1. Medical Informatics Assignment II I.T. in General Practice The Castle Surgery, Carrickfergus Leah Spence, Philip Anderson

2. Outline • Brief overview of the surgery • An Introduction to the software • Features of the System: Advantages & Disadvantages of: • Appointments • Prescriptions • Communications • Patient Notes • Future Developments

3. 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

4. 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

5. 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

7. General System • Regular System online Upgrades • Integrated with Microsoft Word • System wide audits

9. 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 ready • Any changes to appointments are made immediately on the doctor’s computer,e.g. cancellations

10. Appointments - Disadvantages • Difficultiy for visually impared patients in seeing the JX board • Reluctance in using self check-in

12. Prescriptions • 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

13. Prescriptions - Advantages • Formulary and Full List of Drugs easilly accessible • Repeat prescriptions easily printed by both doctor and receptionist • Reduces manual errors e.g. illegible handwriting • Automated warnings • Allergy warnings • Review reminders • Last date of issue shown • Flags up potential drug overuse

14. Prescriptions - Disadvantages • Relies on drug information being up to date • Aptitude of the staff using software • E.g. ordering appropriate quantities • Discretion required in dealing with automated warnings

16. 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

17. Communications - Disadvantages • No mechanism for dealing with lab results which appear normal, but need to be acted upon. • Staff have to check for new messages regularly • 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 confidentiality

18. Clinical Decision Support - Mentor Library • Clinical Handbook • Travel Advice • Consise Oxford Textbook of Medicine • DeRmis • Drug Info Leaflets • Patient Info Leaflets • DVLA and Drug Misuse guidelines • PRODIGY

19. Security • Daily backups, every night upto tape • 2 copies • Fireproof safe • Location outside of practice

20. Security - Advantages • All staff have their own user ID and password • Computer locks itself when left unattended • Firewall and anti-virus software on all computers • Audit Trail • Sensitive material can only beviewed by appropriate personnel

21. 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

22. 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 inand attached to patient’s noted • Summary sheets can beprinted out prior to a home visit

23. 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 potentiallyslower • Possible system failure • Problems with patientcontact

24. 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 monitoring

25. Future enhancements • Online prescription ordering • Online appointment booking • Referral letters by e-mail • NHS Net • IT training for doctors