Documents and databases for the NPfIT record
William Hooper is Senior Advisor, Healthcare, Xerox Global Services and writes as a guest author.
This blog has frequently looked at humans and computers in healthcare. Let us introduce another factor—types of information.
Historically, pretty much an entire acute note has been un-structured. Some forms have been used for transactions such as ordering tests or receiving results, and nurses, as ever, are organised. I have not yet found a fag-packet in notes, but you get the idea.
The National Programme attempts to take a structured approach. GPs have been working this way for years, and it has many advantages. Computers are good at validating entries, when supplied with sensible rules. The advantages in terms of activities such as prescriptions are obvious. They can also be programmed to make sensible suggestions on care given a set of patient conditions. To say that programming these care paths is complex and time consuming is an under-statement.
Databases (which are what underlie the clinical systems of CRS) are good at holding structured observations and measurements. But, it will be many years before they have comprehensively encoded the bulk of medical practice (if ever).
Meanwhile, clinicians today are still adding both free-text and documentary additions to GP and acute notes, to say nothing of psychiatric observations. Paper is being generated too, and a tiny proportion is now being scanned and added to the database note.
A database stores a blood-pressure reading effectively where the care-plan says one should be taken. Documents can store anything and everything from the patient’s mood this morning to a sketch of a planned intervention.
The technology is now available to integrate documentary with data notes. This is to be supplied in most NPfIT clusters. Rather than talking about heaps of paper as being a problem for records managers to sort out, should we not be concentrating on who needs what information to deliver care, and how best to make best use of this?