9 Appendix 3: Views of Clinicians
Of particular importance are the views of those using eHealth to deliver patient care. In June 2014 a survey was conducted of 4,247 clinicians covering all professions and all NHS Boards seeking their views on priorities for future investment.
The findings were essentially consistent across NHS Boards, staff groups and care locations, the top 3 priorities being:
1. Better information about my patients from all contributors to care, including accurate and up-to-date medication records:
a. A GP patient information summary is identified as the key item, but the concept extends to a community staff patient summary, a medication summary, an inpatient episode summary, and the 'take' of other clinicians;
b. To counter 'information overload', summary information at the top level that allows access if required to lower level detail. The argument is advanced that summaries should be nationally defined so as to avoid inconsistency which could impact patient safety, in particular in the context of cross-border flows;
c. A shift from fragmented to integrated information. Where information is spread across systems the risk of missing something increases. Clinical portals have helped with this as has 'single sign-on' and this approach should be extended, including better capability to retain the 'patient context' when switching between applications;
d. In addition to a display of information by category, an option that shows a patient-centred timeline view. This would speed up accessing the important and most relevant information. Ideally clickable tags would allow access to the more detailed information about an individual patient event;
e. As well as being able to explore patient information through 'clicking', an option to employ search tools on the EPR.
2. More daily tasks more efficient: new or slicker IT to help me (e.g.) assess, plan, record, confer, vet, reconcile medicines, prescribe/administer drugs, discharge:
a. Test requesting / tracking / results checking and sign-off. A mix of paper and IT exists and the need is for ease of access and clear presentation, and defined, consistent sign-off and workflow procedures that are owned by the clinicians / business;
b. Slicker production and editing of all types of letters including internal and tertiary referrals;
c. Email exchange with patients, and email / messaging with colleagues about patients, with messages being recorded within the EPR and workflow initiated and tracked;
d. Intelligent workflow / pathway support. This includes active alerts for the arrival of information or results outside an expected range, and the capability to define an expected sequence of events for patients with prompts at appropriate points for various players to take action;
e. Medicines: reconciliation and hospital prescribing / recording of administration. Reconciliation applies to the movement of patients between primary and secondary care (which has been considered in the Closing the Loop project) whilst hospital medicines would be addressed through a HEPMA solution.
3. Mobile device (laptop/tablet) to work with my patients' electronic records anywhere, with keyboards and large screens available to connect to in appropriate places.
a. Clearly this applies to mobile staff and care provided away from NHS premises, but it also has resonance with hospital based staff. It can also be expected to include the third sector and private sector suppliers in the care sector.
Email: Alan Milbourne