NHS IT, Records and Data

Communicating effectively

Advances in information management in laboratory medicine will allow better communication between pathologists in the laboratory and clinicians on the front line, reports Richard Mackillican

Establishing efficient and effective lines of communication between different departments can greatly enhance the quality of care delivered to patients.

Now that much of that communication is done digitally, it is vitally important that the systems puts in place to facilitate this are as effective as possible.

According to Prof Jonathan Kay, consultant chemical pathologist at Oxford Radcliffe NHS Hospitals Trust, the big issues at the moment are around getting fully computerised requesting from clinicians to the laboratory and then reporting the results back to clinicians.

A typical laboratory will be based within an acute trust, with about half its work coming from the hospitals within that trust and about half from primary care. Although this is the most common pattern, it varies between trusts.

“We now have fully computerised reporting to all general practices. We use a messaging architecture between laboratory systems and the receiving GPs’ system which we developed in Oxford about twenty years ago and which has become something which many people take for granted. It is the only widely used structured clinical communication in the NHS.

“One of the issues around this system is around stopping the paper reports because at the moment many practices will get reports both digitally and by paper. However, there is an issue with removing the paper, because some practices tell us that having the report printed out on paper does allow for easier downstream processing after receipt, than with the information which has been sent digitally to their practice systems. In Oxford, we still have about a quarter of GPs’ surgeries receiving both paper and digital reports.

“This is because it is much easier to do things like passing a note on to someone else or asking a receptionist to talk to a patient by using the paper. In order to address this issue in Oxford, we write to each practice to find out how they would like to do it. Usually one would assume that everyone gains by getting rid of the paper, but that is simply not the case.”

So given the popularity of using paper in this way, will GPs’ practices ever go totally paperless?

“I simply don’t know. It is really up to each individual GP practice and their suppliers. Even the practices which are paper-light with laboratory reports will still be receiving vast amount of information on paper anyway, so this question is also part of a wider issue of how we plan to digitise all of that paperwork in the future.

“Another interesting area is that of the computerisation of requesting by clinicians and there are some great products already available. The most difficult issue here is that there are so many different types of GPs’ computer systems, but the middleware supplier will usually handle that integration and there are really big benefits from using these systems.

“These benefits include removing the need for copy typing on request cards and improving data quality. We’re getting some great results from those projects.”

The project which Jonathan mentioned has been running for around a year and involved their supplier installing the requesting system between the hospital and all of the surrounding GPs’ practices.

“For my discipline, which is clinical biochemistry, over 80 per cent of our requests are now coming in from computer to computer. There are some really big benefits of doing it that way.”

These benefits have now been recognised at a national level and gradually individual laboratories are implementing different systems as time goes on.

“One major benefit of using this kind of system is improved data quality because it avoids the need for all of that re-keying. Then there is also the improvement in productivity at the stage when the specimen is being booked in at the laboratory because all we really do now is swipe a barcode which allows all the details of the request to be imported into the laboratory system. This is in contrast to before, when we had people copy typing from request cards.”

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