Computer-Mediated Clinical Consultations: the Impact of the Computer - Term Paper Example

Computer-mediated clinical consultations; the impact of the computer Name Affiliated Institute Date Introduction Hospital staffs spend 25% of their time collecting and record data from patients to inform preventive action. Consequently, the process is cumbersome and provides no guarantee on the quality of data collected. Also, the safety of the data gathered and its availability for retrieval so that the doctor makes reference to it posses extra challenges. These led to the introduction of electronic patient record systems with Dr. Jeremy Bradshaw Smith taking the lead to have the first computerized paperless practice at Ottery St. Mary health center in 1975 (Benson, 2002). Computerization aimed at reducing the time consumed during the performance of routine tasks in the clinical setup, however, the dream of integrating the use of computers in clinical consultations remained elusive for a long duration of time due to technical difficulties. Moreover, lack of adequate funding despite the introduction of computers in the early 70's, lack of a supportive policy framework, and the diverse nature of medical practice (BradshawSmith, 1976). Medical record and its role Over the years, health informatics' goals included the development of computerized patient records. It is a general requirement that such records safely and efficiently rightly provide the information to the right person at the right place and time. The computerized records require minimal effort in manipulation and gleaning crucial clinical data. Also, the records are useful in the direct care of patients, preventive care, support to clinical decision making, auditing and accounting for services, litigation purposes, financial management, clinical research trials, and comparative studies across institutions locally and internationally (Grummit, 1976). The use of computerized medical records is successful in setups with a clear understanding of their scope of use for instance in general practice and a single unit within a hospital. Weeds developed a problem-oriented medical record (POMR) which is widely used in general practice following its introduction as a component of the Abies-Meditel System 5 in the year 1987. The record helps in retrieving information quickly by its multiple views displaying dates, problems, topics and reminder prompts making it more advantageous over paper records. The computerized records contribute to reducing the great nature associated with medical records (Benson, 2002). Contents of electronic medical records are determined by the discretion of the doctor reviewing a patient with restricted access by clinicians involved in patient care. The records have a flexible input format allowing narratives, abbreviations with no restricted codes as well as direct and convenient data input. The system allows data input through the use of a keyboard whose output is displayed on the visual display unit (VDU). The record provides multiple commands that are useful for navigating between tasks during manipulation of the records (Grummit, 1976). Exeter Hospital and Royal Devon have exclusive lines linking the computer center and the VDUs of their computers. The secretary originates the medical records and assigns each patient a unique number that is useful for connecting the various parts of the medical record on different screens. The medical record comprises of display summary, display medication as well as display extension (Benson, 2002). Introduction of the computer to support clinical consultations John Preece pioneered computerization of medical records by showing its feasibility in 1970. In 1975, Medical practitioners at Ottery St. Mary in collaboration systems analysts from Exeter Community Health Services Computer Project designed computerized clinical records hence replacing the National Health Services (NHS) medical envelopes. Mount Pleasant Health Centre, Exeter adopted the same system in 1976 as part of a project initiated by the installation of ICL 1904A in 1973. Before then, the initial system that addressed registration of clients in the health center became functional in 1973 (Grummit, 1976). Simultaneous development of the applications of the system took place in the early days of its introduction. General practitioners tested the basic system by summarizing 10,000 records on A3 forms then feeding them through the paper tape to batch files. These were then analyzed, and output recorded on a microfiche. The process yielded valuable information on the likely problems that the real system would present at an early stage of its development (Benson, 2002). Full integration of the system at Ottery with the local hospital allowed hospital staff and general practitioners to share information. The same project also realized the development of a computer printed prescription form thus greatly informing today's practice. Based on the developments, several governments started sponsoring computing projects in the 1960s and 1970s, but this support waded off at the close of the 70's (Grummitt, 1976). Due to budgetary constraints, some of the countries that had undertaken these projects converted them to constitute centers of excellence as academic departments in health informatics consequently losing the integration that had been realized including the Exeter system. This undermined the progress realized by integration of the computerized systems. As such, only a few hospitals successfully achieved the integration of patient administration as well as reporting systems for laboratory services that are accessible from outpatient clinics and ward terminals (Benson, 2002). Impact on the patient care and the system The Exeter Community Health Services Computer Project commonly referred to as "the Project" helped in the provision of better quality patient care with an improvement in the efficiency of both clinical as well as administrative procedures. Also, the project promoted the availability of valuable information essential for research activities that inform the quality of patient care. Moreover, the computerized based medical consultations are useful in informing management practices. The Integrated Patient Record that addressed the needs of administrative staff, nurses and doctors integrated as a computer system facilitated the realization of improved patient care and streamlined administrative practices (Grummit, 1976). Computer-based medical consultations mainly impacted on attendance of surgeries whereby the general practitioners relied on the visual display units to quickly review the patient's history before they came in for the prescribed procedure. In areas remote from the health center, the general practitioners relied on a portable microfiche folder in retrieving, reviewing, and making additions to patient records for over a period of one month by use of tape recording devices or a special notepad and, later on, amending the changes in the visual display units. This was also possible in cases of smaller populations whereby the GP utilized the Copedex visible record unit in the performance of these tasks (Grummit, 1976). Realization of these benefits was through the exploitation of editing functions available on the visual display units namely deleting, changing, insertion or addition of data in the maintenance of a predefined format. The clear display precisely laid out with clarity and brevity of content emphasized data priority. Consequently, this created an ease in the retrieval of data linked to the patient's symptoms, the medical diagnoses, and prescribed treatments. All the contents of the entire patient record were properly indexed and clearly cross-referenced (BradshawSmith, 1976). Termiprinters at the Health center released prints of repeat prescriptions based on the information keyed in by the general practitioner during the initial prescription given to the patient. The VDU included a pattern of the drugs used assisting the general practitioner in limitation of the frequency and duration of repeat prescriptions. During referrals of patients, a standardized summary of the patient’s record or its portions was printed on a termiprinter and availed to the next consultant. The records also helped in addressing issues of return visits by the addition of special markers that signalled the general practitioner in the event the consultations failed to take place (Grummit, 1976). Upon leaving a GP’s practice, subsequent patient care following a visit to the general practitioner was made possible by complete up to date printouts of the current patient's record. Searching and analysing all the medical records from computerized based medical consultations provide invaluable information for screening, surveillance, and research targeting informed medical practices (Benson, 2002). The presence of control screens as well as graphical records eases management of treatments and repeat prescriptions. The ability to print out summarized medical records improves the efficiency and effectiveness of the daily running of the medical practice. The computer-mediated system also provides a unique ability to marshal and manipulate medical information as opposed to the paper-based records. Essentially, the system markedly improves the care of the patients and the entire health system with potential for introduction of novel clinical processes (BradshawSmith, 1976). Discussion and conclusion Computer-mediated medical consultations have undoubted beneficial effects and positively impact on patient care as evidenced by the evidence obtained during the development of the said systems. Further advancements and integration of the systems are possible with ease of testing them through simulating the existing record structure and linking them to a similar framework. Initial costs for installation of the relevant applications remain relatively high but once operation, the system transforms medical practice and its outcomes on patient care. The system lays the ground for the effective and efficient performance of tasks by staff with invaluable support from the computers at a constantly reducing unit cost. The integrated patient record is very clear, easy to update with editing facilities thus saves time consumed while reading and searching for information. The flexibility of the record allows doctors to design their desired methods of using the record and provides backup of the obtained data in the portable microfiche. References Benson, T. (2002). Why General Practitioners use Computers and Hospital Doctors do not- Part 1. British Medical Journal, 1086-1089. Benson, T. (2002). Why General Practitioners use Computers and Hospital Doctors, do not- Part 2. British Medical Journal, 1090-1093. BradshawSmith, J. (1976). A Computer Record Keeping System for General Practice. British Medical Journal, 1395-1397. Grummit, A. (1977). Real-Time Record Management in General Practice. Int. J. Biomedical Computing, 1-20. Read More