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Making information technology work for hospital juniors

Section 3 - Requirements and future recommendations
The BMA and JDC endorse the ‘Specification of Core Requirements for Clinical Information Systems in support of Secondary Care’ produced by the Academy of Medical Royal Colleges Information Group (ACIG).

It is beyond the scope of this document to attempt to replicate this with a comprehensive list of standards. Rather it aims to highlight certain areas and make further additions appropriate to hospital doctors in training. Where we perceive that requirements are not reflected in the current NHS IT strategy, or are of increased priority, we have highlighted further recommendations.

Clinical information and risk
- Requirements for patient information during acute admission:
- Availability of a patient’s current diagnoses, medication, allergies, immunisations, and social support (this may come in part from recent discharge summaries, clinical letters, or primary care records)
- Availability of previous imaging and lab results.

Recommendation 1.
As a priority, existing clinic letters and discharge summaries already stored electronically should be made available through a trust-wide interface.

Requirements for safe continuity of information between shifts:
- Highlighting patients who are potentially unstable, requiring regular review
- Access to brief summaries of active problems for all patients
- Notification of outstanding clinical tasks which need completion
- Critical result reporting from investigations requested during a previous shift to be diverted to the doctor providing cover
- Patient administration systems need to be a live record of patient location and responsible consultant/team.

Recommendation 2.
Robust systems to facilitate hand-over between shifts should be developed as a priority (prior to the full implementation of the Integrated Care Record Service)

Recommendation 3.
The structure of the ICRS allows an ‘active problem list’ and ‘management plan’ to be recorded, with aggregate reporting across multiple patients

Recommendation 4.
24hr data quality should be ensured on patient administration systems to avoid potential for clinical risk (ie out-of-date ward location/responsible clinician).

Requirements for clinical decision support:
- All local hospital guidelines and procedures should be placed on the hospital intranet
- National consensus guidelines should be made available through the National Electronic Library for Health (NeLH)
- Full text browsing of key journals should be made available though the NeLH
- Full text versions of key clinical texts should be made available through NeLH.

Recommendation 5.
Full text availability of core books should be provided through the National Electronic Library for Health to support care in the acute / emergency setting.

Improving efficiency – thereby working hours
Requirements for ordering, prescribing and results reporting:
- Live results reporting and ordering of investigations
- Availability of electronic imaging.

Requirements for access devices and security:
- Full functionality of results browsing, imaging, ordering, prescribing and patient record entry to be available at the point of care
- Mechanisms for user authentication must take account of likely multiple users on single machines with a need to log-on and off rapidly, and have book-marking ability.

Recommendation 6.
Investment should be made in piloting technology to support real-time information at the point of care (eg wireless notepads/digital assistants (PDAs)).

Requirements to minimise interruptions:
- The need to distinguish between urgent and non-urgent communication
- Ability to transmit messages between staff, without requiring verbal communication.

Requirements to facilitate provision of on-call cover from home
- Full functionality of results browsing, imaging, ordering, prescribing and patient record updating to be available outside the hospital via secure remote link

Education and training support
Requirements to support individual learning:
- For doctors to be able to save lists of cases they wish to follow up, and be notified of investigation results (unless patient consent is not granted).

Requirements to supporting teaching:
- The ability for individuals and institutions to highlight patient cases/images for later (anonymous) use as teaching material.

Requirements for supporting training and revalidation:
- For doctors to save lists of cases they wish to record for training purposes within the Integrated Care Record Service
- The system should have the ability to produce customised, aggregate reports on clinical activities and exposure to support appraisal.

Requirements for informatics training
- There must be adequate training in the use of new information systems and pathways.
- There must also be training around data protection legislation and responsibility for protecting clinical information.

Recommendation 7.
Funding should be identified to ensure adequate training for junior doctors in the use of IT systems and clinical responsibility for data.

Communication within the NHS
Requirements for communication devices:
- To distinguish between urgent and non-urgent communications
- To allow voice communication and text messaging
- To allow voicemail
- To allow browsing of directory services
- To allow receipt and sending of email

Recommendation 8.
The bleep system should be replaced with mobile communicator devices

Requirements for electronic directory services:
- To provide a lifelong, portable, NHS-wide email address for each doctor
- To provide role-specific email addresses/phone numbers at local level
- To link and forward between these two addresses as appropriate
- To integrate with duty rotas to provide live contact details for the duty clinician
- For relevant non-NHS bodies (including deaneries, colleges, the GMC and BMA) to have access to this directory.

Recommendation 9.
The NHS-wide directory should link to junior doctors’ roles and rotas at a local level to make it easy to contact them on the basis of role as well as name.

Requirements for communication within the Integrated Care Record Service:
- To link with staff rotas and directory services to show automatically contact details of the duty doctor responsible for a patient
- To provide a simple means of generating a message to a care provider from within the patient record, to automatically convey patient details, document the message, and save time wasted telephoning
- For reporting systems to convey (live) abnormal/critical results to the duty doctor, as well as the doctor requesting the investigation (who may be off duty).

Recommendation 10.
Further research and piloting to be undertaken to explore integration of communication strategies within the Integrated Care Record Service