.2011.02781.x
  • de Lusignan S, Sadek N, Mulnier H, Tahir A, Russell-Jones D, Khunti K. (2012) 'Miscoding, misclassification and misdiagnosis of diabetes in primary care.'. Wiley Diabet Med, 29 (2), pp. 181-189.
    doi: 10.1111/j.1464-5491.2011.03419.x
    Full text is available at: http://epubs.surrey.ac.uk/7272/

    Abstract

    Aims:  To determine the effectiveness of self-audit tools designed to detect miscoding, misclassification and misdiagnosis of diabetes in primary care. Methods:  We developed six searches to identify people with diabetes with potential classification errors. The search results were automatically ranked from most to least likely to have an underlying problem. Eight practices with a combined population of 72 000 and diabetes prevalence 2.9% (n = 2340) completed audit forms to verify whether additional information within the patients' medical record confirmed or refuted the problems identified. Results:  The searches identified 347 records, mean 42 per practice. Pre-audit 20% (n = 69) had Type 1 diabetes, 70% (n = 241) had Type 2 diabetes, 9% (n = 30) had vague codes that were hard to classify, 2% (n = 6) were not coded and one person was labelled as having gestational diabetes. Of records, 39.2% (n = 136) had important errors: 10% (n = 35) had coding errors; 12.1% (42) were misclassified; and 17.0% (59) misdiagnosed as having diabetes. Thirty-two per cent (n = 22) of people with Type 2 diabetes (n = 69) were misclassified as having Type 1 diabetes; 20% (n = 48) of people with Type 2 diabetes (n = 241) did not have diabetes; of the 30 patients with vague diagnostic terms, 50% had Type 2 diabetes, 20% had Type 1 diabetes and 20% did not have diabetes. Examples of misdiagnosis were found in all practices, misclassification in seven and miscoding in six. Conclusions:  Volunteer practices successfully used these self-audit tools. Approximately 40% of patients identified by computer searches (5.8% of people with diabetes) had errors; misdiagnosis is commonest, misclassification may affect treatment options and miscoding in omission from disease registers and the potential for reduced quality of care.

  • Dmitrieva O, Michalakidis G, Mason A, Jones S, Chan T, de Lusignan S. (2012) 'Consistent Data Recording across a Health System and Web-Enablement Allow Service Quality Comparisons: Online Data for Commissioning Dermatology Services.'. Stud Health Technol Inform, Netherlands: 174, pp. 84-88.
    doi: 10.3233/978-1-61499-052-9-84
  • de Lusignan S, Cashman J, Poh N, Michalakidis G, Mason A, Desombre T, Krause P. (2012) 'Conducting Requirements Analyses for Research using Routinely Collected Health Data: a Model Driven Approach.'. Stud Health Technol Inform, Netherlands: 180, pp. 1105-1107.
    doi: 10.3233/978-1-61499-101-4-1105
  • de Lusignan S, Krause P, Michalakidis G, Vicente MT, Thompson S, McGilchrist M, Sullivan F, van Royen P, Agreus L, Desombre T, Taweel A, Delaney B. (2012) 'Business Process Modelling is an Essential Part of a Requirements Analysis. Contribution of EFMI Primary Care Working Group.'. Schattauer Publishers Yearb Med Inform, Germany: 7 (1), pp. 34-43.
  • Swindells M, de Lusignan S. (2012) 'Lessons from the English National Programme for IT about Structure, Process and Utility.'. Stud Health Technol Inform, Netherlands: 174, pp. 17-22.
    doi: 10.3233/978-1-61499-052-9-17
  • De Lusignan S. (2011) 'On-going technical advances, can we use them to deliver more personalised medicine?'. Informatics in Primary Care, 19 (2), pp. 55-56.
  • de Lusignan S, Chan T, Parry G, Dent-Brown K, Kendrick T. (2011) 'Referral to a new psychological therapy service is associated with reduced utilisation of healthcare and sickness absence by people with common mental health problems: A before and after comparison'. Journal of Epidemiology and Community Health,
    doi: 10.1136/jech.2011.139873
  • Stevens PE, Farmer CK, de Lusignan S. (2011) 'Effect of Pay for Performance on Hypertension in the United Kingdom.'. Am J Kidney Dis,
    doi: 10.1053/j.ajkd.2011.06.010
  • Hall S, Kulendran M, Sadek AR, Green S, de Lusignan S. (2011) 'Variability in selecting patients to manage in the community: a service evaluation of community matron's case-finding strategies.'. Fam Pract, England: 28 (4), pp. 414-421.
    doi: 10.1093/fampra/cmq095
  • De Lusignan S. (2011) 'Making health information and communications technology (ICT) relevant and usable for quality improvement and research'. Informatics in Primary Care, 19 (4), pp. 187-188.
  • de Lusignan S, Nitsch D, Belsey J, Kumarapeli P, Vamos EP, Majeed A, Millett C. (2011) 'Disparities in testing for renal function in UK primary care: cross-sectional study.'. Fam Pract,
    doi: 10.1093/fampra/cmr036
  • Dhoul N, de Lusignan S, Dmitrieva O, Stevens P, O'Donoghue D. (2011) 'Quality achievement and disease prevalence in primary care predicts regional variation in renal replacement therapy (RRT) incidence: an ecological study.'. Nephrol Dial Transplant,
    doi: 10.1093/ndt/gfr347
  • de Lusignan S, Liaw ST, Krause P, Curcin V, Vicente MT, Michalakidis G, Agreus L, Leysen P, Shaw N, Mendis K. (2011) 'Key Concepts to Assess the Readiness of Data for International Research: Data Quality, Lineage and Provenance, Extraction and Processing Errors, Traceability, and Curation. Contribution of the IMIA Primary Health Care Informatics Working Group.'. Yearb Med Inform, Germany: 6 (1), pp. 112-120.
  • De Lusignan S, Michalakidis G, Vicente MT, Pearce C, Shaw NT, Liaw S-T, Michalakidis G, Vicente MT, Bainbridge M. (2011) 'What are the barriers to conducting international research using routinely collected primary care data?'. Studies in Health Technology and Informatics, 165, pp. 135-140.
    doi: 10.3233/978-1-60750-735-2-135
  • de Lusignan S, Pearce C, Kumarapeli P, Stavropoulou C, Kushniruk A, Sheikh A, Shachak A, Mendis K. (2011) 'Reporting Observational Studies of the Use of Information Technology in the Clinical Consultation. A Position Statement from the IMIA Primary Health Care Informatics Working Group (IMIA PCI WG).'. Yearb Med Inform, Germany: 6 (1), pp. 39-47.
  • de Lusignan S. (2011) 'Informatics in primary care: 20 years on--editor's report 2011.'. Inform Prim Care, England: 19 (3), pp. 183-186.
  • de Lusignan S, Liaw ST, Michalakidis G, Jones S. (2011) 'Defining datasets and creating data dictionaries for quality improvement and research in chronic disease using routinely collected data: an ontology-driven approach.'. Inform Prim Care, England: 19 (3), pp. 127-134.
  • Poh N, de Lusignan S. (2011) 'Data-modelling and visualisation in chronic kidney disease (CKD): a step towards personalised medicine.'. Inform Prim Care, England: 19 (2), pp. 57-63.
  • de Lusignan S, Tomson C, Harris K, van Vlymen J, Gallagher H. (2011) 'Creatinine fluctuation has a greater effect than the formula to estimate glomerular filtration rate on the prevalence of chronic kidney disease.'. Karger Nephron Clinical Practice, Switzerland: 117 (3), pp. c213-c224.
    doi: 10.1159/000320341
    Full text is available at: http://epubs.surrey.ac.uk/186033/

    Abstract

    Cases of chronic kidney disease (CKD) are defined by the estimated glomerular filtration rate (eGFR), calculated using the Modified Diet in Renal Disease (MDRD) or, more recently, the CKD Epidemiology Collaboration (CKD-EPI) formula. This study set out to promote a systematic approach to reporting CKD prevalence. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: The study explores the impact of the way in which eGFR is calculated on the prevalence of CKD. We took into account whether including (1) ethnicity, (2) using a single eGFR, (3) using more than 1 eGFR value or (4) using the CKD-EPI formula affected the estimates of prevalence.

  • de Lusignan S. (2011) 'SNOMED is coming, and more about using and interacting with technology in primary care.'. Inform Prim Care, England: 19 (1), pp. 1-2.
  • De Lusignan S, Navarro R, Chan T, Parry G, Dent-Brown K, Kendrick T. (2011) 'Detecting referral and selection bias by the anonymous linkage of practice, hospital and clinic data using Secure and Private Record Linkage (SAPREL): Case study from the evaluation of the Improved Access to Psychological Therapy (IAPT) service'. BioMed Central BMC Medical Informatics and Decision Making, 11 (61)
    doi: 10.1186/1472-6947-11-61
    Full text is available at: http://epubs.surrey.ac.uk/186034/

    Abstract

    Background: The evaluation of demonstration sites set up to provide improved access to psychological therapies (IAPT) comprised the study of all people identified as having common mental health problems (CMHP), those referred to the IAPT service, and a sample of attenders studied in-depth. Information technology makes it feasible to link practice, hospital and IAPT clinic data to evaluate the representativeness of these samples. However, researchers do not have permission to browse and link these data without the patients’ consent. Objective: To demonstrate the use of a mixed deterministic-probabilistic method of secure and private record linkage (SAPREL) - to describe selection bias in subjects chosen for in-depth evaluation. Method: We extracted, pseudonymised and used fuzzy logic to link multiple health records without the researcher knowing the patient’s identity. The method can be characterised as a three party protocol mainly using deterministic algorithms with dynamic linking strategies; though incorporating some elements of probabilistic linkage. Within the data providers’ safe haven we extracted: Demographic data, hospital utilisation and IAPT clinic data; converted post code to index of multiple deprivation (IMD); and identified people with CMHP. We contrasted the age, gender, ethnicity and IMD for the in-depth evaluation sample with people referred to IAPT, use hospital services, and the population as a whole. Results: The in IAPT-in-depth group had a mean age of 43.1 years; CI: 41.0 - 45.2 (n = 166); the IAPT-referred 40.2 years; CI: 39.4 - 40.9 (n = 1118); and those with CMHP 43.6 years SEM 0.15. (n = 12210). Whilst around 67% of those with a CMHP were women, compared to 70% of those referred to IAPT, and 75% of those subject to indepth evaluation (Chi square p< 0.001). The mean IMD score for the in-depth evaluation group was 36.6; CI: 34.2 - 38.9; (n = 166); of those referred to IAPT 38.7; CI: 37.9 - 39.6; (n = 1117); and of people with CMHP 37.6; CI 37.3- 37.9; (n = 12143). Conclusions: The sample studied in-depth were older, more likely female, and less deprived than people with CMHP, and fewer had recorded ethnic minority status. Anonymous linkage using SAPREL provides insight into the representativeness of a study population and possible adjustment for selection bias.

  • Tahir MA, Dmitrieva O, de Lusignan S, van Vlymen J, Chan T, Golmohamad R, Harris K, Tomson C, Thomas N, Gallagher H. (2011) 'Confidence and quality in managing CKD compared with other cardiovascular diseases and diabetes mellitus: a linked study of questionnaire and routine primary care data.'. BMC Fam Pract, England: 12
    doi: 10.1186/1471-2296-12-83
  • Stevens PE, Farmer CKT, De Lusignan S. (2011) 'Effect of pay for performance on hypertension in the United Kingdom'. American Journal of Kidney Diseases, 58 (4), pp. 508-511.
    doi: 10.1053/j.ajkd.2011.06.010
  • de Lusignan S, Chan T, Jones S. (2011) 'Large complex terminologies: more coding choice, but harder to find data--reflections on introduction of SNOMED CT (Systematized Nomenclature of Medicine--Clinical Terms) as an NHS standard.'. Inform Prim Care, England: 19 (1), pp. 3-5.
  • de Lusignan S. (2011) 'Auditing quality in kidney disease and diabetes: is the precise the enemy of the good? A commentary on difficulties auditing pathology results containing 'greater than' or 'less than' signs.'. Inform Prim Care, England: 19 (4), pp. 189-190.
  • de Lusignan S. (2011) 'International lessons in clinical quality and evaluation'. Informatics in Primary Care, 18 (3), pp. 145-146.
  • Phillips CB, Pearce CM, Hall S, Travaglia J, de Lusignan S, Love T, Kljakovic M. (2010) 'Can clinical governance deliver quality improvement in Australian general practice and primary care? A systematic review of the evidence'. AUSTRALASIAN MED PUBL CO LTD MEDICAL JOURNAL OF AUSTRALIA, 193 (10), pp. 602-607.
  • Debar S, Kumarapeli P, Kaski JC, de Lusignan S. (2010) 'Addressing modifiable risk factors for coronary heart disease in primary care: an evidence-base lost in translation.'. Fam Pract, England: 27 (4), pp. 370-378.
    doi: 10.1093/fampra/cmq025
  • Murray J, Saxena S, Millett C, Curcin V, de Lusignan S, Majeed A. (2010) 'Reductions in risk factors for secondary prevention of coronary heart disease by ethnic group in south-west London: 10-year longitudinal study (1998-2007).'. Fam Pract, England: 27 (4), pp. 430-438.
    doi: 10.1093/fampra/cmq030
  • Stone MA, Camosso-Stefinovic J, Wilkinson J, de Lusignan S, Hattersley AT, Khunti K. (2010) 'Incorrect and incomplete coding and classification of diabetes: a systematic review (vol 27, pg 491, 2010)'. WILEY-BLACKWELL PUBLISHING, INC DIABETIC MED, 27 (6), pp. 732-732.
    doi: 10.1111/j.1464-5491.2010.03030_1.x
  • Gallagher H, de Lusignan S, Harris K, Cates C. (2010) 'Quality-improvement strategies for the management of hypertension in chronic kidney disease in primary care: a systematic review.'. Br J Gen Pract, England: 60 (575), pp. e258-e265.
    doi: 10.3399/bjgp10X502164
  • Crinson I, Gallagher H, Thomas N, de Lusignan S. (2010) 'How ready is general practice to improve quality in chronic kidney disease? A diagnostic analysis.'. Br J Gen Pract, England: 60 (575), pp. 403-409.
    doi: 10.3399/bjgp10X502100
  • Stone MA, Camosso-Stefinovic J, Wilkinson J, de Lusignan S, Hattersley AT, Khunti K. (2010) 'Incorrect and incomplete coding and classification of diabetes: a systematic review.'. Diabet Med, England: 27 (5), pp. 491-497.
    doi: 10.1111/j.1464-5491.2009.02920.x
  • de Lusignan S, Khunti K, Belsey J, Hattersley A, van Vlymen J, Gallagher H, Millett C, Hague NJ, Tomson C, Harris K, Majeed A. (2010) 'A method of identifying and correcting miscoding, misclassification and misdiagnosis in diabetes: a pilot and validation study of routinely collected data.'. Diabet Med, England: 27 (2), pp. 203-209.
    doi: 10.1111/j.1464-5491.2009.02917.x
  • de Lusignan S. (2010) 'Looking beyond the National Programme for IT in primary care informatics.'. Inform Prim Care, England: 18 (2), pp. 79-80.
  • de Lusignan S. (2010) 'Computerised routinely collected primary care data: essential for patient access to records, quality improvement and research.'. Inform Prim Care, England: 18 (1), pp. 5-7.
  • de Lusignan S. (2010) 'Bibliometric analysis of primary care research, childhood obesity, the importance of understanding small area data and diabetes.'. Inform Prim Care, England: 18 (4), pp. 217-218.
  • de Lusignan S, Hogg F, Hinchliffe RJ. (2010) 'Getting the signal to noise ratio right in the management of diabetes in primary care: time to stratify risk and focus on outcomes rather than process.'. Inform Prim Care, England: 18 (4), pp. 219-221.
  • Stone MA, Camosso-Stefinovic J, Wilkinson J, De Lusignan S, Hattersley AT, Khunti K. (2010) 'Erratum: Incorrect and incomplete coding and classification of diabetes: A systematic review (Diabetic Medicine (2010) 27 (491-497))'. Diabetic Medicine, 27 (6), pp. 732-732.
    doi: 10.1111/j.1464-5491.2010.03030_1.x
  • Hogg F, de Lusignan S, Hinchliffe RJ. (2010) 'Commentary on: creating a diabetes foot reminder-based registry using the electronic medical record.'. Inform Prim Care, England: 18 (4), pp. 288-289.
  • de Lusignan S, Krause P. (2010) 'Liberating the NHS: an information revolution--think beyond the electronic patient record, think service orientated architecture!'. Inform Prim Care, England: 18 (3), pp. 147-148.
  • Pearce C, Kumarpeli P, de Lusignan S. (2010) 'Getting seamless care right from the beginning - integrating computers into the human interaction.'. Stud Health Technol Inform, Netherlands: 155, pp. 196-202.
    doi: 10.3233/978-1-60750-563-1-196
  • de Lusignan S, Sullivan F, Krause P. (2010) 'Vault, cloud and agent: choosing strategies for quality improvement and research based on routinely collected health data.'. Inform Prim Care, England: 18 (1), pp. 1-4.
  • de Lusignan S, Krause P. (2010) 'The Hayes principles: learning from the national pilot of information technology and core generalisable theory in informatics.'. Inform Prim Care, England: 18 (2), pp. 73-77.
  • Chan T, van Vlymen J, Dhoul N, de Lusignan S. (2010) 'Using routinely collected data to evaluate a leaflet campaign to increase the presentation of people with memory problems to general practice: a locality based controlled study.'. Inform Prim Care, England: 18 (3), pp. 189-196.
  • Pflug B, Kumarapeli P, van Vlymen J, Ammenwerth E, de Lusignan S. (2010) 'Measuring the impact of the computer on the consultation: an open source application to combine multiple observational outputs.'. Inform Health Soc Care, England: 35 (1), pp. 10-24.
    doi: 10.3109/17538150903358693
  • Hogg F, de Lusignan S, Hinchliffe RJ. (2010) 'Implementing an integrated computerised information system about foot problems in diabetes is not enough to ensure adoption. Commentary on: general practitioners' and nurses' experiences of using computerised decision support in screening for diabetic foot disease: implementing Scottish Clinical Information - Diabetes Care in routine clinical practice.'. Inform Prim Care, England: 18 (4), pp. 269-271.
  • Chan T, Cohen A, de Lusignan S. (2010) 'Using routine data to conduct small area health needs assessment through observing trends in demographics, recording of common mental health problems (CMHPs) and sickness certificates: longitudinal analysis of a northern and London locality.'. Inform Prim Care, England: 18 (4), pp. 273-282.
  • Herbert I, de Lusignan S. (2009) 'Further changes are needed if the National Care Record Service (NCRS) implementation is to succeed.'. Inform Prim Care, England: 17 (3), pp. 161-164.
  • de Lusignan S. (2009) 'In this issue of Informatics in Primary Care: ethnicity, learning and diabetes.'. Inform Prim Care, England: 17 (2), pp. 65-66.
  • Masic I, Kern J, Zvarova J, de Lusignan S. (2009) 'Task force of the EFMI journals: background, rationale and purpose.'. Stud Health Technol Inform, Netherlands: 150, pp. 946-950.
    doi: 10.3233/978-1-60750-044-5-946
  • Vaziri A, Connor E, Shepherd I, Jones RT, Chan T, de Lusignan S. (2009) 'Are we setting about improving the safety of computerised prescribing in the right way? A workshop report.'. Inform Prim Care, England: 17 (3), pp. 175-182.
  • de Lusignan S. (2009) 'Usability: a neglected theme in informatics.'. Inform Prim Care, England: 17 (4), pp. 199-200.
  • De Lusignan S, Chan T, Gallagher H, Van Vlymen J, Thomas N, Jain N, Tahir A, Nation M, Moore J, Reid F, Harris K, Hague N. (2009) 'Chronic kidney disease management in southeast England: A preliminary cross-sectional report from the QICKD - Quality Improvement in Chronic Kidney Disease study'. Primary Care Cardiovascular Journal, 2 (SPEC. ISS.), pp. 33-39.
    doi: 10.3132/pccj.2009.034
  • de Lusignan S, Kumarapeli P, Debar S, Kushniruk AW, Pearce C. (2009) 'Using an open source observational tool to measure the influence of the doctor's consulting style and the computer system on the outcomes of the clinical consultation.'. Stud Health Technol Inform, Netherlands: 150, pp. 1017-1021.
    doi: 10.3233/978-1-60750-044-5-1017
  • Bagheri A, Sadek A, Chan T, Khunti K, de Lusignan S. (2009) 'Using surrogate markers in primary electronic patient record systems to confirm or refute the diagnosis of diabetes.'. Inform Prim Care, England: 17 (2), pp. 121-129.
  • de Lusignan S, Gallagher H, Chan T, Thomas N, van Vlymen J, Nation M, Jain N, Tahir A, du Bois E, Crinson I, Hague N, Reid F, Harris K. (2009) 'The QICKD study protocol: a cluster randomised trial to compare quality improvement interventions to lower systolic BP in chronic kidney disease (CKD) in primary care.'. BioMed Central Implementation Science, England: 4 (39)
    doi: 10.1186/1748-5908-4-39
    Full text is available at: http://epubs.surrey.ac.uk/191650/

    Abstract

    BACKGROUND: Chronic kidney disease (CKD) is a relatively newly recognised but common long-term condition affecting 5 to 10% of the population. Effective management of CKD, with emphasis on strict blood pressure (BP) control, reduces cardiovascular risk and slows the progression of CKD. There is currently an unprecedented rise in referral to specialist renal services, which are often located in tertiary centres, inconvenient for patients, and wasteful of resources. National and international CKD guidelines include quality targets for primary care. However, there have been no rigorous evaluations of strategies to implement these guidelines. This study aims to test whether quality improvement interventions improve primary care management of elevated BP in CKD, reduce cardiovascular risk, and slow renal disease progression DESIGN: Cluster randomised controlled trial (CRT) METHODS: This three-armed CRT compares two well-established quality improvement interventions with usual practice. The two interventions comprise: provision of clinical practice guidelines with prompts and audit-based education. The study population will be all individuals with CKD from general practices in eight localities across England. Randomisation will take place at the level of the general practices. The intended sample (three arms of 25 practices) powers the study to detect a 3 mmHg difference in systolic BP between the different quality improvement interventions. An additional 10 practices per arm will receive a questionnaire to measure any change in confidence in managing CKD. Follow up will take place over two years. Outcomes will be measured using anonymised routinely collected data extracted from practice computer systems. Our primary outcome measure will be reduction of systolic BP in people with CKD and hypertension at two years. Secondary outcomes will include biomedical outcomes and markers of quality, including practitioner confidence in managing CKD. A small group of practices (n = 4) will take part in an in-depth process evaluation. We will use time series data to examine the natural history of CKD in the community. Finally, we will conduct an economic evaluation based on a comparison of the cost effectiveness of each intervention. CLINICAL TRIALS REGISTRATION: ISRCTN56023731. ClinicalTrials.gov identifier.

  • de Lusignan S. (2009) 'Flagging fasting plasma glucose specimens: time to routinely label the context in which pathology specimens are recorded.'. Inform Prim Care, England: 17 (2), pp. 63-64.
  • de Lusignan S. (2009) 'In this issue: use of electronic patient record (EPR) system data for emergency care, quality improvement and research--things not to take for granted.'. Inform Prim Care, England: 17 (3), pp. 143-144.
  • Rollason W, Khunti K, de Lusignan S. (2009) 'Variation in the recording of diabetes diagnostic data in primary care computer systems: implications for the quality of care.'. Inform Prim Care, England: 17 (2), pp. 113-119.
  • Pearce C, Shachak A, Kushniruk A, de Lusignan S. (2009) 'Usability: a critical dimension for assessing the quality of clinical systems.'. Inform Prim Care, England: 17 (4), pp. 195-198.
  • Debar S, De Lusignan S, Kaski JC. (2009) 'Assessing cardiovascular risk in the 10-minute consultation'. Primary Care Cardiovascular Journal, 2 (4), pp. 181-183.
    doi: 10.3132/pccj.2009.058
  • de Lusignan S, Buxton N, Kent A. (2008) '10-MINUTE CONSULTATION New patient asking for a benzodiazepine prescription'. B M J PUBLISHING GROUP BRITISH MEDICAL JOURNAL, 337 Article number ARTN a658
    doi: 10.1136/bmj.a658
    Full text is available at: http://epubs.surrey.ac.uk/185980/
  • Belsey J, de Lusignan S, Chan T, van Vlymen J, Hague N. (2008) 'Abnormal lipids in high-risk patients achieving cholesterol targets: a cross-sectional study of routinely collected UK general practice data.'. Curr Med Res Opin, England: 24 (9), pp. 2551-2560.
    doi: 10.1185/03007990802321964
  • Belsey J, de Lusignan S, van Vlymen J, Chan T, Hague N. (2008) 'Reducing coronary risk by raising HDL-cholesterol: risk modelling the addition of nicotinic acid to existing therapy.'. Curr Med Res Opin, England: 24 (9), pp. 2703-2709.
    doi: 10.1185/03007990802374633
  • de Lusignan S, Chan T. (2008) 'The development of primary care information technology in the United kingdom.'. Lippincott, Williams & Wilkins J Ambul Care Manage, United States: 31 (3), pp. 201-210.
    doi: 10.1097/01.JAC.0000324664.88131.d2
    Full text is available at: http://epubs.surrey.ac.uk/189424/

    Abstract

    UK primary care is highly computerized; initially led by enthusiastic general practitioners who developed their own systems. This preceded the development of a National Health Service information strategy and an ambitious National Programme for IT.

  • de Lusignan S. (2008) 'Automated password generation of offensive expressions: Choose and Book and poppycock.'. Inform Prim Care, England: 16 (3), pp. 241-242.
  • de Lusignan S. (2008) 'Autumn issue of Informatics in Primary Care: extending our understanding and the case for greater research capacity and capability in informatics. Editorial.'. Inform Prim Care, England: 16 (3), pp. 171-173.
  • de Lusignan S, Buxton N, Kent A. (2008) 'New patient asking for a benzodiazepine prescription.'. BMJ BMJ, England: 337
    doi: 10.1136/bmj.a658
    Full text is available at: http://epubs.surrey.ac.uk/189396/
  • de Lusignan S, Kumarapeli P, Chan T, Pflug B, van Vlymen J, Jones B, Freeman GK. (2008) 'The ALFA (Activity Log Files Aggregation) toolkit: a method for precise observation of the consultation.'. J Med Internet Res, United States: 10 (4)
    doi: 10.2196/jmir.1080
  • de Lusignan S, Aarts J. (2008) 'UK's National Programme for IT welcomes recommendation for a more sociotechnical approach to evaluation: a commentary on the Greenhalgh evaluation of the summary care record.'. Inform Prim Care, England: 16 (2), pp. 75-77.
  • de Lusignan S. (2008) 'Using routinely collected patient data with and without consent: trust and professionalism.'. Inform Prim Care, England: 16 (4), pp. 251-254.
  • de Lusignan S. (2008) 'Developing primary care informatics.'. Inform Prim Care, England: 16 (1), pp. 1-2.
  • de Lusignan S. (2008) 'Prescribing support software recommends more expensive prescriptions.'. Inform Prim Care, England: 16 (1), pp. 61-62.
  • Refsum C, Kumarapeli P, Gunaratne A, Dodds R, Hasan A, de Lusignan S. (2008) 'Measuring the impact of different brands of computer systems on the clinical consultation: a pilot study.'. Inform Prim Care, England: 16 (2), pp. 119-127.
  • de Lusignan S. (2008) 'Change of Editor'. Informatics in Primary Care, 16 (1), pp. 63-63.
  • Klebe B, Farmer C, Cooley R, de Lusignan S, Middleton R, O'Donoghue D, New J, Stevens P. (2007) 'Kidney disease management in UK primary care: guidelines, incentives and information technology.'. Fam Pract, England: 24 (4), pp. 330-335.
    doi: 10.1093/fampra/cmm026
  • Klebe B, Irving J, Stevens PE, O'Donoghue DJ, de Lusignan S, Cooley R, Hobbs H, Lamb EJ, John I, Middleton R, New J, Farmer CK. (2007) 'The cost of implementing UK guidelines for the management of chronic kidney disease.'. Nephrol Dial Transplant, England: 22 (9), pp. 2504-2512.
    doi: 10.1093/ndt/gfm248
  • Stevens PE, O'Donoghue DJ, de Lusignan S, Van Vlymen J, Klebe B, Middleton R, Hague N, New J, Farmer CK. (2007) 'Chronic kidney disease management in the United Kingdom: NEOERICA project results.'. Kidney Int, United States: 72 (1), pp. 92-99.
    doi: 10.1038/sj.ki.5002273
  • New JP, Middleton RJ, Klebe B, Farmer CK, de Lusignan S, Stevens PE, O'Donoghue DJ. (2007) 'Assessing the prevalence, monitoring and management of chronic kidney disease in patients with diabetes compared with those without diabetes in general practice.'. Diabet Med, England: 24 (4), pp. 364-369.
    doi: 10.1111/j.1464-5491.2007.02075.x
  • de Lusignan S, Chan T, Theadom A, Dhoul N. (2007) 'The roles of policy and professionalism in the protection of processed clinical data: a literature review.'. Int J Med Inform, Ireland: 76 (4), pp. 261-268.
    doi: 10.1016/j.ijmedinf.2005.11.003
  • Kumarapeli P, De Lusignan S, Ellis T, Jones B. (2007) 'Using Unified Modelling Language (UML) as a process-modelling technique for clinical-research process improvement.'. Med Inform Internet Med, England: 32 (1), pp. 51-64.
    doi: 10.1080/14639230601097705
  • Kumarapeli P, de Lusignan S, Koczan P, Jones B, Sheeler I. (2007) 'The feasibility of using UML to compare the impact of different brands of computer system on the clinical consultation.'. Inform Prim Care, England: 15 (4), pp. 245-253.
  • Moulene MV, de Lusignan S, Freeman G, van Vlymen J, Sheeler I, Singleton A, Kumarapeli P. (2007) 'Assessing the impact of recording quality target data on the GP consultation using multi-channel video.'. Stud Health Technol Inform, Netherlands: 129 (Pt 2), pp. 1132-1136.
  • de Lusignan S, Teasdale S. (2007) 'Achieving benefit for patients in primary care informatics: the report of a international consensus workshop at Medinfo 2007.'. Inform Prim Care, England: 15 (4), pp. 255-261.
  • Tai TW, Anandarajah S, Dhoul N, de Lusignan S. (2007) 'Variation in clinical coding lists in UK general practice: a barrier to consistent data entry?'. Inform Prim Care, England: 15 (3), pp. 143-150.
  • Crinson I, Shaw A, Durrant R, De Lusignan S, Williams B. (2007) 'Coronary heart disease and the management of risk: Patient perspectives of outcomes associated with the clinical implementation of the National Service Framework targets'. ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD HEALTH RISK & SOCIETY, 9 (4), pp. 359-373.
    doi: 10.1080/13698570701612527
  • Pigott K, De Lusignan S, Rapley A, Robinson J, Pritchard-Copley A. (2007) 'An Informatics benchmarking statement'. SCHATTAUER GMBH-VERLAG MEDIZIN NATURWISSENSCHAFTEN METHODS OF INFORMATION IN MEDICINE, 46 (4), pp. 394-398.
    doi: 10.1160/ME0442
    Full text is available at: http://epubs.surrey.ac.uk/186001/
  • de Lusignan S, Katić M. (2007) 'UK and Croatia: family practice, its medical records and computerisation in the context of an enlarged Europe.'. Inform Prim Care, England: 15 (3), pp. 169-173.
  • Kumarapeli P, De Lusignan S, Kumarapeli P, Ellis T, Jones B. (2007) 'Using Unified Modelling Language (UML) as a process-modelling technique for clinical-research process improvement'. Informatics for Health and Social Care, 32 (1), pp. 51-64.
    doi: 10.1080/14639230601097705
  • de Lusignan S. (2007) 'An educational intervention, involving feedback of routinely collected computer data, to improve cardiovascular disease management in UK primary care.'. Schattauer Methods Inf Med, Germany: 46 (1), pp. 57-62.
    Full text is available at: http://epubs.surrey.ac.uk/185998/

    Abstract

    To report the lessons learned from eight years of feeding back routinely collected cardiovascular data in an educational context

  • de Lusignan S. (2007) 'Relearning the lessons about the implementation of information systems in primary care: a report from the European Federation for Medical Informatics (EFMI) Special Topic Conference 2007 in Croatia.'. Inform Prim Care, England: 15 (3), pp. 167-168.
  • Sheeler I, Koczan P, Wallage W, de Lusignan S. (2007) 'Low-cost three-channel video for assessment of the clinical consultation.'. Inform Prim Care, England: 15 (1), pp. 25-31.
  • de Lusignan S, Belsey J, Hague N, Dhoul N, van Vlymen J. (2006) 'Audit-based education to reduce suboptimal management of cholesterol in primary care: a before and after study.'. Oxford University Press J Public Health (Oxf), England: 28 (4), pp. 361-369.
    doi: 10.1093/pubmed/fdl052
    Full text is available at: http://epubs.surrey.ac.uk/186007/

    Abstract

    Statins are recommended for the secondary prevention of cardiovascular disease, although they are often used in suboptimal doses and some patients may not receive lipid-lowering therapy. The Primary Care Data Quality (PCDQ) programme is an audit-based educational intervention.

  • Gomez GB, de Lusignan S, Gallagher H. (2006) 'Chronic kidney disease: a new priority for primary care.'. Br J Gen Pract, England: 56 (533), pp. 908-910.
  • Leong A, Koczan P, De Lusignan S, Sheeler I. (2006) 'A framework for comparing video methods used to assess the clinical consultation: a qualitative study.'. Med Inform Internet Med, England: 31 (4), pp. 255-265.
    doi: 10.1080/14639230600991668
  • de Lusignan S, van Vlymen J, Hague N, Dhoul N. (2006) 'Using computers to identify non-compliant people at increased risk of osteoporotic fractures in general practice: a cross-sectional study.'. Springer Osteoporosis International, England: 17 (12), pp. 1808-1814.
    doi: 10.1007/s00198-006-0188-9
    Full text is available at: http://epubs.surrey.ac.uk/191661/

    Abstract

    National guidelines recommend bisphosphonates for secondary prevention of osteoporotic fractures; however, poor compliance may result in sub-optimal prevention.

  • de Lusignan S. (2006) 'Chronic kidney disease.'. Br J Gen Pract, England: 56 (532)
  • Kumarapeli P, Stepaniuk R, de Lusignan S, Williams R, Rowlands G. (2006) 'Ethnicity recording in general practice computer systems.'. J Public Health (Oxf), England: 28 (3), pp. 283-287.
    doi: 10.1093/pubmed/fdl044
  • Schade CP, Sullivan FM, de Lusignan S, Madeley J. (2006) 'e-Prescribing, efficiency, quality: lessons from the computerization of UK family practice.'. BMJ Publishing Group J Am Med Inform Assoc, United States: 13 (5), pp. 470-475.
    doi: 10.1197/jamia.M2041
    Full text is available at: http://epubs.surrey.ac.uk/188342/

    Abstract

    Nearly all general practice physicians (GPs) in the United Kingdom (UK) have electronic health record (EHR) systems in their practices compared with perhaps 15% of primary care physicians in the United States (U.S.). Based on interviews of 13 general GPs and review of current literature, the authors argue that the historical experience of widespread electronic health record uptake in the UK provides insight into features that might motivate broad adoption in the United States. These features include electronic prescribing, improved quality and consistency of care, practice efficiencies that have both timesaving and revenue generating effects, and potential shielding from malpractice claims.

  • Petri A, de Lusignan S, Williams J, Chan T, Majeed A. (2006) 'Management of cardiovascular risk factors in people with diabetes in primary care: cross-sectional study.'. Public Health, England: 120 (7), pp. 654-663.
    doi: 10.1016/j.puhe.2006.03.010
  • de Lusignan S, van Weel C. (2006) 'The use of routinely collected computer data for research in primary care: opportunities and challenges.'. Oxford University Press Fam Pract, England: 23 (2), pp. 253-263.
    doi: 10.1093/fampra/cmi106
  • Dhoul N, van Vlymen J, de Lusignan S. (2006) 'Quality of smoking data in GP computer systems in the UK'. Informatics in Primary Care, 14 (4), pp. 242-245.
  • de Lusignan S, Metsemakers JF, Houwink P, Gunnarsdottir V, van der Lei J. (2006) 'Routinely collected general practice data: goldmines for research? A report of the European Federation for Medical Informatics Primary Care Informatics Working Group (EFMI PCIWG) from MIE2006, Maastricht, The Netherlands.'. Inform Prim Care, England: 14 (3), pp. 203-209.
  • Leong A, Koczan P, De Lusignan S, Sheeler I. (2006) 'A framework for comparing video methods used to assess the clinical consultation: A qualitative study'. Informatics for Health and Social Care, 31 (4), pp. 255-265.
    doi: 10.1080/14639230600991668
  • Chan T, De Lusignan S, Roberts AP, Cohen A, De Lusignan S, Dhoul N, Hague N, Van Vlymen J. (2006) 'Prescription of psychotropic medications in primary care: A cross-sectional study of general practice computer records'. Primary Care Mental Health, 4 (2), pp. 81-92.
  • Robinson J, de Lusignan S, Kostkova P, Madge B, Southgate L. (2006) 'Specific classification of elibrary resources says more about users' preferences.'. Stud Health Technol Inform, Netherlands: 124, pp. 719-724.
  • Robinson J, de Lusignan S, Kostkova P, Madge B, Marsh A, Biniaris C. (2006) 'The Primary Care Electronic Library: RSS feeds using SNOMED-CT indexing for dynamic content delivery.'. Inform Prim Care, England: 14 (4), pp. 247-252.
  • de Lusignan S. (2006) 'Chronic kidney disease [5]'. British Journal of General Practice, 56 (532), pp. 885-885.
  • de Lusignan S, Mimnagh C. (2006) 'Breaking the first law of informatics: the Quality and Outcomes Framework (QOF) in the dock.'. Inform Prim Care, England: 14 (3), pp. 153-156.
  • Williams PH, de Lusignan S. (2006) 'Does a higher 'quality points' score mean better care in stroke? An audit of general practice medical records.'. Inform Prim Care, England: 14 (1), pp. 29-40.
  • de Lusignan S. (2006) 'The optimum granularity for coding diagnostic data in primary care: report of a workshop of the EFMI Primary Care Informatics Working Group at MIE 2005.'. Inform Prim Care, England: 14 (2), pp. 133-137.
  • de Lusignan S, Hague N, Belsey J, Dhoul N, van Vlymen J. (2006) 'The 'rule of halves' still applies to the management of cholesterol in cardiovascular disease: 2002-2005'. British Journal of Cardiology, 13 (2), pp. 145-153.
  • de Lusignan S. (2006) 'Biomedical Informatics: developing university, healthcare and industrial partnerships.'. Inform Prim Care, England: 14 (4), pp. 255-256.
  • de Lusignan S, Metsemakers JFM, Houwink P, Houwink P, Gunnarsdottir V, van der Lei J. (2006) 'Routinely collected general practice data: Goldmines for research?'. Informatics in Primary Care, 14 (3), pp. 203-209.
  • Kumarapeli P, de Lusignan S, Robinson J. (2006) 'Online resources for chronic kidney disease (CKD) for primary care.'. Inform Prim Care, England: 14 (2), pp. 139-142.
  • de Lusignan S, Hague N, van Vlymen J, Kumarapeli P. (2006) 'Routinely-collected general practice data are complex, but with systematic processing can be used for quality improvement and research.'. Inform Prim Care, England: 14 (1), pp. 59-66.
  • de Lusignan S, Hague N, van Vlymen J, Dhoul N, Chan T, Thana L, Kumarapeli P. (2006) 'A study of cardiovascular risk in overweight and obese people in England.'. Eur J Gen Pract, England: 12 (1), pp. 19-29.
    doi: 10.1080/13814780600757260
  • de Lusignan S, Shaw A, Wells S, Rowlands G. (2006) 'Practice-based commissioning: The impact of motivational and organisational factors on its success'. British Journal of Health Care Management, 12 (6), pp. 174-180.
  • Robinson J, de Lusignan S, Kostkova P, Madge B. (2006) 'Using UMLS to map from a library to a clinical classification: Improving the functionality of a digital library.'. Stud Health Technol Inform, Netherlands: 121, pp. 86-95.
  • Williams B, Shaw A, Durrant R, Crinson I, Pagliari C, de Lusignan S. (2005) 'Patient perspectives on multiple medications versus combined pills: a qualitative study.'. QJM, England: 98 (12), pp. 885-893.
    doi: 10.1093/qjmed/hci139
  • Anandarajah S, Tai T, de Lusignan S, Stevens P, O'Donoghue D, Walker M, Hilton S. (2005) 'The validity of searching routinely collected general practice computer data to identify patients with chronic kidney disease (CKD): a manual review of 500 medical records.'. Nephrol Dial Transplant, England: 20 (10), pp. 2089-2096.
    doi: 10.1093/ndt/gfi006
  • de Lusignan S, Chan T, Wood O, Hague N, Valentin T, Van Vlymen J. (2005) 'Quality and variability of osteoporosis data in general practice computer records: implications for disease registers.'. Public Health, England: 119 (9), pp. 771-780.
    doi: 10.1016/j.puhe.2004.10.018
  • Shaw A, de Lusignan S, Rowlands G. (2005) 'Do primary care professionals work as a team: a qualitative study.'. J Interprof Care, England: 19 (4), pp. 396-405.
    doi: 10.1080/13561820500053454
  • de Lusignan S. (2005) 'The barriers to clinical coding in general practice: a literature review.'. Med Inform Internet Med, England: 30 (2), pp. 89-97.
    doi: 10.1080/14639230500298651
  • de Lusignan S, Chan T, Stevens P, O'Donoghue D, Hague N, Dzregah B, Van Vlymen J, Walker M, Hilton S. (2005) 'Identifying patients with chronic kidney disease from general practice computer records.'. Oxford University Press Fam Pract, England: 22 (3), pp. 234-241.
    doi: 10.1093/fampra/cmi026
  • Lusignan S, Sismanidis C, Carey IM, DeWilde S, Richards N, Cook DG. (2005) 'Trends in the prevalence and management of diagnosed type 2 diabetes 1994-2001 in England and Wales.'. BMC Fam Pract, England: 6 (1)
    doi: 10.1186/1471-2296-6-13
  • De Lusignan S, Wells S, Shaw A, Rowlands G, Crilly T. (2005) 'A knowledge audit of the managers of primary care organizations: top priority is how to use routinely collected clinical data for quality improvement.'. Med Inform Internet Med, England: 30 (1), pp. 69-80.
    doi: 10.1080/14639230400028455
  • de Lusignan S, van Vlymen J, Hague N, Thana L, Dzregah B, Chan T. (2005) 'Preventing stroke in people with atrial fibrillation: a cross-sectional study.'. Oxford University Press J Public Health (Oxf), England: 27 (1), pp. 85-92.
    doi: 10.1093/pubmed/fdh201
    Full text is available at: http://epubs.surrey.ac.uk/189404/

    Abstract

    The annual stroke rate in atrial fibrillation is around 5 per cent with increased risk in those with hypertension, diabetes, left ventricular dysfunction and other cardiovascular risk factors. This study set out to identify the patients with atrial fibrillation and modifiable risk factors for stroke.

  • Majeed A, Williams J, de Lusignan S, Chan T. (2005) 'Management of heart failure in primary care after implementation of the National Service Framework for Coronary Heart Disease: a cross-sectional study.'. Public Health, England: 119 (2), pp. 105-111.
    doi: 10.1016/j.puhe.2004.06.006
  • de Lusignan S. (2005) 'Codes, classifications, terminologies and nomenclatures: definition, development and application in practice.'. Inform Prim Care, England: 13 (1), pp. 65-70.
  • De Lusignan S, Wells S, Shaw A, Rowlands G, Crilly T. (2005) 'A knowledge audit of the managers of primary care organizations: Top priority is how to use routinely collected clinical data for quality improvement'. Informa Healthcare Informatics for Health and Social Care, 30 (1), pp. 69-80.
    doi: 10.1080/14639230400028455
  • Robinson J, de Lusignan S, Kostkova P. (2005) 'The Primary Care Electronic Library (PCEL) five years on: open source evaluation of usage.'. Inform Prim Care, England: 13 (4), pp. 271-280.
  • de Lusignan S. (2005) 'Web-based health applications provide useful and cost-effective tools; however, they should include key clinical variables and incorporate a coding or classification system.'. Inform Prim Care, England: 13 (1), pp. 42-44.
  • De Lusignan S, Shaw A, Wells S, Rowlands G, De Lusignan S. (2005) 'Why do some practices innovate: A qualitative study of the views of primary care professionals'. Clinician in Management, 13 (3-4), pp. 135-143.
  • De Lusignan S, Thana L, Dhoul N, Hague N, Van Vlymen J, Chan T, Cohen A. (2005) 'Health education and prevention for people with severe mental illness: A cross-sectional study of general practice computer records'. Primary Care Mental Health, 3 (3), pp. 221-233.
  • Tringali M, de Lusignan S. (2005) 'Foundations of a healthcare knowledge management application system.'. AMIA Annu Symp Proc, United States:
    Full text is available at: http://epubs.surrey.ac.uk/188346/

    Abstract

    Much of the knowledge management (KM) literature suggests that organizations should adopt either a "personalization" or "codification" strategy and that to mix the two is unwise. Two European schools have come to the conclusion that a broad strategy is needed. Its key conceptual elements are in three dimensions: the type (explicit - tacit), focus (information - learning) and organization (digital - social) of knowledge. Without this broad approach it is impossible to reconcile the wish to provide (codified) evidence-based solutions to populations at the same time as personalized care for individuals.

  • de Lusignan S, Ellis B. (2005) 'Is the time right for direct entry into a career in health and biomedical informatics?'. Inform Prim Care, England: 13 (3), pp. 167-170.
  • van Vlymen J, de Lusignan S. (2005) 'A system of metadata to control the process of query, aggregating, cleaning and analysing large datasets of primary care data.'. Inform Prim Care, England: 13 (4), pp. 281-291.
  • De Lusignan S. (2005) 'The barriers to clinical coding in general practice: A literature review'. Informatics for Health and Social Care, 30 (2), pp. 89-97.
    doi: 10.1080/14639230500298651
  • Chan T, de Lusignan S, Brew S. (2004) 'Overcoming the barriers to using information systems.'. Nurs Times, England: 100 (49), pp. 44-46.
  • Cox S, de Lusignan S, Chan T. (2004) 'General practitioners believe that hypnotherapy could be a useful treatment for irritable bowel syndrome in primary care.'. BioMed Central BMC Fam Pract, England: 5 (22)
    doi: 10.1186/1471-2296-5-22
    Full text is available at: http://epubs.surrey.ac.uk/188348/

    Abstract

    Irritable bowel syndrome is a common condition in general practice. It occurs in 10 to 20% of the population, but less than half seek medical assistance with the complaint.

  • Chan T, Brew S, de Lusignan S. (2004) 'Community nursing needs more silver surfers: a questionnaire survey of primary care nurses' use of information technology.'. BMC Nurs, 3 (1)
    doi: 10.1186/1472-6955-3-4
    Full text is available at: http://epubs.surrey.ac.uk/186022/

    Abstract

    BACKGROUND: In the UK the health service is investing more than ever before in information technology (IT) and primary care nurses will have to work with computers. Information about patients will be almost exclusively held in electronic patient records; and much of the information about best practice is most readily accessible via computer terminals. OBJECTIVE: To examine the influence of age and nursing profession on the level of computer use. METHODS: A questionnaire was developed to examine: access, training received, confidence and use of IT. The survey was carried out in a Sussex Primary Care Trust, in the UK. RESULTS: The questionnaire was sent to 109 nurses with a 64% response rate. Most primary care nurses (89%) use their computer regularly at work: 100% of practice nurses daily, compared with 60% of district nurses and 59% of health visitors (p < 0.01). Access to IT was not significantly different between different age groups; but 91% of practice nurses had their own computer while many district nurses and health visitors had to share (p < 0.01). Nurses over 50 had received more training that their younger colleagues (p < 0.01); yet despite this, they lacked confidence and used computers less (p < 0.001). 96% of practice nurses were confident at in using computerised medical records, compared with 53% of district nurses and 44% of health visitors (p < 0.01.) One-to-one training and workshops were the preferred formats for training, with Internet based learning and printed manuals the least popular (p < 0.001). CONCLUSIONS: Using computers in the surgery has become the norm for primary care nurses. However, nurses over 50, working out in the community, lack the confidence and skill of their younger and practice based colleagues.

  • de Lusignan S, Belsey J, Hague N, Dzregah B. (2004) 'End-digit preference in blood pressure recordings of patients with ischaemic heart disease in primary care.'. J Hum Hypertens, England: 18 (4), pp. 261-265.
    doi: 10.1038/sj.jhh.1001663
  • Chan T, de Lusignan S, Pritchard K. (2004) 'Nurses and IT: a survey of use among community clinical staff.'. Prof Nurse, England: 19 (8), pp. 449-452.
  • de Lusignan S, Hague N, Brown A, Majeed A. (2004) 'An educational intervention to improve data recording in the management of ischaemic heart disease in primary care.'. Oxford University Press J Public Health (Oxf), England: 26 (1), pp. 34-37.
    doi: 10.1093/pubmed/fdh104
    Full text is available at: http://epubs.surrey.ac.uk/185997/

    Abstract

    Gaps in computerized medical records and a lack of a systematic approach to data recording make progress towards achieving quality standards in primary care difficult to demonstrate. The aim of this study was to examine the effect of an educational intervention on data quality in primary care.

  • de Lusignan S, Teasdale S, Little D, Zapp J, Zuckerman A, Bates DW, Steele A. (2004) 'Comprehensive computerised primary care records are an essential component of any national health information strategy: report from an international consensus conference.'. Inform Prim Care, England: 12 (4), pp. 255-264.
  • Faulconer ER, de Lusignan S. (2004) 'An eight-step method for assessing diagnostic data quality in practice: chronic obstructive pulmonary disease as an exemplar.'. Inform Prim Care, England: 12 (4), pp. 243-254.
  • de Lusignan S, Singleton A, Wells S. (2004) 'Lessons from the implementation of a near patient anticoagulant monitoring service in primary care.'. Inform Prim Care, England: 12 (1), pp. 27-33.
  • de Lusignan S, Valentin T, Chan T, Hague N, Wood O, van Vlymen J, Dhoul N. (2004) 'Problems with primary care data quality: osteoporosis as an exemplar.'. Inform Prim Care, England: 12 (3), pp. 147-156.
  • de Lusignan S, Wilson E, Dyble A, Grant T, Theadom A, Chan T. (2003) 'The feasibility of using pattern recognition software to measure the influence of computer use on the consultation.'. BioMed Central BMC Med Inform Decis Mak, England: 3 (12)
    doi: 10.1186/1472-6947-3-12
    Full text is available at: http://epubs.surrey.ac.uk/189427/

    Abstract

    A key feature of a good general practice consultation is that it is patient-centred. A number of verbal and non-verbal behaviours have been identified as important to establish a good relationship with the patient. However, the use of the computer detracts the doctor's attention away from the patient, compromising these essential elements of the consultation. Current methods to assess the consultation and the influence of the computer on them are time consuming and subjective. If it were possible to measure these quantitatively, it could provide the basis for the first truly objective way of studying the influence of the computer on the consultation. The aim was to assess whether pattern recognition software could be used to measure the influence and pattern of computer use in the consultation. If this proved possible it would provide, for the first time, an objective quantitative measure of computer use and a measure of the attention and responsiveness of the general practitioner towards the patient.

  • de Lusignan S, Chan T, Wells S, Cooper A, Harvey M, Brew S, Wright M. (2003) 'Can patients with osteoporosis, who should benefit from implementation of the national service framework for older people, be identified from general practice computer records? A pilot study that illustrates the variability of computerized medical records and problems with searching them.'. Elsevier Public Health, England: 117 (6), pp. 438-445.
    doi: 10.1016/S0033-3506(03)00129-X
  • de Lusignan S. (2003) 'The National Health Service and the internet.'. Royal Society of Medicine Press Journal of the Royal Society of Medicine, England: 96 (10), pp. 490-493.
    doi: 10.1258/jrsm.96.10.490
  • Braithwaite D, Emery J, De Lusignan S, Sutton S. (2003) 'Using the Internet to conduct surveys of health professionals: a valid alternative?'. Fam Pract, England: 20 (5), pp. 545-551.
  • de Lusignan S. (2003) 'What is primary care informatics?'. J Am Med Inform Assoc, United States: 10 (4), pp. 304-309.
    doi: 10.1197/jamia.M1187
  • Wells S, de Lusignan S. (2003) 'Does screening for loss of lung function help smokers give up?'. Br J Nurs, England: 12 (12), pp. 744-750.
  • de Lusignan S, Lakhani M, Chan T. (2003) 'The role of informatics in continuing professional development and quality improvement in primary care.'. Medknow Publications J Postgrad Med, India: 49 (2), pp. 163-165.
    Full text is available at: http://epubs.surrey.ac.uk/191651/
  • de Lusignan S. (2003) 'Commentary: Improve the quality of the consultation.'. BMJ, England: 326 (7382), pp. 202-206.
  • de Lusignan S. (2003) 'Commentary: improve the quality of the consultation'. BRITISH MED JOURNAL PUBL GROUP BRITISH MEDICAL JOURNAL, 326 (7382), pp. 205-206.
  • de Lusignan S, Wells S, Russell C. (2003) 'A model for patient-centred nurse consulting in primary care.'. Br J Nurs, England: 12 (2), pp. 85-90.
  • Theadom A, de Lusignan S, Wilson E, Chan T. (2003) 'Using three-channel video to evaluate the impact of the use of the computer on the patient-centredness of the general practice consultation.'. Inform Prim Care, England: 11 (3), pp. 149-156.
  • De Lusignan S, Wilson E, Dyble A, Grant T, Theadom A, Chan T. (2003) 'The feasibility of using pattern recognition software to measure the influence of computer use on the consultation'. BioMed Central BMC Medical Informatics and Decision Making, 3 (12), pp. 1-10.
    doi: 10.1186/1472-6947-3-12
    Full text is available at: http://epubs.surrey.ac.uk/189426/

    Abstract

    Background: A key feature of a good general practice consultation is that it is patient-centred. A number of verbal and non-verbal behaviours have been identified as important to establish a good relationship with the patient. However, the use of the computer detracts the doctor's attention away from the patient, compromising these essential elements of the consultation. Current methods to assess the consultation and the influence of the computer on them are time consuming and subjective. If it were possible to measure these quantitatively, it could provide the basis for the first truly objective way of studying the influence of the computer on the consultation. The aim was to assess whether pattern recognition software could be used to measure the influence and pattern of computer use in the consultation. If this proved possible it would provide, for the first time, an objective quantitative measure of computer use and a measure of the attention and responsiveness of the general practitioner towards the patient. Methods: A feasibility study using pattern recognition software to analyse a consultation was conducted. A web camera, linked to a data-gathering node was used to film a simulated consultation in a standard office. Members of the research team enacted the role of the doctor and the patient, using pattern recognition software to try and capture patient-centred, non-verbal behaviour. As this was a feasibility study detailed results of the analysis are not presented. Results: It was revealed that pattern recognition software could be used to analyse certain aspects of a simulated consultation. For example, trigger lines enabled the number of times the clinician's hand covered the keyboard to be counted and wrapping recorded the number of times the clinician nodded his head. It was also possible to measure time sequences and whether the movement was brief or lingering. Conclusion: Pattern recognition software enables movements associated with patientcentredness to be recorded. Pattern recognition software has the potential to provide an objective, quantitative measure of the influence of the computer on the consultation.

  • de Lusignan S. (2003) 'Introduction to the Primary Care Informatics Working Group of the European Federation for Medical Informatics (EFMI).'. Inform Prim Care, England: 11 (3), pp. 175-176.
  • de Lusignan S, Teasdale S. (2003) 'Commentary'. Informatics in Primary Care, 11 (4), pp. 234-237.
  • De Lusignan S, Dzregah B, Hague N, Chan T. (2003) 'Cholesterol management in patients with IHD: An audit-based appraisal of progress towards clinical targets in primary care'. British Journal of Cardiology, 10 (3), pp. 223-228.
  • de Lusignan S, Wells SE, Hague NJ, Thiru K. (2003) 'Managers see the problems associated with coding clinical data as a technical issue whilst clinicians also see cultural barriers.'. Schattauer Methods of Information in Medicine, Germany: 42 (4), pp. 416-422.
    doi: 10.1267/METH03040416
    Full text is available at: http://epubs.surrey.ac.uk/188602/

    Abstract

    In UK general practice, the coding of clinical data (Read Coding) is far from universal. This study set out to examine the barriers to recording structured information in computerised medical records; and to explore whether managers and clinicians had different perspectives in how these barriers should be overcome.

  • Thiru K, De Lusignan S, Sullivan F, Brew S, Cooper A. (2003) 'Three steps to data quality.'. Inform Prim Care, England: 11 (2), pp. 95-102.
  • Carr-Bains S, de Lusignan S. (2003) 'Moving to paperlessness: a case study from a large general practice.'. Inform Prim Care, England: 11 (3), pp. 157-163.
  • de Lusignan S, Wells SE, Russell C, Bevington WP, Arrowsmith P. (2002) 'Development of an assessment tool to measure the influence of clinical software on the delivery of high quality consultations. A study comparing two computerized medical record systems in a nurse run heart clinic in a general practice setting.'. Med Inform Internet Med, England: 27 (4), pp. 267-280.
    doi: 10.1080/1463923031000081603
  • Howitt A, Clement S, de Lusignan S, Thiru K, Goodwin D, Wells S. (2002) 'An evaluation of general practice websites in the UK.'. Fam Pract, England: 19 (5), pp. 547-556.
  • de Lusignan S, Pritchard K, Chan T. (2002) 'A knowledge-management model for clinical practice.'. Medknow Publications. J Postgrad Med, India: 48 (4), pp. 297-303.
    Full text is available at: http://epubs.surrey.ac.uk/185983/
  • De Lusignan S, Stephens PN, Adal N, Majeed A. (2002) 'Does feedback improve the quality of computerized medical records in primary care?'. BMJ J Am Med Inform Assoc, United States: 9 (4), pp. 395-401.
    doi: 10.1197/jamia.M1023
    Full text is available at: http://epubs.surrey.ac.uk/188337/

    Abstract

    The MediPlus database collects anonymized information from generalpractice computer systems in the United Kingdom, for research purposes. Data quality markers are collated and fed back to the participating general practitioners. The authors examined whether this feedback had a significant effect on data quality.

  • Harvey M, De Lusignan S. (2002) 'Osteoporosis in postmenopausal women.'. Br J Gen Pract, England: 52 (479), pp. 496-497.
  • Cooper A, Brew S, de Lusignan S. (2002) 'The effectiveness of blood tests in detecting secondary osteoporosis or mimicking conditions in postmenopausal women.'. Br J Gen Pract, England: 52 (477), pp. 311-313.
  • de Lusignan S, Wells S, Singleton A. (2002) 'Why general practitioners do not implement evidence. Learning environments must be created that capitalise on teams' wealth of knowledge.'. BMJ, England: 324 (7338)
  • Temple J, De Lusignan S, Wells S, Singleton A. (2002) 'Why general practitioners do not implement evidence [3] (multiple letters)'. British Medical Journal, 324 (7338), pp. 674-674.
  • De Lusignan S, Wells SE, Russell C, Bevington WP, Arrowsmith P. (2002) 'Development of an assessment tool to measure the influence of clinical software on the delivery of high quality consultations. A study comparing two computerized medical record systems in a nurse run heart clinic in a general practice setting'. Informatics for Health and Social Care, 27 (4), pp. 267-280.
    doi: 10.1080/1463923031000081603
  • De Lusignan S, Hague N, Yates C, Harvey M. (2002) 'A case study from a Sussex Primary Care Group: Improving secondary prevention in coronary heart disease using an educational intervention'. British Journal of Cardiology, 9 (6)
  • Pluskiewicz W, Drozdzowska B, Halaba Z, Harvey M, De Lusignan S, Versluis RGJA. (2002) 'Osteoporosis in postmenopausal women (multiple letters)'. British Journal of General Practice, 52 (479), pp. 496-498.
  • de Lusignan S, Wells S, Johnson P, Meredith K, Leatham E. (2001) 'Compliance and effectiveness of 1 year's home telemonitoring. The report of a pilot study of patients with chronic heart failure.'. Eur J Heart Fail, Netherlands: 3 (6), pp. 723-730.
  • Johnson P, Andrews DC, Wells S, de Lusignan S, Robinson J, Vandenburg M. (2001) 'The use of a new continuous wireless cardiorespiratory telemonitoring system by elderly patients at home.'. J Telemed Telecare, England: 7 Suppl 1, pp. 76-77.
  • De Lusignan S, Thiru K, Majeed A. (2001) 'Use of computer systems in a primary care research network: Implications for the NHS information strategy'. Clinician in Management, 10 (1), pp. 32-37.
  • de Lusignan S, Minmagh C, Kennedy J, Zeimet M, Bommezijn H, Bryant J. (2001) 'A survey to identify the clinical coding and classification systems currently in use across Europe.'. Stud Health Technol Inform, Netherlands: 84 (Pt 1), pp. 86-89.
  • Clement S, Pickering A, Rowlands G, Thiru K, Candy B, de Lusignan S. (2000) 'Towards a conceptual framework for evaluating primary care research networks.'. Br J Gen Pract, ENGLAND: 50 (457), pp. 651-652.
  • de Lusignan S, Thiru K, Wells S, Dobson M, Howitt A. (2000) 'Overcoming the constraints to becoming paperless.'. Br J Gen Pract, ENGLAND: 50 (455), pp. 504-505.
  • Starkey C, Michaelis J, de Lusignan S. (2000) 'Computerised systematic secondary prevention in ischaemic heart disease: a study in one practice.'. Public Health, ENGLAND: 114 (3), pp. 169-175.
    doi: 10.1038/sj.ph.1900642
  • de Lusignan S, Wells S, Thiru K. (2000) 'Stopping antihypertensive drugs in general practice - Response'. ROYAL COLL GENERAL PRACTITIONERS BRITISH JOURNAL OF GENERAL PRACTICE, 50 (454), pp. 407-408.
  • de Lusignan S, Thiru K, Meredith K, Majeed A, Johnson P. (2000) 'Measuring blood pressure at the wrist: more comfortable for patients and more convenient for doctors?'. Elsevier Public Health, ENGLAND: 114 (3), pp. 165-168.
    doi: 10.1038/sj.ph.1900614
    Full text is available at: http://epubs.surrey.ac.uk/188832/

    Abstract

    To compare the agreement between conventional measurement of blood pressure and measurements obtained using two automated devices; and to compare how comfortable each of the three methods of measurement were for patients.

  • de Lusignan S, Wells S, Thiru K. (2000) 'Stopping antihypertensive drugs in general practice.'. Br J Gen Pract, ENGLAND: 50 (454), pp. 407-408.
  • Muir Gray JA, De Lusignan S. (2000) 'Correction: National electronic library for health (NeLH) (British Medical Journal (1999) 4 December (1476-9))'. British Medical Journal, 320 (7230), pp. 296-296.
  • De Lusignan S, Wells S, Thiru K. (2000) 'Letter to the editor'. British Journal of General Practice, 50 (454), pp. 407-408.
  • de Lusignan S, Althans A, Wells S, Johnson P, Vandenburg M, Robinson J. (2000) 'A pilot study of radiotelemetry for continuous cardiopulmonary monitoring of patients at home'. ROYAL SOC MEDICINE PRESS J TELEMED TELECARE, 6 (1), pp. 119-122.
    doi: 10.1258/1357633001934384
  • Gray JAM, de Lusignan S. (1999) 'National electronic Library for Health (NeLH) (vol 320, pg 1476, 2000)'. BRITISH MED JOURNAL PUBL GROUP BRIT MED J, 319, pp. 1476-1479.
    doi: 10.1136/bmj.319.7223.1476
    Full text is available at: http://epubs.surrey.ac.uk/189395/

    Abstract

    Modern healthcare professionals have to resolve the information paradox; they are overwhelmed with information but cannot find particular information when and where they need it.1 The internet and its associated technologies, especially the world wide web, have the potential to both exacerbate and reduce these problems. Simply providing access to the world wide web per se may exacerbate the problems of information overload, since every web browser has access to hundreds of millions of pages of information. However, the cost effective provision of access to timely, current, and high quality information is what internet technology potentially offers. Creation of the National electronic Library for Health (NeLH) should be seen as an attempt to harness internet technologies to solve this information paradox. Sir Edward Waine, regius professor of medicine in Glasgow, who invented Waine's thyroid index, an early, pre-computer, decision support system, used to teach about “la maladie du petit papier.” This described the patient who, somewhat nervously, took a little bit of paper out of his jacket pocket towards the end of the consultation and used this paper to remind him of the questions that he knew he was bound to forget in the stress of the consultation. Many clinicians have now found that le maladie du petit papier is now but a fond memory as they face daily “la maladie du grand print-out,” an altogether more daunting challenge. The world wide web has blown away the walls and doors of medical libraries, which once shielded medical knowledge from the public gaze. Members of the public can now have access to almost all the information that professionals have.

  • Muir Gray JA, de Lusignan S. (1999) 'National electronic Library for Health (NeLH)'. BMJ, ENGLAND: 319 (7223), pp. 1476-1479.
  • Thiru K, de Lusignan S, Hague N. (1999) 'Have the completeness and accuracy of computer medical records in general practice improved in the last five years? the report of a two-practice pilot study'. Health Informatics Journal, 5 (4), pp. 224-232.
    doi: 10.1177/146045829900500410
  • de Lusignan S, Meredith K, Wells S, Leatham E, Johnson P. (1999) 'A controlled pilot study in the use of telemedicine in the community on the management of heart failure--a report of the first three months.'. Stud Health Technol Inform, NETHERLANDS: 64, pp. 126-137.
  • de Lusignan S, Brown A. (1998) 'Internet can be accessed from NHSnet.'. BMJ, ENGLAND: 317 (7168)

Conference papers

  • Michalakidis G, Kumarapeli P, Ring A, van Vlymen J, Krause P, de Lusignan S. (2010) 'A system for solution-orientated reporting of errors associated with the extraction of routinely collected clinical data for research and quality improvement.'. Studies in Health Technology and Informatics: Proceedings of the 13th World Congress on Medical Informatics, Cape Town, South Africa: MEDINFO 2010 160 (Pt 1), pp. 724-728.
    doi: 10.3233/978-1-60750-588-4-724
  • Krause P, de Lusignan S. (2010) 'Procuring interoperability at the expense of usability: a case study of UK National Programme for IT assurance process.'. Studies in Health Technology and Informatics: Seamless care, safe care: the challenges of interoperability and patient safety in health care: Proceedings of the EFMI Special Topic Conference, Reykjavik, Iceland: EFMI Special Topic Conference 155, pp. 143-149.
    doi: 10.3233/978-1-60750-563-1-143
  • de Lusignan S. (2009) 'Improving Data Quality and Clinical Records: Lessons from the UK National Programme about Structure, Process and Utility'. SRCE UNIV COMPUTING CENTRE, UNIV ZAGREB PROCEEDINGS OF THE ITI 2009 31ST INTERNATIONAL CONFERENCE ON INFORMATION TECHNOLOGY INTERFACES, Cavtat, CROATIA: 31st International Conference on Information Technology Interfaces, pp. 13-14.
    doi: 10.1109/ITI.2009.5196042
  • de Lusignan S, Sullivan F. (2006) 'Integration, Interoperability or Linkage: Which Elements of National IT Strategy Best Support Primary Care?'. AKADEMISCHE VERLAGSGESELLSCH AKA GMBH INTEGRATING BIOMEDICAL INFORMATION: FROM E-CELL TO E-PATIENT, Timiaoara, ROMANIA: European-Federation-for-Medical-Informatics Special Topic Conference, pp. 79-84.
  • Stevens PE, O'Donoghue DJ, de Lusignan S, Walker M, Van Vlymen J, Middleton R, Dzregah B, Farmer CK. (2005) 'Identification of CKD from interrogation of primary care electronic patient records: Factors predicting level of and decline in estimated GFR'. OXFORD UNIV PRESS NEPHROLOGY DIALYSIS TRANSPLANTATION, Istanbul, TURKEY: 42nd Annual Meeting of the European-Renal-Association/European-Dialysis-and-Transplant-Association (ERA-EDTA) 20, pp. V287-V288.
  • van Vlymen J, de Lusignan S, Hague N, Chan T, Dzregah B. (2005) 'Ensuring the Quality of Aggregated General Practice Data: Lessons from the Primary Care Data Quality Programme (PCDQ)'. I O S PRESS CONNECTING MEDICAL INFORMATICS AND BIO-INFORMATICS, Geneva, SWITZERLAND: 19th International Congress of the European-Federation-for-Medical-Informatics 116, pp. 1010-1015.
  • de Lusignan S. (2005) 'Using Feedback to Raise the Quality of Primary Care Computer Data: a Literature Review'. I O S PRESS CONNECTING MEDICAL INFORMATICS AND BIO-INFORMATICS, Geneva, SWITZERLAND: 19th International Congress of the European-Federation-for-Medical-Informatics 116, pp. 593-598.
  • de Lusignan S, Wells S. (2002) 'Is the lack of emphasis on learning a barrier to the effective deployment of informatics? Content analysis of NHS strategy and information strategy since 1998?'. HANLEY & BELFUS INC MED PUBLISHERS AMIA 2002 SYMPOSIUM, PROCEEDINGS, San Antonio, TX: Annual Symposium of the American-Medical-Informatics-Association, pp. 1005-1005.
  • Johnson P, Andrews DC, Wells S, de Lusignan S, Robinson J, Vandenburg M. (2001) 'The use of a new continuous wireless cardiorespiratory telemonitoring system by elderly patients at home'. ROYAL SOC MEDICINE PRESS LTD JOURNAL OF TELEMEDICINE AND TELECARE, LONDON, ENGLAND: 8th International Conference on Telemedicine and Telecare 7, pp. S76-S77.

Departmental Duties

Research leadership within the Department of Health Care Management & Policy

Member of Health and Medical Strategy Committee