Electronic patient records
In the past all patient records were kept on paper and this caused many problems, these included:
- Many medical staff needed to access the same patient records and sometimes they needed them simultaneously. The only way two doctors could access them at the same time would be to photocopy them which is expensive and wasteful.
- huge numbers of paper-based records caused storage and retrieval problems.
- handwritten notes written quickly meant that others could not always understand them.
- patient records frequently went missing, as doctors kept them on their desk rather than returning them to the medical records department
- patient records filled in the wrong place meant that many tests had to be repeated, wasting time and money.
Electronic patient records
There are many advantages in storing data electronically rather than on paper, these include:
- Patient details are available to be viewed wherever there is a terminal. in some cases the details can be accessed on mobile devices such as laptops or PDA's
- there is only one set of data kept so it is easier to ensure the consistency of the data
- it is much easier to back up the data
- you do not need to transport patient files from place to place as with the paper system
When a patient arrives at the hospital they are allocated a unique number, which in some cases is their NHS number. This number is important as it provides the key field for the patient database and is used to distinguish between patients with the same name living in the same address.
Patient identification is extremely important in hospitals, so each patient is issued with a wristband with a barcode on it. This system provides the critical first step in making sure that patients are correctly identified.
the coded wrist band contains the following information about the patient:
- patient names
- date of birth
- blood type
- NHS number or some other number that uniquely identifies the patient.
Blood Bar coding tracking systems
Blood transfusions can cause a big risk to the patient. If either the blood or the patient is incorrectly identified. Putting the wrong blood into a patient can prove fatal so it is important that identification mistakes do not occur. Also there needs to be a way of determining who gave the blood and who received it. As many infections can be passed through blood product.
If in the future it was indentified that either the donor or the reciever had a medical problem, then both could be indentified.
Blood bags used for transfusions are routinely bar coded with certain information at the blood bank before being delivered to the hospital.
How blood tracking works
Hospitals use computerised ICT system for this purpose, which works in the following way:
1) blood is taken from donors and is then tested to determine certain characteristics of the blood such as blood group ( A,B,AB,O etc.)
2) Blood is stored at the National Blood Transfusion Service. Cross matching takes place and bar coded labels are produced during testing and attached to the blood bags
3) matched blood is sent to the hospital where it is kept in a blood bank/fridge. The details of the blood contained in the barcode are scanned in before a blood bag is placed in the fridge.
4) hospital staff remove the required blood by first scanning their ID card. The magnetic locks on the fridge/bank then unlock, allowing the blood to be removed. the identification barcode on the blood is scanned and the blood taken to the ward.
How blood tracking works ( cont )
5) the patient who requires the transfusion has their bar code on their wristband scanned using a handhelp PDA. if it matches then the blood transfusion is given. Advantages of the blood tracking system:
- eliminates the need for staff to keep paper records so saves time
- can find the donor or receiver of the blood if there has been a danger of cross-infection
- provides security by only allowing certain staff to access blood in the fridge
- used for stock control so that the blood match the patient's needs is always available
Other uses for bar coding in health care : bar coding is fast and efficient input method and is used in medical applications apart from patient identification and blood tracking such as:
- identifying labratory specimens ( blood, urine etc.)
Use of internet
The internet can be used by a hospital for:
- sending emails to patients they find difficult to contact by phone
- communicate with patients using a hospital website
- allow staff to perform research
- enable patients to communicate with their friends and family
- send information on lab tests or x-rays requested by doctors in primary e.g. a GP or secondary care from hospital or lab servers.
Intranets & Extranets
Intranet: private internal network which allows employees of an organisation to access information resources within the organisation.
They are used for the sending of messages and data around the network. Only hospital staff are allowed access to the intranet. Many hospitals use intranets as a way of transferring patient data to different devices such as PCs, laptops, PDAs around the hospital.
Extranet: extranets are intranets opened to select groups of users outside the company such as customers, suppliers etc.
Use the same technology as the internet but allow people who are not employees of the hospital or trust to exchange information . They how ever must be authorised to use the extranet. Extranets can be used by:
- Suppliers - so that they are able to check that vital drugs and equipment never run out
Databases, where the data is stored on a number of servers are often in different locations. The user will not know that the data is being obtained from different servers.
Distributed databases have the advantage that:
- security can be improved as the data is not all kept in one place databases can be easily replicated
- speed of access is improved because one server does not have to deal with all the requests for information from users.
Back up and recovery procedures
Copies of software and data kept so that the data can be recovered should there be a total loss of the ICT system.
Medical databases lie at the heart of patient care and it is crucial that this data is kept secure and back up regularly.
Recovery procedures must be in place so that staff can recover any lost data, and it is essential that the procedures are tested to make sure that the system can be recovered in the event of a problem.
considerations for back up:
- whether any downtime is acceptable- if downtime is not acceptable then a RAID system should be used.
- how much data needs to be backed up- tape stores the most.
- where the data is to be stored - copies of data should be kept off-site
- how often copies of the database should be taken- this depends on how often the data changes.
Ensuring the privacy of patient records
The privacy of patient recods is taken very seriously by hospitals and medical staff, they have to make sure that personal and medical details are only disclosed to authorised staff.
The privacy of the EPR system is asured by:
- Access levels - these control what a user can do. For example, read only access would only allow a member of staff to view certain data but not copy, delete or alter the data in any way.
- 128-bit encryption- this ensures that data being sent along networks is coded, so that even if it were intercepted, the data would not make sense. The data is only able to be decoded and hence understood by the correct recipient.
- password - a system of password ensures that users are only allowed to access to those parts of the patient records needed for their particular job. For example, admin staff would not have access to medical records, where as doctors and nurses would.
Sensors analogue and digital
There are many physiological measurements that need to be recorded for a patient in hospital. In order to free up time for medical staff, this routine recording of data can be performed automatically using sensors.
sensors are devices that can be used to detect physical, chemical and biological signals and provide a method of measuring and recording them using processors or computers,
there are two different types of sensors:
- Analogue: used to measure an analogue quantity, which is a quantity that can have an almost infinite set of values such as temperature,pressure etc.
- digital: these are sensors that can detect digital quantities. For example, a switch can only have two positions( on and off or 0 and 1) and so can be represented as a digital quantity.
Data measured by sensors and its uses
sensors are used in medicine to measure the following:
- blood pressure
- central venous pressure (to determine the amount of blood returning to the heart and the capacity of the heart to pump blood into the arteries)
- respiratory rate
- blood sugar
- brain activity
- measurements are never missed as they are taken automatically
- reduces costs - one member of staff can be responsible for more patients in intensive care units
- more accurate readings - sensors produce more accurate readings than people, who can make mistakes when taking readings.
MRI (magnetic resonance image)
An MRI scanner makes use of magnetic and radio waves to build up a picture of the inside of a patient. MRI scans do not use X-RAYS, which means they do not cause any damage to the patient.
the patient lies inside a large, very powerful cylindrical magnet and powerful radio waves are sent into the patients body. The hydrogen atoms in the patients body emit radio waves of their own and the scanner picks these up and turns them into pictures.
A computer is needed to analyse the data from these radio waves and produce an image on the screen. The image is modelled from the location and the strength of the radio signal that is recieves.
The MRI scan is used to produce clear pictures and it is the best technique for doctors to use when they are checking for tumours.
MRI scans can also be used for:
- examining the heart and its blood vessels for damage
- examining joints and the spine for damage
- checking the function of certain organs such as the liver, kidneys and spleen.
CAT ( Computer axial tomography )
A CT scanner is a special and more complicated type of X-ray machine. Unlike ordinary X-ray machines, which only send out a single X-ray, CT scans send out several X-ray beams at different angles to the body. The X-rays are then detected after they have passed through the patient's body.
The scanner therefore can assemble a picture based on signal strength and after processing these signals on a computer, the system produces a two-demensional picture on a screen.
CT scans are more detailed than ordinals X-rays and some of the large CT scanners can even produce three-dimensional images. They allow virtual images to be produced, which enables doctors to see what a surgeon would normally see during an operation without actually operating.
CT scans are mainly used for pinpointing tumours in the body. They also are used for the planning of radiotherapy for the treatment of the tumours.
Advantages of scanning devices
- Higher cure rate - early detection of tumours means the patient is more likely to be cured.
- scanning can be done routinely - can detect illnesses so that the treatment can be started before the symptoms appear.
- help surgeons plan operations - enables the surgeon to look at the positions and shape of internal organs so they can understand what they have to do before they operate
- safe in the case of MRI scans - MRI scanning is a very safe scanning method, but CT scans are not,as they involve the use of X-ray
Disadvantages of scanning devices
- sophisticated computer-controlled scanning equipment is very expensive.
- can break down more therefore means that more things could go wrong
- can be dangerous for staff to use as CT scans can expose the patient and staff to ionising radiation, so they need to take care
- with MRI scans, the patient needs to keep still for times up to about an hour in very enclosed space and this is uncomfortable and distressing for some patients.
There are some limitations in the use of scanning, life support and other computer- controlled equipment which include:
- bandwidth is sometimes limited, which means scans cannot be stored with other patient record details, it takes too long to transfer the file, they take up too much storage space etc.
- life support malfunctions can cause the death of seriously ill patients
- ethical problems, when should the life support machine be turned off?
- all this equipment is very expensive and could be better used for prevention rather than cure.