Study Of A Computer System In A Clinical Setting

Regional Nephrology Unit

Belfast City HospitalBy

Paul McMackin, Christopher Henry, John Haughey

Background InformationBackground InformationBCH: 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

What Information?

How Is It Stored?

Types Of Information Types Of Information Stored In The UnitStored In The Unit.

Confidential Patient Information: Names Addresses Medical Records Lab Results, X-Rays etc.

Admission/Discharge InformationStock Control – Out-Patient Dept.Appointment SchedulesClinical Audit – No. Of Patients Receiving Treatment etc.

Professional Manuals and Journals

Problems With Conventional Problems With Conventional Paper Based SystemsPaper Based Systems

Mislaid RecordsAccessibilityConfidentialityStorage SpaceDifficulty With Organisation (e.g. Out-Patient

Management) Communication TimeCost

So Why Use Computers?So Why Use Computers?

Clinical AuditContinuity Of Care

Forward Planning

Up-To-DateCommunicationAccessibility

ConfidentialityAdministrationSpace

SpeedAnalysisOrganisation

Use Of Computers In Nephrology Unit:

In-Patient Department

The management of inpatients is The management of inpatients is aided by the use of computers in aided by the use of computers in

several ways.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

Facilities and Resources Facilities and Resources available to the doctoravailable to the doctor

E-mail a colleague for a second opinion.

Consultants can also be contacted via e-mail

Send for lab tests and/or X-rays

Consult the ‘Up-To-Date’ program

available

Use the internet to find additional information

Up-To-DateUp-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.

Up-To-DateUp-To-Date

This disc is easily searchableThere are keywords that link to further useful resources on the discThe reference lists contain complete abstracts, enabling the doctor to easily find related articles on the webThe disc is reissued quarterly so as to remain up to date.Used to assist the practice of evidence-based medicine.

Internet ResourcesInternet 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.

Labs and X-Ray facilitiesLabs 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

Labs and X-ray facilitiesLabs 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 resultsX-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.

Adding results to patient Adding results to patient recordsrecords

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.

Discharge ProceduresDischarge 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

Discharge proceduresDischarge procedures

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

Use Of Computers In Nephrology Unit:

Out-Patient Department

Nephrology UnitNephrology UnitOut-Patient DepartmentOut-Patient Department

State Of The Art Building Completed in 1992Accommodates 50 Renal Dialysis Patients in one session2 Sessions/Day 5 Days/Week ~ 500 Patients/Week2 Treatment Areas Each With Centrally Located Nurse Stations Storage BasementWater Treatment PlantMachine Maintenance

Use Of Computers In Out-Use Of Computers In Out-Patient Information Patient Information

ManagementManagementFlexibility:

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

Use Of Computers In Out-Patient Information

Management 2Machine 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

Use Of Computers In Out-Use Of Computers In Out-Patient Information Patient Information

Management 3Management 3Water Treatment:

Ultra Filtrated Water must be used for DialysisNormal Tap water not sufficientUnit has own water treatment facilityThis System has to be monitored very closelyMonitoring is automated by a computer system

Use Of Computers In Nephrology Unit:

General Uses

Other uses of computersOther 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

AuditAudit

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.

AuditAudit

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.

AuditAudit

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.

Uses of PowerPointUses 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

E-mailE-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.

Other features of the unitOther 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.

Use Of Computers In Nephrology Unit:

Computers Come With Their Own Problems...

Protecting data securityProtecting 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)

ProblemsProblems

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

SummarySummary

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