Handheld Technology and XML

1. Introduction

The Royal Brompton & Harefield NHS Trust is the largest cardiothoracic centre in the UK and probably the largest in Europe. Both hospitals are at the leading edge nationally and internationally in the investigation, treatment and care of people with heart and lung disease.

The Trust provides comprehensive patient services for all age groups from infancy to old age. The Trust has established an international reputation for innovation and leadership in research, treatment and education in heart and lung disease.

From April 1998, Royal Brompton & Harefield NHS Trust is the merged organization comprising Royal Brompton Hospital and Harefield Hospital.

The Trust's mission is to be the leading national and international centre for the diagnosis, treatment and care of patients with heart and lung disease, creating and disseminating knowledge through research and education.

2. Background

In 1999 the Trust introduced XML based systems to produce Discharge Summary Letters, Operation Notes, Clinic Letters and Bronchoscopy Reports. The successful deployment of these systems was the foundation for the deployment of an Electronic Patient Record (EPR) system. The EPR is now being piloted in wards and clinics on both sites. Links to the legacy Patient Administration Systems (PAS) have been developed and tested. Pathology results are linked and displayed within the EPR. Links have also been created to proprietary Picture Archiving Systems (PACS) for radiology and ECHO Cardiology systems for Ultrasound pictures. This gives clinicians access to written reports, results and the visual images related to the written reports.

3. Developments

The next phase is to implement systems for ordering tests from within the EPR. This is a relatively complex area, not in IT terms, but in negotiating the changes in working practice required to implement. Whilst difficult the work is necessary and benefits are beginning to emerge. An initiative from within the working group has led to work starting on bar coding patient identification, an important area that will reduce the chances of error.

The specialist nature of the Trust means a large volume of Cardiac Catheter files are generated. These files are in DICOM format, work has been going on to convert these images into MPEG format to allow them to be displayed within the EPR. Final testing is currently in progress.

4. Hand held solutions

Increasingly medical staff have been using their Palm or PocketPC devices to record notes on patients. There was an urgent need to develop systems that allowed medical and nursing staff to access the EPR remotely using hand-held devices. The Health Authority agreed to fund a pilot study using Modernisation Funds; the pilot is being developed in the Adult Intensive Care Unit (AICU) on the Brompton site. This is a very busy area with a lot of technically competent staff that are keen to use the technology.

The first phase is to install the wireless area network and ensure there is adequate coverage and that there is no interference with medical equipment in the AICU.

XML style sheets to allow access to results and reports are being developed for the PocketPC; once these are operational we will develop ordering. The pattern of deployment is similar to the main EPR, a gradual roll out enabling us to learn as we develop and to make use of more powerful hardware and software as this becomes available.

The following screenshots show the concept we are working towards and deliver in the Spring/early Summer of 2001:

Figure 1: Patient list

A simple list of patients to select from.

Figure 2: Available documents

Having selected a patient the documents available are listed on screen.

Figure 3: Choosing a document

In this example, X-Ray was selected.

Figure 4: Access to chosen document

This then gives access to the written X-Ray report.

Figure 5: Image display

There is the potential to display an image, obviously this is not suitable for diagnostic purposes but there may be uses in contacts with patients.

This allows staff to view existing information held on the central servers supporting the EPR. The next phase is to allow interaction to order tests etc. The following screenshots show hoe we are developing in this area.

Figure 6: Ordering tests

This figure shows the concept of how a blood test might be ordered over the wireless area network and acknowledged below.

Figure 7: Test order confirmation

The development of hand held technology is very exciting. At last there is the possibility of gathering all patient information in a simple manner. At present it is estimated that 80% of a patient record is in paper form. The development of hand held data capture devices should mean that percentage can be reversed. The ability to gather such large volumes of patient data in a simple and affordable manner will have enormous benefits for research. The Royal Brompton & Harefield Trust is committed to be the leading national and international centre for the diagnosis, treatment and care of patients with heart and lung disease, creating and disseminating knowledge through research and education.

The XML based EPR with all the potential for searching plus the XML based hand held data capture systems will be an important part of the matrix that will enable the Trust to carry out its mission.

Design and Development by deepX Ltd.