Study Of A Computer System In A Clinical Setting

1. Study Of A Computer System In A Clinical Setting Regional Nephrology Unit Belfast City Hospital By Paul McMackin, Christopher Henry, John Haughey

2. Background Information • BCH: Home To One Of 3 Regional Nephrology Units In N.I. • Functions On 3 Levels: • Out-Patient Department • In-Patient Department • Staff and Administrative Element • Keen To Implement Computers Into Any Areas That Can Benefit From Their Integration

3. What Information? How Is It Stored?

4. Types Of Information Stored In The Unit. • Confidential Patient Information: • Names Addresses • Medical Records • Lab Results, X-Rays etc. • Admission/Discharge Information • Stock Control – Out-Patient Dept. • Appointment Schedules • Clinical Audit – No. Of Patients Receiving Treatment etc. • Professional Manuals and Journals

5. Problems With Conventional Paper Based Systems • Mislaid Records • Accessibility • Confidentiality • Storage Space • Difficulty With Organisation (e.g. Out-Patient Management) • Communication Time • Cost

6. Organisation Analysis Speed Space Administration Confidentiality Accessibility Communication Up-To-Date Forward Planning Continuity Of Care Clinical Audit So Why Use Computers?

7. Use Of Computers In Nephrology Unit: In-Patient Department

8. The management of inpatients is aided by the use of computers in several ways. • The patient’s previous medical history (previous procedures, drugs they are taking etc.) is logged on the computer, and the recordings taken at their previous dialysis sessions is usually added. • The very dialysis machine contains a processor which regulates it’s actions. • The stock levels of the electrolyte solutions used is logged on a separate computer

9. Facilities and Resources available to the doctor

10. Up-To-Date • Up-To-Date is a multimedia CD-ROM based reference tool available to the doctor. • This provides textbook information, pictures, sound files, microscopic slides, accepted peer review articles, links and treatment recommendations for a wide variety of searchable conditions.

11. Up-To-Date • This disc is easily searchable • There are keywords that link to further useful resources on the disc • The reference lists contain complete abstracts, enabling the doctor to easily find related articles on the web • The disc is reissued quarterly so as to remain up to date. • Used to assist the practice of evidence-based medicine.

12. Internet Resources • Medline is also available to the doctor over the internet • It provides a staggering list of journal articles • It is a very powerful search engine, which is clearly laid out and is relatively simple to use, with the ability to combine searches and set filters before searching.

13. Labs and X-Ray facilities • Should the doctor remain uncertain after consulting the previous resources, or perhaps upon the recommendation of one of them, he may send a blood sample to the labs for testing, or choose to have an x-ray taken of the patient

14. Labs and X-ray facilities • The results of the blood tests are sent directly back to the doctor over the hospital intranet. This saves time on the old system of sending someone to the labs to collect results • X-ray images are not sent across the intranet, though there are plans to implement this. Instead, an assessment of the x-ray by a radiologist is sent to the doctor in a plain text format, highlighting any complications spotted.

15. Adding results to patient records • Upon a confirmed diagnosis, the condition is added to the patients records, and listed on the computer terminals under ICD-10 coding. • The lab results can also be added to the records easily.

16. Discharge Procedures • Program used by JHO’s and Registrars to discharge patients • Uses ICD-10 Coding, 27,000 codes stored on computer • Most common diseases are on a drop down menu • Registrars can verify JHO’s diagnosis

17. Discharge procedures • Patient details, diagnosis, procedures carried out and drugs administered are all entered into the program. Any other notes are forwarded to the GP • Discharge note issued once Registrar checks what JHO has input. • Patient is discharged quickly yet properly treated

18. Use Of Computers In Nephrology Unit: Out-Patient Department

19. Nephrology UnitOut-Patient Department • State Of The Art Building Completed in 1992 • Accommodates 50 Renal Dialysis Patients in one session • 2 Sessions/Day • 5 Days/Week ~ 500 Patients/Week • 2 Treatment Areas Each With Centrally Located Nurse Stations • Storage Basement • Water Treatment Plant • Machine Maintenance

20. Use Of Computers In Out-Patient Information Management • Flexibility: • Patients go for Dialysis 1-3 Times per week • Each Session lasts 3-5 Hours • Unit must accommodate patients as much as possible e.g. work, school etc. • Stock Control: • Supply of artificial kidneys and other machine components • Supply of disposables • Underground warehouse • Monitoring of deliveries • Monitoring of usage for re-ordering of stock

21. Use Of Computers In Out-Patient Information Management 2 • Machine Maintenance: • High cost of each machine + number required • More cost effective to have dedicated staff of engineers to maintain the machines • Machines themselves are computers • Nursing Station: • Large number of desktops to manage patient records for each visit • E-mail to Doctor if there are any problems or for confirmation • Links to the system for bringing up Lab results

22. Use Of Computers In Out-Patient Information Management 3 • Water Treatment: • Ultra Filtrated Water must be used for Dialysis • Normal Tap water not sufficient • Unit has own water treatment facility • This System has to be monitored very closely • Monitoring is automated by a computer system

23. Use Of Computers In Nephrology Unit: General Uses

24. Other uses of computers • With the unit receiving £9 million each year, it must be able to justify such funding • It must also be able to present figures and projections for upcoming years to highlight any problems that may arise

25. Audit • The staff of the unit are able to easily access patient records and to swap the data contained therein between programs. • Much of the data in the units reports is shown graphically.

26. Audit • These graphs are produced using Microsoft Excel. Many of the predictions are produced the same way, by inputting the data and applying a formula to it. • Current projections estimate that unit capacity would be reached in 2006.

27. Audit • Such predictions are easily made, and are quite accurate. Thus the need for further investment in the department can easily be shown. • Also, using Autoroute, the report highlighted the problems of patients living outside the various hospital’s catchment areas.

28. Uses of PowerPoint • When giving a lecture, PowerPoint proves invaluable to the lecturer, and the consultants in the unit make full use of the program in any presentations they might have to make. • Images and movies from other sources (e.g. Up-To-Date) are easily imported

29. E-mail • Each of the computers in the unit features Outlook. • This program enables all staff to communicate with one another and others outside the hospital via e-mail.

30. Other features of the unit • The consultants are each issued with a Compaq PDA (Personal Digital Assistant) or a Palmtop PC. • This enables them to work whilst on the move, to set up meeting schedules, and to synchronise data with their desktop machines.

31. Use Of Computers In Nephrology Unit: Computers Come With Their Own Problems...

32. Protecting data security • Great deal of personal information stored. • Important to maintain privacy • Network access passwords for all staff changed monthly • Network behind firewall, making it difficult to hack into. • Room for improvement (data encryption)

33. Problems • Whilst the nephrology unit can be commended for the positive usage and attitude towards computers, there are security issues that were worrying. • Care has to be taken to ensure the PC’s in the ward are not accidentally left on with the password already input, as this would leave anyone free to access the information

34. And Finally...

35. Summary • Computers are used in the unit for their many benefits: • Communication, Reference, Assistance, Data Storage etc. • They provide quick and easy access to a wealth of information, as and when required. • If properly used, they can be very secure, but human error can also leave the system open to interrogation by unauthorised individuals. • The nephrology unit of the Belfast City Hospital is well-maintained, and computers have assisted in the stream-lining of it’s operation. • Ultimately, the usage of PC’s is well controlled and of great benefit to the users in the unit