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:– Appointments– Prescriptions– Communications– Patient Notes– Future Developments

The Castle Surgery

• 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

• “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

• 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 SystemGeneral 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

• 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 potentiallyslower

• 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

• Online prescription ordering

• Online appointment booking

• Referral letters by e-mail

• NHS Net

• IT training for doctors