List of additional functions that would be useful in future renal unit electronic patient record systems

For RIXG, June 2007

Please add as many new features as you like at the foot of the table. Remember that you are describing your dream system. Nobody else knows what it looks like yet and some suggestions will be highly innovative. Please give some details in column four to allow us to understand what your suggestion will do and how it might work if it is not obvious from the name.

When you have completed your list, score each entry in column five from 0 (don’t need this at all) to 100 (essential in a new system).

Thanks

Feature / Solution / Rationale / comment / Score
1 / Creation of a standard method of exchanging data adhering to acceptable international standards / Probably xml and HL7 should be specified for the future but the present bespoke systems work well and should be supported until the new systems are ready / There is a lot of work underway at the moment and funds may be available.
Using a standard scheme for data exchange will reduce costs and allow software to be standardised for interfaces
2 / Comprehensive interfaces to all other relevant computer systems to support the clinical work. / Real time links to labs, patient admin systems, primary care and clinical machines (HD, PD, BP ...). / Required if the EPR is to become the definitive and most rapidly available source of information.
Allow rapid two-way communication with primary care so that some clinical data eg lists of medicines and some results (BP, allergies, diagnoses …) could be shared in real time.
This is already on the national IT plan and is very important for renal units.
3 / Links to registries and other renal units using the agreed data exchange format / Either direct links or via a clearing house? eg CfH spine, SuS or in Scotland SCI? / Allow quick update of records when a patient moved between renal units eg for visitor dialysis or for a transplant.
4 / Link to RPV or a similar method of providing the same facilities / Allow patient to view their results in a convenient and secure way.
5 / Security systems / That determine who can see what about whom and when.
eg it may be appropriate to allow wide access for a short period to on call staff who are coving a range of tasks overnight.
User identification that does not rely on a physical token and password. These can be lost or forgotten in the heat of a crisis. Is it possible to use anthropometric systems eg retinal scanning (now used in some passport controls), voice recognition (used in monitoring people with legal restriction orders) or finger print scanning with card and password used as a backup?
6 / Security log / Who has viewed or updated what, when and from where.
Log of files received, processed and sent.
7 / Roll back / If a major error is discovered a roll back facility allows the system to be reset to where it was at a specified time, from which point updates can be monitored and added if appropriate or excluded if corrupt.
8 / Images / Links to an image server
Incorporate routine clinical sketches, operation notes, photos taken in the clinic and ward eg rashes. / Image files are often very large and it may be best not to store them on every clinical system but rather to provide very rapid links that would allow them to be seen and used as if they were on the renal EPR. eg micrographs could be used for CPCs and added to letters. This would include annotated images specific to a user or unit. Templates could be available to help the artistically challenged.
9 / Data extraction tools / Link a well structured database to powerful data extraction and export software that can be used by clinicians / Clinicians should refine their skills at designing questions and analysing the data without necessarily requiring low level programming skills.
10 / Drugs / Link to a comprehensive prescribing system with facilities to look up the BNF and to provide warnings of interactions, side effects, monitoring required.
Links to pharmacy and primary care so that renal EPRs show the current list of medicines from the patients GP
11 / Correspondence / Links to a word processor
Selective retrieval and viewing system to allow listing by many keys eg author (your notes), role of author (operation notes, medical notes), by dates.
Ability to add annotated images, tables with data, other images / To include all types of correspondence including ward round notes.
12 / Email link from and to a patient record / Need to exclude spam and note the source. At present, email communication about patients is common but bypasses their record which is dangerous. A method of sending emails from and copying emails to a patient’s record would be useful.
13 / A system for linking the problems (diagnoses) to the investigations and treatments / So that looking back you can follow the clinical logic, X was done because Y and should be followed up by Z.
14 / A “To do & done list” / To allow ad hoc and planned investigations and treatment and to discourage apparently un-necessary repeat investigations.
eg Prompts to immunise at the correct time, monitor TFTs occasionally, plan dialysis access, timely work up for Tx,
This could be populated automatically for many set pieces eg renal biopsy, CV catheter insertion, Tx work up, new patient attendance, routine follow up by nurse fro condition X.
Consultants would have a tool for setting the rules, which could become the unit protocols but would give a method of executing them.
15 / Ability to use voice recognition for entering data / Letter dictation would be a good start but routine data entry and entry of diagnose and procedures should be the goal unless all other data entry can be automated by links to labs, patients scales, BP monitors etc.
16 / Safety systems / A method of recoding undesired actions or outcomes that may not qualify as critical incident. The accumulation of these mirror errors may make the difference between a mediocre service and a great one. At the moment we don’t have a reliable method of measure these frequent minor problems.
17 / Decision support / Ranging from on line unit protocols which pop up at the right time to automatic literature reviews based on the patients coded problem list. The aim would be to encourage “Do It Right First Time” (DIRFT) practice rather than get it wrong and pick it up in audit.

Please add:

Your name:

Your email address:

Your renal unit

Please rename the file with your unit name and your initials at the end, save and return by email to or

Your unit can send more than one reply if that is convenient.

File
ver / date / author / comment
01 / 20 may 2007 / ks / 1st draft
02 / 22 may 2007 / JM / Comments on links c GP & security log
03 / 24 May 2007 / KS / Voice recognition
04 / 25 May 2007 / Tidy up
05 / 29 May 2007 / NT / Format, email addresses

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