1.25 Million Electronic Patient Records in XML at Poole

1. Introduction

• XML Based Electronic Patient Records (EPR)

• why we did it

• how we did it

• what we learned

• the future

2. Why we did it

Information for Health

• Department of Health Strategy 1998-2005

• Frank Burns, CE Wirral Hospital

• Electronic Patient Records (EPR) - episodes

• Electronic Health Records (EHR) - lifelong

• Messaging between care providers

• Building on 1992 strategy

  • unique ID, Network

The Upton Decision 1997

Essential elements of a medical record

• any previous discharge letters

• pathology and radiology results

• the referral from primary care

With these and no paper records, the clinicians felt reasonably comfortable to treat without casenotes.

To aid culture change

• Doctors are our least IT literate group

• To move from all paper to all electronic will be

  • very difficult,

  • time consuming

  • traumatic

• Exploring issues that arise

• solving real problems for junior doctors

Advantages of electronic record

• Available in several places at once

• 24 hour access - and remote from home

• self sorting - different views of data

• avoid loss of records (dependant on resilience)

• audit trail of use of documents

• capture legible information

• completeness of requests

• link to evidence based medicine

3. How we did it

Figure 1: How we did it

List of features from Junior docs

• Access to radiology reports & discharge summaries

• Ward and consultant lists

• Graphing trends of pathology tests

• Ordering Pathology & Radiology

• Phlebotomy lists

• Ordering and delivery of blood products

• Scanned referral letters available

Extracts from existing systems

• Patient administration

  • SQL queries initiated from audit trail

  • patients, inpatients, outpatients, PAMs, A&E attendances,

  • some clinic letters & discharge summaries

• Path/Rad results

  • tap into GP results feed

  • problems of ID for GP originated requests

Ordering forms - iterated from Paper

• Start point paper forms

• Intranet HTML mock ups for discussion

  • Use of drop down menus

  • prefilled fields

  • mandatory fields - which are necessary?

• Resulting form engineered

Volumes of data (each 1+ document)

Patients	1.25 mill	Path res	1.25 m
OPD visits	207k pa	Path test	10.7 m
A&E visits	44k pa	Radiol	102 K
Transfers	17.7k pa
Discharges	60k pa

Registry total (Mar '01) 12.3 million docs

Access to Evidence Based Medicine

• Link directly from patient records

• needs organisation to define key terms

Figure 2: Access to evidence based medicine

4. What we learned

Clinical involvement crucial to success

• Doctor on IT team

  • catching and training doctors

  • encouragement to use

  • feedback on good and bad features

• Nurse on IT team

  • same for nurse specialists

• sponsorship by consultants

All is not as it seems

• policies bent on paper, not easy on computer

  • Consultant authorisation before forms filled

• Holes in existing requesting/ reporting flows

  • filling out/data entry on path/rad request forms

  • Pathology & Radiology data to GPs

• Majority of pathology results hand transcribed

  • and signing/filing paper reports is a nightmare!

Doctors generally keen to use system

• Little resistance to worthwhile features

• no tolerance for slow/cumbersome features

• those that have worked with an electronic record know what they are missing

  "do everything electronically, please hurry, we're lagging behind" a Poole Registrar

• medical secretaries saving pulling casenotes

• patients get instant answer to query

5. The future

Migration from Paper to computer

• Use of electronic record across site

• use of mobile technology

• dependence on paper archive - 8 years

• Access to e-record to limit growth in demands

  • Medical secretaries 107% increase

  • A&E - Previous ECGs over 5 years

  • Audit

Roll out - features and users

• Clinical Coding summary

• Endoscopy and Cardiology

  • requests and reports

• Replace printing for pathology results

• Explore authorisation for requests

• Spread availability around site

The Future

• Integrated Care Pathways (ICPs)

• Electronic prescribing and administration

• Lifelong electronic record

  • linking primary, secondary & social services

• Patient held records - or patient holding key

• Internet accessible - by patient

Design and Development by deepX Ltd.