A Case Study of Computer
Systems
The Belfast City Hospital
Nephrology unit
What is information?
 Defined
making”
as “that which helps decision
Patient Information consists of
two components
 Clinical
Data
 Clinical Knowledge
Clinical Data
 Presenting
Symptoms and signs
 Laboratory results
Clinical Knowledge
 General
Facts about diseases
 How to interpret lab results
 How to choose therapies
Question
 How
are Clinical Data and knowledge
managed within the Nephrology unit at
BCH?
Roles of information technology
 Shifts
away from conventional paper
medical records towards computerised
systems.
 Many problems are associated with the
use of paper records
Problems with Paper Records
 Accessibility
of Info ( necessary to
search through numerous letters,
reports and notes before finding
answers).
 Missing records
 Bulk of paper storage
 Incompleteness
 Cost
 Confidentiality (paper notes easily
photo copied).
Use of computers in Nephrology
 Unique
coding and classification for
presenting complaints
 Computerised discharge system
 E-mail for communication - I.e..
arranging meetings, forwarding test
results and patient information.
 Clinical programs
 Office programs
The Clinical Programs
 The
Registrars Discharge program
 Medline “Up to Date”
 Online Lab Results
 Online X-Ray Results
Patient Discharge program
 This
is a program used by the JHO’s
and Registrars to discharge a patient
from the Nephrology department.
 Although it is configured slightly
differently for Nephrology the same
program is used by all of the
departments of the hospital
Features
 The
program uses ICD-10 coding
 All 27,000 codes are stored on the
computer.
 The 100 most common diseases in
Nephrology appear in a scroll down list.
 JHO’s use same system as registrars
 Registrars can verify JHO’s diagnosis
using the verify manager.
Details entered into the program
include….
 Standard
patient details
 The Admission diagnosis
 The procedure done to the patient
 Any additional note to be forwarded to
the GP.
 Drugs given
The Registrar checks what the JHO has entered and a
Discharge note is generated for the GP and patient
Discharge
JHO Performs discharge
Registrar verifies discharge
Discharge letter produced
for patient
Patient Discharged
Info passed onto coding office
GP discharge letter produced
(Currently a paper copy)
General Opinion
 The
program is good. Before this
system paper discharge notes were
used.
 Registrars find it easy to check a JHO’s
diagnosis.
 Generally JHO’s do actually use the
system though people still write
discharge notes by hand when in a rush
Medline “Up to Date”
 A CD-ROM
which allows doctors to
perform “Evidence Based medicine”
 The CD is updated every few months by
the supplier.
 It contains the most up to date forms of
treatment for patients.
What Does it contain?
 Text
book information
 Articles
 Treatment recommendations
 Pictures ( e.g.. ECG’s)
 Sound files ( e.g.. Heart sounds)
 Movies / animation's
 Microscopic slides
 Slides for lectures
Features
 Other
information can be accessed by
clicking on certain keywords in the
article ( like the Internet).
 The reference lists contain complete
abstracts.
 Pictures and other media are easily
exported for lecture preparation.
Features
 Medline
is also available over the
Internet and provides access to various
medical journals.
 Internet site contains a very powerful
search engine.
 Internet links are available
 References are easily printed out or
saved to disk.
Opinions
“
The program acts like an interactive
text book”
 “It’s Very handy for research or just if
you want to leave one of your junior
doctors to do a lecture for you”
 Everyone spoken to found the
multimedia features of use in diagnosis.
Online Lab and X-Ray Access
 The
Lab program is called Master Lab
 It is a menu driven interface.
 The X-ray program is known as BCH
Rad
Features of Master Lab
 Lab
times for the program are quicker results can be obtained the same day
rather than the proceeding day.
 It stores a history of previous test
results for a patient - which is stored in
easy to use, one-key menus.
Features of BCH Rad
 Currently
the X-ray results are limited to
text format. That is you only get the
radiologists report on the X-ray.
 Plans are underway to use digital
technology to store X-rays on the
computer as well.
Other Non-Clinical Programs
 E-mail
 Microsoft
PowerPoint
 Microsoft Excel
 Speech to Text
E-mail
 Most
consultants and registrars have Email on their own PC’s.
 The PC’s are permanently connected to
the Internet.
Uses of e-mail
 General
letters / Personal messages
 Attachments of patient data files
 Schedules of meetings
 Patient appointments
 Although it is currently not occurring
there are plans for patient results to be
sent to GP’s Directly over the E-mail.
PowerPoint
 A tool
used more frequently by medical
lecturers in preparing lectures for
medical students.
 Images are easily imported from
Medline.
 Files can be transferred over the E-mail
to junior doctors if they need to take the
lectures.
Excel
 During
our visit the consultant received
and Excel file attachment over the Email.
 Excel is often the form that dialysis
results and blood tests for patients on
the ward are stored on.
 It enables easy printing of specific
patients details.
Speech to Text
 Two
versions on different computers
 Older version (On Apple) - programmed
to recognise medical terms.
 Speech has to be slow and staccato.
 Newer version - able to recognise fluid
speech but not medical terms.
Opinion of Speech to Text
 A method
preferred by some of the
older doctors who are less proficient at
typing.
 It will never replace high speed typing
but is a useful tool for generating large
quantities of text.
 Takes a relatively long time to train to
recognise your voice.
Security of Data
 In
response to growing use of computer
technology, the BMA has developed
nine principles of data security
BMA Confidentiality Principles
 Access
control
 Record opening
 Control
 Consent and notification
 Persistence
 Attribution
 Information flow
BMA Confidentiality Principles
 Aggregation
control
 Trusted Computing base
Strict adherence to those principles
prevents breach of patient confidentiality
Security problems on Computers
 Problems
with access to all records by
all users
 Password sharing
 Terminals left permanently on in wards
 Information may be easily printed out (
though records may be made of this)
Security aspects
 Patient
information can only be
accessed using passwords - these are
needed to log on and access each
individual program.
 Each staff member has a different
password and different access levels.
 Only staff named on the access control
list may view patient files.
Summary
 Computer
systems in Medicine are…
 Time savers
 Secure sites of information storage
 Sites for research and stores of text
book information
 Ways of communicating
 Convenient - though not always
Sometimes they can just be a Pain!