Clinergy looks virtually identical to a of a piece of software
which last year was promoted by VAMP (Reuters Health) under the
name of "Notation". I should perhaps say promoted through VAMP as
it was being developed  by a team from Manchester University. Our
surgery piloted an early release (cannot remember if it was the
alpha or beta  - difficult to tell sometimes :)) and I used
Notation and Vision exclusively in my consultations for ~6 weeks.

Pros:

1. Relatively quick way of entering concise and readable medical
text. (i.e. something like: Moderately severe sore throat for 5
days, getting worse. Associated fever. O/E Mild pharyngitis. No
exudate. Diagnosis Viral URTI).

2. Pretty GUI (Graphical User Interface) which might help reduce
the steep learning curve required with any new clinical system.

Cons:
NB this applies only to its use with Vision and at an earlier
stage of development. Some of these problems may since have been
ironed out, or may not be applicable to its use with EMIS or
Meditel (although the screen cam shots on offer do show a
virtually identical product to the one that I piloted.) These
views only represent my opinion and are not intended as
statements of fact.

1. Cost

* I do not know how much this product is retailing at, but if
sold to me by my GP software supplier, it is too much!  I would
like to pay ONE software provider for a single clinical system
and not have to fork out for a number of separate modules. I
understand the need for this in cases where a new function is
required. But to be honest, I think that the GUI, coding and data
entry should be an integral part of any GP software.

2. Speed

* It slowed the initial loading of Vision by nearly a minute at
boot up. Only a once a day delay, unless more than one Dr uses
the same PC. On a P90 with 32Mb RAM there was a slight, but
perceptible slowing of data entry.

* In day to day use I found the GUI and diagrams (which initially
give the product an innovative feel and is one of their selling
features) were not practical to use at speed. I finished up not
using them at all, as there were always quicker keyboard
shortcuts.

3. Coding issues

* There was an unhealthy desire to want to read-code every bit of
data entered, despite my protestations. Each examination finding
was read-coded (why?)

* I share Sheila's concern about the mapping and future
compatibility of the Read codes which I would imagine, given the
indiscriminate use of coding in this product will prove to be a
nightmare to maintain.

4. Data presentation

* Each aspect of the examination finding was entered on a
separate line. This meant that for a single topic there were
often multiple entries all describing the examination findings.
This was a reflection of the developers perceived need to code
all the data. In fact IMHO it would have acceptable to put all
this data on one line of free text next to the appropriate read
code.

* Whilst there was an option to enter free text this was entered
in a different field which was not linked visually to the topic
in question and could not be seen (in Vision) without a separate
mouse click.

* There was no facility to prioritise the entries, which IMHO is
going to be an essential part of any  medical software system.
Once Drs get used to the paperless concept  where everything gets
recorded on the computer (sorry folk, but the way is clear) there
will be little choice. Prioritising our diagnoses or any other
data entry for that matter is the means by which we can sort the
chaff (and there is a lot of it) from the wheat. Even if you are
only recording limited clinical information on your system, START
PRIORITISING NOW - I guarantee you will thank me for this advice.

* It was a difficult system to document the psychosocial element
of the consultation (a pretty major component at that!)

I was not privy to the discussions between the Manchester
development team and Reuters, but I suspect that the some of the
above agendas proved insurmountable stumbling blocks and there
was a parting of the ways. When negotiating terms prior to taking
on the pilot I asked to have the software "gratis" after it had
been developed - a request which was declined. Interestingly I
still have this software stalled on my system and could be using
it today. In its current form (i.e. the beta release on my
system) I choose NOT to use it with or without a fee, as in
Vision at least,  it slows me down and presents my data in a way
which I find unacceptable. This might of course be taken as a
tribute to the speed and ease with which I can already do this
within Vision :)

The great part of the package was the way it allows rapid entry
of medical data by clicking through a series of well presented
options and displays that data as readable text. I thought that
this aspect had much promise, at least until such time as
functional speech recognition redefines how we input data into
our PCs - two to three years??

Laurie Slater
GP West London



-----Original Message-----
From:	[log in to unmask]
[mailto:[log in to unmask]] On Behalf Of SHEILA
TEASDALE
Sent:	15 July 1998 11:37
To:	[log in to unmask]
Subject:	Re: Clinergy Software

> Any experiences out there in cyberdoc?

My other worry is to do with the coding itself - who is doing the
coding / mapping exercise, how is it being kept up to date with
developments in Read Code, what are the quality control
mechanisms?
Those questions were not answered in the presentation.  Anyone
got
any experience of the system in use?

Sheila

--------------------------------------------------
Sheila Teasdale, MMedSci    Tel 0115-924 9924 ext 44258
Research Fellow             Fax 0115-970 9389
Collection of Health Data from General Practice
Dept of General Practice
Queens Medical Centre
University of Nottingham
NOTTINGHAM NG7 2UH
email [log in to unmask]
--------------------------------------------------



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