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 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 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 • • • • • Online prescription ordering Online appointment booking Referral letters by e-mail NHS Net IT training for doctors