Until recently many hospitals and health-care centers developed their own self-sufficient patient administration systems: “two hospitals in the same town might have completely different software running on completely different types of computers 3 ”. No wonder that health services experienced communication difficulties. Thus, to ensure the consistency of information, the UK government has introduced a new strategy for NHS information systems, with the core objectives of 3,7,6 :
– lifelong health records for every person in the UK
– 24 hour on-line access to patient information
– an NHS network linking community, GPs and hospitals
– public access to information using on-line services
– information resources for NHS managers
To implement these ambitions it was essential to bring to life CPR administration systems, like Hospital Information Support System (HISS) – “an initiative that links different departments within a Trust together through an integrated network, designed to facilitate the communication between departments, making ordering resources, drugs, meals and tests easier and providing better access to information 3 ”. Staff has the right to use the data that is relevant to their own needs from terminals around the hospital grounds, but they cannot access information about other departments 6,3 . This capacity to correspond between departments has been improved by the introduction of NHSnet e-mail service – NHS nationwide project, that connects every hospital, GP practice and health center to a unified national network with the aim “to facilitate immediate access to patient’s notes and X-rays, wherever in the UK the patient happens to be and to eliminate case note duplication and records being sent from one place to another 3 ”. A Londoner taken ill in Aberdeen , for example, could have his details beamed across the country.
Previous episodes of NHS computerization, mostly of administrative character, made some clinicians disappointed and disillusioned about what IT can do for them with relevance to clinical practice 6,8 . But nowadays much more effort is placed on development of systems that help doctors, nurses and other healthcare professionals give better care to patients within communicative and real-time working environment 9 . This means that a clinician can see all the information, even held in different places and on different systems, on the computer/laptop. Clinical comment in the form of immediate feedback to the clinician is more effective than retrospective reports 9 . Computers can help to do job-order tests, prescribe drugs, do care assessment and care plans, maintain records, do discharge letters. They can also give advice, alerts and warnings and links to sources of knowledge like the Internet as clinicians do their work 9,10 . Online booking of hospital appointments would allow patients to choose convenient times and reschedule if they were unable to attend 7,11 The digitization of patient records makes it easier for hospitals and local doctors to exchange information 10,11 .
CPAS can significantly increase the efficiency and effectiveness of patient care. Simply displaying relevant patient information on history, test results, interventions related to particular clinical problems in an organized way can greatly improve efficiency and even reduce the number of investigations performed having the right information at the right time, e.g. having current medication and dietary analysis sensibly organized and displayed will reduce time to make decisions as well as promote their accuracy 9,10 . 32% reduction in laboratory test charges came after introducing CPAS to organize and display results 9,10 .
It took the UK government quite a lot of effort to address the issue of IT in health care, but eventually rates of computerization of GPs’ reached 98% in 2003 (the rate of GP practice connection to NHSnet: 1999 – 75 (0.9%), 2000 – 4 611 (53%), 2001 – 8 125 (93%) 5 . This is a direct consequence of removal of a government requirement for paper-based records 5 . Gradual introduction of high-speed connection for NHSnet users will improve the link between hospitals and GP surgeries across the UK 5 , as part of the programme to bring broadband to every GP surgery and school in the country by 2006 12 . Without it data exchange can be very time consuming and potentially subject to glitches of dial-up connections 12 . In a £168mln. broadband deal with BT, patients, who normally have to wait weeks to see a specialist might witness waiting time cuts, e.g. doctors may perform online diagnoses using imaging or video-conferencing. Also small hospitals will be able to treat patients locally, using online experts to guide them 12 .
Another unique innovation of NHS is the introduction of standardized clinical terminology ( SNOMED CT ). This standardization of coding is important in terms of electronic communication between primary and secondary care and other health service providers (laboratories, pharmacies) as well as for the scope of health care research 5 . New technology systems in GP medicine include e-mail communication between doctors and patients, patients booking their own appointments online and receiving e-mailed reminders for repeat medications and scheduled tests. Electronic communication can greatly increase the efficiency of millions of letters a year between GPs and hospitals 9,10 . This eliminates the problems of overloaded telephone lines and the difficulty in making contact with someone working in a practice 5,7 .
50% of patients eligible for influenza vaccine were actually given it by doctors using CPR system which gave a reminder, when only 30% was found in the control group of doctors not receiving reminders or using paper records 9,13 . Alerts can be patient-specific and depend on circumstances, e.g. the system cancelled 0.07% of all prescriptions on the grounds of clinical safety at one teaching hospital in Birmingham within a year. In a subsequent user survey 82% of doctors and nurses considered the system to be an improvement on conventional procedures as it has contributed to safety and patient care 14 . The system assists clinicians when they write a prescription by making available information on patients and supports clinical decision making 14 . Electronic transmission of prescriptions from doctors to pharmacists would avoid the errors caused by unclear handwriting, and cut costs by recommending generic drugs automatically 11 .
The benefits of CPR are manifold: it allows doctors, nurses, secretaries and medical records staff to have better control “of administrative processes whether for inpatient treatment, outpatient attendances or for maintenance of waiting lists 6 ”. It provides clinicians with a valuable information management system and removes many of the clerical irritations, which they meet. CPR can also improve job satisfaction, eliminating some of the dull routine activities such as multiple recording of patient details, manual statistics, etc. In the nursing ward setting the recorded assessment of patients after a move from paper to computer rose from 62% to 95% and nursing computerized care planning is of a higher quality than manual one: analysises and reports of paperwork can be performed with greater speed and accuracy 9 . There are significant benefits for patients too. Problems of lost patient charts, overbooked clinics, inaccurate waiting lists, patients’ complaining of long outpatient delays and unsuitable appointment times can all be reduced 6,7,15 . Where management and clinicians are in effective partnership the CPAS provides information, which is hugely beneficial in terms of planning and running the hospital 15 .
An annual NHS report says that NHS Direct and NHS Direct Online provide first point of contact with the NHS for 13 mln. people every year 16 . Good IT systems are already in place and future targets are to refine them, ensuring, for example, “every GP has a desktop connection to e-mail and full electronic collection and storage of patients’ clinical notes” 5,6 . Clinicians do not usually need a working knowledge of computers but it is essential that their clinical and secretarial support staff is adequately trained in using the system and knows how to deal with the problems 15 . This also removes the responsibility for maintenance from GPs as practices generally do not have IT departments or the resources to handle the technical support required. This is important as primary care trusts in the UK are becoming responsible for funding computer technology and keeping data secure 5 .
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The dimensions of the change in the UK