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The dimensions of the
change in the UK
Until recently many hospitals and health-care centers developed their
own self-sufficient patient administration systems: “two hospitals in
the same town might have completely different software running on completely
different types of computers 3 ”. No wonder that health services experienced
communication difficulties. Thus, to ensure the consistency of information,
the UK government has introduced a new strategy for NHS information systems,
with the core objectives of 3,7,6 :
- lifelong health records for every person in the UK
- 24 hour on-line access to patient information
- an NHS network linking community, GPs and hospitals
- public access to information using on-line services
- information resources for NHS managers
To implement these ambitions it was essential to bring to life CPR administration
systems, like Hospital Information Support System (HISS) – “an initiative
that links different departments within a Trust together through an integrated
network, designed to facilitate the communication between departments,
making ordering resources, drugs, meals and tests easier and providing
better access to information 3 ”. Staff has the right to use the data
that is relevant to their own needs from terminals around the hospital
grounds, but they cannot access information about other departments 6,3
. This capacity to correspond between departments has been improved by
the introduction of NHSnet e-mail service - NHS nationwide project, that
connects every hospital, GP practice and health center to a unified national
network with the aim “to facilitate immediate access to patient's notes
and X-rays, wherever in the UK the patient happens to be and to eliminate
case note duplication and records being sent from one place to another
3 ”. A Londoner taken ill in Aberdeen , for example, could have his details
beamed across the country.
Previous episodes of NHS computerization, mostly of administrative character,
made some clinicians disappointed and disillusioned about what IT can
do for them with relevance to clinical practice 6,8 . But nowadays much
more effort is placed on development of systems that help doctors, nurses
and other healthcare professionals give better care to patients within
communicative and real-time working environment 9 . This means that a
clinician can see all the information, even held in different places
and on different systems, on the computer/laptop. Clinical comment in
the form of immediate feedback to the clinician is more effective than
retrospective reports 9 . Computers can help to do job-order tests, prescribe
drugs, do care assessment and care plans, maintain records, do discharge
letters. They can also give advice, alerts and warnings and links to
sources of knowledge like the Internet as clinicians do their work 9,10
. Online booking of hospital appointments would allow patients to choose
convenient times and reschedule if they were unable to attend 7,11 The
digitization of patient records makes it easier for hospitals and local
doctors to exchange information 10,11 .
CPAS can significantly increase the efficiency and effectiveness of
patient care. Simply displaying relevant patient information on history,
test results, interventions related to particular clinical problems in
an organized way can greatly improve efficiency and even reduce the number
of investigations performed having the right information at the right
time, e.g. having current medication and dietary analysis sensibly organized
and displayed will reduce time to make decisions as well as promote their
accuracy 9,10 . 32% reduction in laboratory test charges came after introducing
CPAS to organize and display results 9,10 .
It took the UK government quite a lot of effort to address the issue
of IT in health care, but eventually rates of computerization of GPs'
reached 98% in 2003 (the rate of GP practice connection to NHSnet: 1999
- 75 (0.9%), 2000 – 4 611 (53%), 2001 – 8 125 (93%) 5 . This is a direct
consequence of removal of a government requirement for paper-based records
5 . Gradual introduction of high-speed connection for NHSnet users will
improve the link between hospitals and GP surgeries across the UK 5 ,
as part of the programme to bring broadband to every GP surgery and school
in the country by 2006 12 . Without it data exchange can be very time
consuming and potentially subject to glitches of dial-up connections
12 . In a £168mln. broadband deal with BT, patients, who normally
have to wait weeks to see a specialist might witness waiting time cuts,
e.g. doctors may perform online diagnoses using imaging or video-conferencing.
Also small hospitals will be able to treat patients locally, using online
experts to guide them 12 .
Another unique innovation of NHS is the introduction of standardized
clinical terminology ( SNOMED CT ). This standardization of coding is
important in terms of electronic communication between primary and secondary
care and other health service providers (laboratories, pharmacies) as
well as for the scope of health care research 5 . New technology systems
in GP medicine include e-mail communication between doctors and patients,
patients booking their own appointments online and receiving e-mailed
reminders for repeat medications and scheduled tests. Electronic communication
can greatly increase the efficiency of millions of letters a year between
GPs and hospitals 9,10 . This eliminates the problems of overloaded telephone
lines and the difficulty in making contact with someone working in a
practice 5,7 .
50% of patients eligible for influenza vaccine were actually given it
by doctors using CPR system which gave a reminder, when only 30% was
found in the control group of doctors not receiving reminders or using
paper records 9,13 . Alerts can be patient-specific and depend on circumstances,
e.g. the system cancelled 0.07% of all prescriptions on the grounds of
clinical safety at one teaching hospital in Birmingham within a year.
In a subsequent user survey 82% of doctors and nurses considered the
system to be an improvement on conventional procedures as it has contributed
to safety and patient care 14 . The system assists clinicians when they
write a prescription by making available information on patients and
supports clinical decision making 14 . Electronic transmission of prescriptions
from doctors to pharmacists would avoid the errors caused by unclear
handwriting, and cut costs by recommending generic drugs automatically
11 .
The benefits of CPR are manifold: it allows doctors, nurses, secretaries
and medical records staff to have better control “of administrative processes
whether for inpatient treatment, outpatient attendances or for maintenance
of waiting lists 6 ”. It provides clinicians with a valuable information
management system and removes many of the clerical irritations, which
they meet. CPR can also improve job satisfaction, eliminating some of
the dull routine activities such as multiple recording of patient details,
manual statistics, etc. In the nursing ward setting the recorded assessment
of patients after a move from paper to computer rose from 62% to 95%
and nursing computerized care planning is of a higher quality than manual
one: analysises and reports of paperwork can be performed with greater
speed and accuracy 9 . There are significant benefits for patients too.
Problems of lost patient charts, overbooked clinics, inaccurate waiting
lists, patients' complaining of long outpatient delays and unsuitable
appointment times can all be reduced 6,7,15 . Where management and clinicians
are in effective partnership the CPAS provides information, which is
hugely beneficial in terms of planning and running the hospital 15 .
An annual NHS report says that NHS Direct and NHS Direct Online provide
first point of contact with the NHS for 13 mln. people every year 16
. Good IT systems are already in place and future targets are to refine
them, ensuring, for example, “every GP has a desktop connection to e-mail
and full electronic collection and storage of patients' clinical notes” 5,6
. Clinicians do not usually need a working knowledge of computers but
it is essential that their clinical and secretarial support staff is
adequately trained in using the system and knows how to deal with the
problems 15 . This also removes the responsibility for maintenance from
GPs as practices generally do not have IT departments or the resources
to handle the technical support required. This is important as primary
care trusts in the UK are becoming responsible for funding computer technology
and keeping data secure 5 .
-
Introduction
-
The dimensions of the change in the UK
-
The
implications of this change
-
Conclusion
-
References
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