Coping with administration as well as medical matters has never been an easy juggling act for many hospital doctors, particularly in state-run healthcare systems where there is not a lot of spare cash for administrative staff. Clinical information systems aim to ease some of that burden by organising the workloads of medical practitioners and lifting some of the more humdrum chores from their shoulders altogether. This article investigates the birth of one such system and how it has developed to fill its niche.
The ophthalmology clinical information system at Guy’s and St Thomas’ hospital was developed in partnership with one of its ophthalmology consultants, Denise Mabey. She started working on the project in 2000. “The reason I started was because I was appointed as a consultant, but I did not have a secretary. I was doing all my clinics, but nobody was typing up my letters. That was the first main driver for me to investigate information systems. I wanted to be able to generate my own letters quickly and easily, so I looked around for software companies that might be able to do this.”
At the time there were no such systems available. However, at the hospital there was a grant-funded research group working on developing a system to cover treatment and scheduling of diabetes patients, called Diabeta3. “This system was also being used for diabetic eye screening, and I thought it might be possible to add on an ophthalmological examination,” Mabey explains. “This would then give me the tools to write down my basic examination and generate letters.”
With Mabey’s help, the research group secured further funding and, in 2002, began work on applying Diabeta3 to general ophthalmology.
Eyeing up the Differences
“One of the major considerations that needed to be taken into account was the fact that eye doctors deal with two eyes, not one person,” Mabey explains. In other words, unlike a disease or a condition, a patient can have two different diagnoses – one for each eye. The presentation of the information is also unique to ophthalmology. “We work so that the information for the right eye is shown on the left side of the page, and the left eye is on the right. It is as if you were holding up a sheet of paper to the patient’s face.” In general ophthalmological consultations there are a limited number of data points to collect and, once the left–right differential diagnoses are sorted, the ways in which the remaining data are displayed are relatively flexible. “When I started this phase of the project, it was initially a very personal configuration,” Mabey added. “The screens were personalised – my individual 10 most-common diagnoses were available as pop-up options.”
The result is a program specific to general ophthalmology, now called Vector Ophthalmology, on which Mabey can record all her findings, for example from visual acuity, field tests, examination and diagnosis, all on the screen. Retinal images can be brought straight into the system and data from the patient information services can also be pulled through, including the name and address of the patient’s general practitioner (GP) and the patient’s personal details – address, phone number, etc. Even in the operating theatre, Mabey can access the system and enter operating data. The whole system is underpinned by the Read Clinical Classification codes.
“At the end it generates a letter for the patient’s GP. Furthermore, the next time that patient comes in to see me I have an electronic copy of his or her record,” she comments. In the ideal world of the paperless office, this would be enough for the official records. “However, because of the way the National Health Service hospital systems work, this cannot replace the hospital ‘note’ system.” Nevertheless, a copy of the GP letter can go straight into the notes, without creating additional work.