>1) What do you think are the ideal qualities of an A&E computer system?
You need careful planning by clinicians that understand the clinical
process and how computers can enhance it. Keep things simple and don't try
to collect data for data's sake. Make sure you know your current clinical
processes, tailor your system to these and don't assume that any change
will be easy. Therefore the system must be inherently flexible- every
department is different. Any new system must be introduced gradually in
phases with careful education and support so that staff make a painless
transition.
Naturally the system must be easy to use, allowing "real-time" data entry
(eg touch screens in critical locations). Once you find your staff entering
data retrospectively, then you know that your system is a failure.
Most of all, remember that doctors and nurses are completely and utterly
Pavlovian at work. They will not use a computer or enter data unless they
perceive a value- preferably some form of instant gratification in return
for every interaction with the system, eg:
-a good (=large) electronic whiteboard with an efficient patient tracking
system/departmental map
-staff only get a clinical sheet to write on/order drugs if they log in to
triage or treat the patient
-staff get automatic generation of request forms (using the triage
complaint), in return for entering investigations ordered.
-when results of lab tests are available, an alert shows up on the
screen/electronic whiteboard
-easy access to clinical guidelines, medline search, pharmaceutical info,
poisindex from any screen
-can't admit a patient to a ward without entering data to print out a
"front-sheet"
-in return for entering procedural codes, investigations ordered, along
with an accurate diagnosis, they get the beginnings of a decent discharge
letter, incorporating presenting complaint, demographics, investigations
ordered, investigation results, interventions and ICD-10 diagnosis. This
might then be automatically forwarded to the GP by email/fax.
There are a number of departments around Oz where these basic concepts were
ignored... therefore lots of boxes getting in peoples way, collecting dust.
In some cases extra clerical staff have been employed to enter almost
useless retrospectively collected data to satisfy health department
reporting requirements!
Simon Brown FACEM
Director of Emergency Medicine
Royal Hobart Hospital
Tasmania Australia
Ambulance Service Medical Officer
Tasmanian Ambulance Service
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