Friday, February 03, 2012

I Wonder What NEHTA and DoHA Are Planning To Address This Problem. You May Only Notice The Problem Once A System Goes Live.

This important wakeup call appeared from the UK a few days ago. It is clear there is a major requirement for care in system design and training to avoid problems.

Bromley GPs redesign e-referral letters

24 January 2012   Rebecca Todd
Bromley GPs have designed new templates for electronic referrals because of concerns about inappropriate patient information being included by “default”.
The latest Bromley Local Medical Committee newsletter says Dr Mark Essop and Dr Hasib Rub have been working on a solution to the “problem of inappropriate information being sent inadvertently when using computer-generated referral letters."
It uses the example of a parasuicide or abortion "from 30 years ago" being included in a referral for a frozen shoulder.
Bromley LMC secretary Dr James Heathcote said the example was hypothetical. No cases had come to light in which inappropriate information had been sent, but the LMC wanted to be proactive in preventing any “disasters."
In the past, referral letters had to be dictated and typed creating an automatic filter on what was included, he said.
Computers had made the transfer of information “all too easy” and local clinical leaders wanted to reduce the risk of inappropriate patient details being inadvertently shared by GPs.
“It’s very tempting to think lots of information is a good thing, but it depends on what that information is,” explained Dr Heathcote.
The newsletter says that most practices find it easier to delete surplus information  than to add relevant data to referral templates.
More here:
The main point here is that is it vital that 2 things happen.
First only current information is transferred into a referral document and second that a human doctor actually reviews the document for relevance to the referral being undertaken.
This all comes back to 2 things. The first is the way an individual system extracts information to develop the draft template and how will educated the practitioner is educated to know just how important careful checking of what is being sent is.
It is not rocket science but getting it wrong can result in an irate or very embarrassed (or both) patient!
David.

5 comments:

Anonymous said...

Red herring and a wasted space. Lots of practices will develop their own systems for many years to come. All NEHTA and DOHA have to do is develop what works, test it fully, deploy it in the field, submit it to professional peer group scrutiny for acceptance, certification and accreditation, then market it in a way which ensures rapid maximum uptake by target customers. Quite straightforward really. Until that time arrives Bromley and everyone else will continue doing their own thing in their own way.

Anonymous said...

so this is NEHTA and DOHA's problem? why? It's sure been addressed in depth in pcEHR etc, but if some vendors and/or GPs out there aren't being careful, do you really want that to be DOHA/NEHTA's problem?

Dr David More MB PhD FACHI said...

Well NEHTA and DoHA are making the information available through sharing it, so its quality is, at least in part, their problem!

David.

Bruce Farnell said...

Quite right David.

Unless someone takes responsibility for, or at least an active role in, maintaining a PCEHR patient record I can see a situation occurring where an acute 'current' condition is listed for a period well beyond its relevance simply due to the passage of time.

Ben said...

Bruce/David,
this is currently a 'problem' with MedicalDirector/BestPractice- the default referral template just pukes all the PMH, Rx etc into the letter. It's up to the doctor to review what is relevant before printing/sending the letter; I think it's inappropriate to built too much business logic into this step- manual review will always be better.