Computer-based health records offer enormous potential value to public health, writes Professor Don E. Detmer
Computer-based health records are an essential technology for quality health care. Arguably the most crucial element of the NHS modernisation effort is its national information strategy. It must succeed. Why? As Will Rogers said: "The future just isn't what it used to be." New discoveries and therapies are emerging from biomedical research at an astonishing rate. Four million people cross national boundaries daily so diseases circulate more rapidly. An ageing population means more chronic illnesses to treat. More people wish to play a greater role in the management of their own health problems and hi-speed telecommunications shorten both distance and time creating a sense of greater urgency. The resultant knowledge explosion manifested by increasingly powerful and life-giving medications and treatments demand that health professionals perform better. Data management techniques from the 18th and 19th century no longer suffice to respond to this powerful set of phenomena. And we now have sufficient evidence to know that emerging computer-based data systems suffused with timely medical knowledge can respond reliably and accurately.
Three types of computer-based health records (personal, population, and patient) are emerging and EHRs focused on the individual and groups plus the EMR used by health professionals will provide the quality improvements if the records are designed so they can interact with one another. The computer-based patient record (also known as the Electronic Medical Record, or EMR) is the one used by doctors and nurses in delivering care and has distinct advantages over paper records.
Firstly they are consistently legible and reliably available on a "need-to-know" and a "right-to-know" basis. To assure confidentiality, audit trails allow one to know who has accessed the information and when and where it was accessed. Studies have shown that when a patient visits his or her doctor there is only a 50-50 chance that the paper-based medical record will be available. Secondly EMRs are far more complete than are paper records since they include all the patient's tests and records of consultation visits. Both of these attributes improve medical care. However it is the third feature of EMRs that is ultimately the most powerful. EMRs allow an integration of evidence-based protocols with care decisions at the time and point of care. This can prevent administration of improper drug dosages, warn of unfavourable drug-drug interactions, suggest safer or less expensive options, and remind doctors of important preventive tests they are more apt to overlook. Today, medical tests are all far too often repeated since data gets either lost or is misplaced or relates to tests received by the patient unbeknownst to the primary care practitioner. Capturing all the data once in a secure EMR saves waste, increases safety, improves communications, and raises the quality of decisions. And as chronic illnesses increase due to ageing populations, the co-ordination amongst primary caregivers, consultants, and home health workers becomes increasingly important.
Historically, while medical records have been the most important health records, surveys of the population have also been extremely important for epidemiological studies whether they are undertaken with the goal of improving health services or to serve public health functions. If we appropriately address the important security and privacy issues involved, the computer-based physician and hospital records (EMRs) allow a number of unique, sophisticated studies of these detailed accurate collections of patient data, the so-called computer-based population, or community health record (CHR). Community health records will be useful for prevention of disease, measuring quality performance, and correlating to human genome datasets.
Looking forward, it is becoming quite apparent that patients and doctors need to be able to communicate via e-mail and websites and patients need to be able to review and annotate their own medical records. This linkage between computer-based personal health records (PHRs) is now just developing in the US but is certain to become a global reality since a number of worthy ends are served. Firstly more and more people are independently buying and taking an array of nutritional pills, potions, and remedies based upon their own internet searches or through the advice of friends or as the result of independent reading. Doctors need to know this information since some of these herbs or concoctions may be contraindicated with the patient's conditions or with other of the patient's medications. Finally collecting this data within the cluster of CHRs will allow health researchers to determine if the health of patients is benefited or harmed through such self-treatment.
In short, computer-based health records offer enormous potential value to public health through health services research and as such they are essential components of the national information strategy for the NHS.
To succeed, and it must, the NHS IT strategy must be sufficiently funded and committed to the substantial leadership, educational and change management challenges involved. Reed Gardner has said that successful IT implementation is 15 per cent technology and 85 per cent sociology. Standards need to be set at an international level and this too is underway. While a great deal has been done, a great deal remains to be accomplished. We are basically engaging a threshold improvement in healthcare using IT both as a strategic and tactical resource. Since the bulk of the recent planning has been quite sound, the test will be on how well the plans get executed. I wish the nation every success in this hugely important undertaking. The rewards should include better services, less suffering and better health, and, most likely, a more productive economy as well.
Case study four:
Doncaster Health and Social Care Community's Electronic Healthcare Record
The innovative work of Doncaster and South Humber Healthcare NHS Trust's Information Technology Department was recognised at the recent 2002 Healthcare IT Effectiveness Awards held in Harrogate. The Doncaster Community's EHR (Electronic Health Record) System beat off national competition to win in the category "Best use of IT in Primary and Secondary Care".
The new system was introduced in response to the government's "Information for Health Strategy", which highlights the need to develop an integrated health and social care electronic health record. Working in partnership with the local health authority, the acute hospital, social services and carers, the Trust took the lead on the Doncaster-wide project to provide health and social care professionals with instant, on-line access to integrated patients' records.
"We were given the task of electronically integrating patient records from the various health and social care providers in Doncaster, to create a central, up-to-date database," explains Ian White, Head of IT for the Trust.
"Access to client and patient information is now available 24 hours a day, seven days a week, from any PC terminal connected to the NHS Net. And of course, the system has been developed to meet the very high standards of patient confidentiality expected of the NHS - all data transmissions are encrypted and are only accessible by authorised professionals."
As well as helping doctors, nurses and social workers to do their jobs more effectively, the new system has obvious patient benefits, not least providing quicker joint agency assessments and access to services. Now that the project has been established successfully in Doncaster, the Trust hopes to extend the EHR system to its other areas of operation - North Lincolnshire, North East Lincolnshire and Rotherham.
Doncaster and South Humber Healthcare NHS Trust currently provides a range of mental health, learning disability, community and rehabilitation services to over 880,000 people across Doncaster, Rotherham, North and North East Lincolnshire.
Rachel Johnson, Doncaster and South Humber Healthcare NHS Trust
