Dear all, I would be grateful for some advice on an issue that has been troubling me for some time. I am a clinician currently on secondment full time to an EHR project. I do not wish to name the software house we are using but they are a major EHR developer with an interest in the UK. The application on which we are currently basing our documentation strategy seems to have a flaw. The following is a made up example but I hope it illustrates a point. The application allows the creation of documents with standard windows form controls (e.g. drop down lists, multiselects, radio buttons etc). When I open a document it pulls though the appropriate value to each field from a previous form. Let's say I have a free text field that says 'Reasons patient unfit for surgery' and I have entered "pneumonia" as the value. I save the document and can view the information from the document viewer. A month later I review the patient and they no longer have pneumonia. I open the pre-op assessment document (which pulls through pneumonia to the relevant field) and delete it. The form is therefore either saving a zero length string or null value. The amended document is saved and the correct information can be viewed in the document viewer. Now, the patient phones up with some additional information which I wish to add to the assessment. I open it up to add that info. On a different page of the document however the 'reasons not fit' box pulls through not the last value (null or "") but the last non-null or "" value i.e. pneumonia. When the document is signed the author has unwittingly signed the fact that the patient is unfit for surgery as that is the value in that field now. The system automatically runs a theatres scheduling query and that patient is permanently rejected as being unfit for surgery. This is one of a number of significant problems with the system that in my opinion make it at best inconvenient or in some cases unsafe to use. All control types are affected and the solution we have been offered thus far is that you don't pull any values through. Therefore you have to retype all the information every time! The other worrying thing is the number of hours spent by Trust staff and IT staff on designing and building all the documentation is phenomenal and has resulted in very little. The UK government has spent an estimated ?2.3 billion on systems for the NHS for the first 3 years of a 10 year contract. This causes me concern given the above issue may be the tip of the iceberg. I am something of an amateur dabbling in the world of IT so would appreciate some informed opinion... Thank you.
Matt - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
