http://www.headstar.com/futurehealth
- DR PAUL SCHMIDT. * GOOD INFORMATION SAVES LIVES. by Derek Parkinson �[EMAIL PROTECTED] When hospitals make mistakes, hair-raising headlines and horror stories often follow; but many of these errors can be traced back to old, inefficient systems for processing information, according to Dr Paul Schmidt, a physician at Portsmouth Hospitals NHS Trust. "A lot of the horror stories happen because people are so busy: there are so many things to remember and write down and pass on to the right people", he says". Schmidt aims to prove his point by developing an e-enabled Medical Assessment Unit (MAU), plans for which he unveiled at last month's Southern Institute for Health Informatics Conference hosted by the University of Portsmouth. Aside from accident and emergency departments, MAUs are the main route for patients into a hospital, the difference being that a patient only arrives at an MAU after referral by a practitioner. But unlike accident and emergency departments, from where around 90 per cent of patients go home, MAU patients are often assessed for up to 36 hours and need long stays in hospital, with specialist treatments and post-acute care. "With complex investigations it's essential to be able to hand tasks on easily, but with a paper-based system it takes ages because of the time needed to fill in forms," Schmidt says. The remedy he has devised is a system that captures data from a patient's arrival at the Portsmouth MAU and can be tracked right through to the point at which they are discharged. To achieve this, Schmidt has identified a four-stage path to implement electronic patient records (EPRs): EPR1 captures a patient's entry and exit points, describing the reasons for referral and discharge; EPR2 provides online access to scanned notes and a diagnostic planner; EPR3 offers templates for graded treatments; and EPR4 contains complete care pathways, bolstered by social and nutritional information. The benefits of this system for quality of care are self-evident, Schmidt says. In addition to easing the flow of information about a patient and providing an 'audit trail' for their treatment, the system should also deliver efficiency gains: "A lot of patients are re-admitted to hospital unnecessarily because only 50 per cent of discharge notes reach GPs within five days" he says. At present, Schmidt is well into the first stage of the four-stage project, but two obstacles lie in his path: technology and funding. The main technology requirements are an XML-enabled browser interface that complies with government metadata standards, a short-range secure wireless network to deliver EPRs to clinicians on the move, and document scanning equipment to capture content from paper-based notes. The first two requirements are more complex than the third because they are also bound up with expectations and habits. Diseases, treatments and prescriptions, for example, may not be described in the same way in different countries, making it difficult to settle on a single metadata system. Having mobile access to a patient's records is appealing, but different situations will favour different access devices: a palmtop device can be carried easily and discreetly, but is unlikely to impress a consultant doing rounds and needing to display records to a group of doctors. "Many doctors have turned into Doctor No - if they can't get on with new technology quickly, they refuse to use it," says Schmidt. Despite these hurdles, the single biggest headache for Schmidt faces is funding. He claims to be building the Portsmouth MAU on "virtually no budget" and prefers not to put a figure on its total cost. Cash flows into his project in a piecemeal way. "Money for technology is like a car in the night: you flag down anything that comes along because there aren't many and when it's gone, it's gone," he says. NOTE: To view slides presented by Schmidt to the Southern Institute for Health Informatics conference, see: http://fastlink.headstar.com/schmidt -- From one of the Linux desktops of Dr Adrian Midgley http://www.defoam.net/
