Medical Informatics Assignment II I.T. in General Practice The Castle Surgery, Carrickfergus

Medical Informatics
Assignment II
I.T. in General Practice
The Castle Surgery, Carrickfergus
Leah Spence, Philip Anderson
• Brief overview of the surgery
• An Introduction to the software
• Features of the System: Advantages &
Disadvantages of:
Patient Notes
Future Developments
The Castle Surgery
10 Doctors, 4 nurses, 2 HCA’s, 13 receptionists
15,000 Patients
25 computers
EMIS system installed 1999
Entirely paperless by 2001
Not subsidised by NHS
EMIS an Introduction
“Egton Medical Information Systems”
Invented in Leeds, 1982
“Written by Doctors for Doctors”
A multifunctional computer program devised
to:– Assist GPs during and after consultations
– Ease the job of the Receptionist
– Provide the best possible service to Patients
Key features of EMIS Primary
Care System
Complete patient Management
Intelligent Prescribing
Definitive Medical Records
Formulary Management
Integrated Consultation Mods
Integrated Appointments
Advanced Decision Support
Integrated with Microsoft Word
User Defined templates
EMIS Drug Explorer
General System
• Regular System online Upgrades
• Integrated with Microsoft Word
• System wide audits
Appointments - Advantages
• Made in person or over the phone
• Patients can check-in at reception or using
the self check-in
• The doctor’s computer notifies them that a
patient is waiting
• JX board calls the patient when the doctor is
• Any changes to appointments are made
immediately on the doctor’s computer,
e.g. cancellations
Appointments - Disadvantages
• Difficultiy for visually impared patients in
seeing the JX board
• Reluctance in using self check-in
• Prescription items are split into two
categories: Acute and Repeat
• Repeat items can be printed by
reception staff, acute items have to be
printed by doctor
Prescriptions - Advantages
• Formulary and Full List of Drugs easilly
• Repeat prescriptions easily printed by both
doctor and receptionist
• Reduces manual errors e.g. illegible
• Automated warnings
– Allergy warnings
– Review reminders
• Last date of issue shown
– Flags up potential drug overuse
Prescriptions - Disadvantages
• Relies on drug information being up to
• Aptitude of the staff using software
– E.g. ordering appropriate quantities
• Discretion required in dealing with
automated warnings
Communications - Advantages
• Electronic transfer of Lab results between
hospital and practice
– Doctor can act on these results, and get reception
staff to contact the patient if required
– Normal ranges indicated with lab results
• Internal messaging between reception staff
and doctors
– So as not to disturb doctor during surgery
– Abusive Patient Warning
Communications - Disadvantages
• No mechanism for dealing with lab results
which appear normal, but need to be acted
• Staff have to check for new messages
• Hospital still use paper for referral letters
– Laborious to scan in, and store in correct location
with the patient’s paper notes
• Issues regarding data security and
Clinical Decision Support Mentor Library
Clinical Handbook
Travel Advice
Consise Oxford Textbook of Medicine
Drug Info Leaflets
Patient Info Leaflets
DVLA and Drug Misuse guidelines
• Daily backups, every night upto tape
• 2 copies
– Fireproof safe
– Location outside of practice
Security - Advantages
• All staff have their own user ID and password
• Computer locks itself when left unattended
• Firewall and anti-virus software on all
• Audit Trail
• Sensitive material can only be
viewed by appropriate personnel
Security - Disadvantages
• Password has to be changed after 60 log ins
• Can only view one patient’s record at a time
• Locum doctors have to use another member
of staff’s account
• Human error
– Forgetting passwords
– Leaving computer on
Patient Records - Advantages
• Full record of each patient’s past medical
history, current drugs, Hospital admission
• Record can be viewed onscreen when the
patient enters the surgery
• Ease of searching
• Easy access
• Hospital letters scanned in
and attached to patient’s noted
• Summary sheets can be
printed out prior to a home visit
Patient Records - Disadvantages
• Time required to put all relevant information
onto the system
• Admission of a new patient takes a long time,
there is no straightforward transfer of patient’s
notes to the computer
• Data input potentially
• Possible system failure
• Problems with patient
New GP Contract
• READ Codes
– Provide a universal way of categorising
conditions, treatments and actions
– Not used by hospital
• System flashes up outstanding
checkups for a patient. e.g. diabetic
Future enhancements
Online prescription ordering
Online appointment booking
Referral letters by e-mail
IT training for doctors