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The Path.Finder project
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Abstract
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Wirral Hospitals NHS Trust, a 1200-bed general hospital with 90 wards,
created the Path.Finder healthcare information system in 1994 to share research
and clinical guidelines among healthcare professionals both within the Trust
and the wider healthcare community. Recently the Trust has replaced the first
version of Path.Finder, which ran on proprietry hypertext technology, with
a solution based around XML.
Data formatted using XML is delivered through a browser inteface, which
has enabled the Trust to roll Path.Finder out to a wider audience. In addition
XML allows the Trust to incorporate a greater range of media types and link
Path.Finder guidelines to web-based information provided by other healthcare
organisations. Working with the Software company Graphnet, the Trust has been
able to create a publishing tool which allows staff to create and maintain
XML documents.
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Contents
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The situation
The Path.Finder project began as a local initiative at Wirral Hospital
NHS Trust in 1994, with the Trust initially providing guidelines for GP's
on topics in which they had expressed an interest. A hypertext package running
on laptops was used to structure and display information, and the system was
piloted with 25 GP's. Most of them found the system very valuable, improving
their clinical practice and the way they referred patients. The Trust the
decided to roll out the system to other GP's and began to develop further
books for use within the Trust. These were made available on PC's in around
a dozen wards. The Trust also joined forces with a number of other Trusts
in 1996 to create a Consortium to develop and promote the Path.Finder system.
The first incarnation of Path.Finder provided significant benefits to
both clinicians and patients. However as the scope of the application grew,
software constraints became apparent. XML offered a way around these constraints
by supporting complex images and digital photography, an important aspect
of medical information tools. It also allowed tables and links to external
applications. The major benefit though was the automation of the maintenance
of the guidelines. With 3500 pages of information within the Wirral alone,
it was nearly impossible to keep track of which pages had passed their expiry
date and to make sure that the authors reviewed them.
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Table of Contents
The solution
To provide it with the expertise to kick start the project, Wirral decided
to work with an extrenal consultancy called Graphnet. A key element of the
solution was an interface that would allow users with basic word processing
skills to create and manipulate XML documents. Graphnet used Visual Basic
and C to develop a publishing tool that allows users to enter text directly
or to draw on existing word processing files. All data is saved on a SQL database.
The flexability of XML allows Wirral to deliver Path.Finder on a number
of platforms including over the NHSnet to standalone PC's running older web
browsers and on touchscreen patient information kiosks which are soon to be
deployed around the Trust. The XML version of Path/Finder is available on
more than 300 PC's around the hospital, users outside the Trust such as GP's
are initially accessing a standalone HTML version of Path.Finder until the
local Health Authority sets up a secure server.
The benefits
Xml has allowed Wirral to solve the issues it faced with the Non-Web
compliant version of Path.Finder. Guidelines can be managed and maintained
more easily, while new data types such as digital images can be incorporated.
In addition, the widespread availability of the webbrowser interface means
Path.Finder can be rolled out to a much wider community of users.
Using XMl has brought other benefits as well. For example, because Path.Finder
data is now stored in a dtabase rather than as pre-constructed pages containing
metatags, users can perform more powerful searches and link directly to relevant
paragraphs. Also because XML sends only unformatted data access times for
staff working remotely are comparable to staff using a locally stored proprietry
system.
The future
The Path.Finder project represents just the first step in Wirral's plans
for XML. Because XML are inherently compatable with database technology, the
Trust is now exploring the possibility of providing referral forms online.
These forms are initially being coded in HTML for evaluation but when the
fina version is decided upon, they will be converted to XML allowing the patient
data to be sent directly to a referral database at the Hospital
In addition the Trust is beginning to develop EPRs using XML, the structure
provided by XML will allow Wirral to link patient and Path.Finder records
together. For example a clinician will be able to use the clinical codes for
the diagnosis in the patient record to jump to the relevant clinical guidelines
for that condition in Path.Finder.
Other projects now being planned include the delivery of education modules
which will allow staff to test their knowledge in around 50 clinical areas
with the ability to make greater use of guidelines developed by other healthcare
providers.