Transcript Medical Informatics

Medical Informatics
Assignment II
I.T. in General Practice
The Castle Surgery, Carrickfergus
Leah Spence, Philip Anderson
Outline
• Brief overview of the surgery
• An Introduction to the software
• Features of the System: Advantages &
Disadvantages of:
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Appointments
Prescriptions
Communications
Patient Notes
Future Developments
The Castle Surgery
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10 Doctors, 4 nurses, 2 HCA’s, 13 receptionists
15,000 Patients
25 computers
EMIS system installed 1999
Entirely paperless by 2001
Not subsidised by NHS
EMIS an Introduction
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“Egton Medical Information Systems”
Invented in Leeds, 1982
“Written by Doctors for Doctors”
A multifunctional computer program devised
to:– Assist GPs during and after consultations
– Ease the job of the Receptionist
– Provide the best possible service to Patients
Key features of EMIS Primary
Care System
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Complete patient Management
Intelligent Prescribing
Definitive Medical Records
Formulary Management
Integrated Consultation Mods
Integrated Appointments
Advanced Decision Support
Integrated with Microsoft Word
User Defined templates
EMIS Drug Explorer
General System
• Regular System online Upgrades
• Integrated with Microsoft Word
• System wide audits
Appointments - Advantages
• Made in person or over the phone
• Patients can check-in at reception or using
the self check-in
• The doctor’s computer notifies them that a
patient is waiting
• JX board calls the patient when the doctor is
ready
• Any changes to appointments are made
immediately on the doctor’s computer,
e.g. cancellations
Appointments - Disadvantages
• Difficultiy for visually impared patients in
seeing the JX board
• Reluctance in using self check-in
Prescriptions
• Prescription items are split into two
categories: Acute and Repeat
• Repeat items can be printed by
reception staff, acute items have to be
printed by doctor
Prescriptions - Advantages
• Formulary and Full List of Drugs easilly
accessible
• Repeat prescriptions easily printed by both
doctor and receptionist
• Reduces manual errors e.g. illegible
handwriting
• Automated warnings
– Allergy warnings
– Review reminders
• Last date of issue shown
– Flags up potential drug overuse
Prescriptions - Disadvantages
• Relies on drug information being up to
date
• Aptitude of the staff using software
– E.g. ordering appropriate quantities
• Discretion required in dealing with
automated warnings
Communications - Advantages
• Electronic transfer of Lab results between
hospital and practice
– Doctor can act on these results, and get reception
staff to contact the patient if required
– Normal ranges indicated with lab results
• Internal messaging between reception staff
and doctors
– So as not to disturb doctor during surgery
– Abusive Patient Warning
Communications - Disadvantages
• No mechanism for dealing with lab results
which appear normal, but need to be acted
upon.
• Staff have to check for new messages
regularly
• Hospital still use paper for referral letters
– Laborious to scan in, and store in correct location
with the patient’s paper notes
• Issues regarding data security and
confidentiality
Clinical Decision Support Mentor Library
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Clinical Handbook
Travel Advice
Consise Oxford Textbook of Medicine
DeRmis
Drug Info Leaflets
Patient Info Leaflets
DVLA and Drug Misuse guidelines
PRODIGY
Security
• Daily backups, every night upto tape
• 2 copies
– Fireproof safe
– Location outside of practice
Security - Advantages
• All staff have their own user ID and password
• Computer locks itself when left unattended
• Firewall and anti-virus software on all
computers
• Audit Trail
• Sensitive material can only be
viewed by appropriate personnel
Security - Disadvantages
• Password has to be changed after 60 log ins
• Can only view one patient’s record at a time
• Locum doctors have to use another member
of staff’s account
• Human error
– Forgetting passwords
– Leaving computer on
Patient Records - Advantages
• Full record of each patient’s past medical
history, current drugs, Hospital admission
• Record can be viewed onscreen when the
patient enters the surgery
• Ease of searching
• Easy access
• Hospital letters scanned in
and attached to patient’s noted
• Summary sheets can be
printed out prior to a home visit
Patient Records - Disadvantages
• Time required to put all relevant information
onto the system
• Admission of a new patient takes a long time,
there is no straightforward transfer of patient’s
notes to the computer
• Data input potentially
slower
• Possible system failure
• Problems with patient
contact
New GP Contract
• READ Codes
– Provide a universal way of categorising
conditions, treatments and actions
– Not used by hospital
• System flashes up outstanding
checkups for a patient. e.g. diabetic
monitoring
Future enhancements
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Online prescription ordering
Online appointment booking
Referral letters by e-mail
NHS Net
IT training for doctors