Our objective was to identify and establish consensus on the most important safety features of GP computer systems, with a particular emphasis on medicines management. We used a two-round electronic Delphi survey, completed by a 21-member multidisciplinary expert panel, all from the UK. The main outcome measure was percentage agreement of the panel members on the importance of the presence of a number of different safety features (presented as clinical statements) on GP computer systems. We found 90% or greater agreement on the importance of 32 (58%) statements. These statements, indicating issues considered to be of considerable importance (rated as important or very important), related to: computerised alerts; the need to avoid spurious alerts; making it difficult to override critical alerts; having audit trails of such overrides; support for safe repeat prescribing; effective computer-user interface; importance of call and recall management; and the need to be able to run safety reports. The high level of agreement among the expert panel members indicates clear themes and priorities that need to be addressed in any further improvement of safety features in primary care computing systems.
There has been considerable discussion in England on the question of where clinical data should reside. On the one hand, the 'point of care' protagonists feel that clinical data (and clinical systems) should be focused on the patient, for use by the clinician at the point of care. On the other hand, those supporting registers and datasets feel that this is not adequate, and that standardised clinical data need to be brought together at a central point so that a number of clinicians and healthcare managers from a variety of healthcare sectors and providers can access them, for a number of differing purposes, such as epidemiology, quality improvement and audit, service planning, research and management.The PHCSG briefing to Sir John Pattison (see page 179) demonstrates which side of the fence we prefer. Our view is that the purposes mentioned as justification for registers are vital to the running and development of the service. However, we believe it is possible to use data from within clinical records for those purposes without the additional step of creating separate registers or databases. It is, of course, essential that the clinical data used are of high quality, and that will require not only considerable training and education but also the availability of clinical computing systems appropriate to the task.In the past few months in England the world has changed rapidly; we are now in a situation where The NHS Plan, which puts the patient's needs and then the clinician's at the centre of the strategy for delivering a health service, is becoming a reality. 1 General practice has been using computers as a part of day-to-day care since 1978 and, since 1997-98, the penetration of computing into general practice is over 98%. Since the change in the GP terms of service in October 2000, there is good evidence that over 80% of GPs use their computers in every consultation. RegistersMy definition of a register?An external database or spreadsheet, containing details of patients with a particular condition or set of conditions, set up for a particular purpose and maintained by some process involving multiple data extractions, questionnaires or discrete data collection exercises. My problems with registers as defined above?Extra work for the data collection agencies and the clinician from whom the data are being acquired. This is fine if they are purely researchers but not if they are primarily clinicians. Inevitable inaccuracy as they will only be as upto-date as the last data extraction, data laundry and entry into another system. Do we have an alternative then? Let's look at an example -diabetes. We run a continuous real-time audit at our practice. Each diabetic patient has embedded in his/ her electronic record reminders for future care so we can assess where the patient is in our agreed care plan. The care is provided through a mixture of templates and decision support protocols. These automatically Read code the responses of the clinician. 2 The design of the templates and protocols takes in the British Diabetic ...
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