What is the patient list?
Every doctor has a list of patients that they look after. It tells them:
- Where the patient is.
- Their hosp no, date of birth,
- Current problems,
- Diagnoses,
- Active problems’,
- Important test results,
- ‘Jobs/Tasks to be done’: Tests to chase/ order, results to chase, medications to prescribe, referrals to make.
- Jobs/ Tasks gets checked off (on the piece of paper).
The patient list is the lifeblood of doctors. Different specialities have different requirements for the patient list. It is NEVER one size fits all.
What does one look like.
A printed sheet of A4 either from a MS Word/ Excel file.
How is one created?
- Every morning, a doctor sits next to a computer and manually updates ALL of the above.
- A sheet (over several) gets printed and this is used to documents changes to ALL of the above throughout the working day.
- At the end of the day (5-6pm), the Word file gets manually updated.
So what happens after hours then???
- Important patients gets handed over to the on call team.
- They then create ANOTHER patient list. This is often handwritten!! or typed into another word/excel file
So what happens for the night shift??
You’ve guessed it, another patient list gets created!! In the morning, the whole process starts again.
But wait, isn’t there plenty of handover software out there to make this process easier?
Handover software only addresses a point in time where patients get handed over to the night shift from the day shift. It does not support everything else. It does not link with blood results systems, ordering systems etc. And it does not address the management of the bulk of the work that happens during the day.
Hospitals up and down the country are investing in handover systems because poor handover causes people to die in hospital.
But that’s completely missing the point. Handover is about handing over responsibility of the care of the patient, the patient’s problems, tasks, jobs, location etc. does not change. Handover is only one part of the larger ‘Patient List’ problem.
If this is so important, why is this area effectively ignored?
- It does not affect the lives of IT directors, Medical Directors or Finance managers who hold the purse strings.
- Junior doctors create these lists and are most heavily dependent on them. They have very little to no say in the running of hospitals.
- NHS trusts does not care about the process of care delivery or coordination within a hospital as long as government and payment targets are met. Junior doctors just compensate for the inefficiency by working longer hours and gritting our teeth.
- A effective electronic intelligent patient list requires integration of various IT systems, PAS, Order Comms, Results and Radiology. IT vendors make this task next to impossible.
So, who is up for the challenge?
Hi Wai – feel your pain on this one. So much so that I started the process and released a free app on the app store called HouseOfficer. http://houseofficerapp.com
Do check it out – it does basic patient list and task management for junior docs, as well as storing frequently called number etc.
It’s an open-source app and it could certainly be improved. Perhaps we could get together a group of people interested in doing this. Here is the app on github – https://github.com/edwallitt/HouseOfficer.app
Also had a play around with producing a web version of a patient list – you can see it over at http://www.houseofficer.me
Let me know what you think.
Ed
Great stuff Ed! I think you have nailed the task management aspect of it! Wouldn’t it be great if it integrated with a hospital PAS system
My crazy vision for this would be a patient list that can get feeds from pathology/ radiology etc so. Your task for ordering scans can have a status from: order -> await scan -> scan done -> review results
There is a massive thread on ‘the patient list problem’ on the NHS hack day forum. I’m sure there will be loads of people can contribute to your efforts.
Do you mind cross posting there? Do you mind if I did that on your behalf?
See: https://groups.google.com/forum/?fromgroups#!topic/nhshackday/8JAwPEQbJbk
Thanks for the re-posting of the discussion we had on Tuesday night Wai Keong. The patient list problem is an ‘easy solve’ and ‘do-able’ in a 48hr hackday. Here are my thoughts on the solution to the problem.
0 – suspend reality
The advice to suspend reality from Sam Smith is good. However, let’s not forget what the reality is….
1 – reduce, reuse, recycle
Suspended, but not forgotten; there are lots of things in reality that we can reusue or recycle to reduce the effort. I propose that we reuse Ben Toth’s suggestion of making better use of RSS. We should also reuse HL7, as this protocol is used for information exchange between clinical systems. We should recycle existing structures too. I imagine (but do correct me) that junior doctors are allocated to wards or perhaps supervised by consultants. These two concepts exist in hospital information systems already. But reusing these two concepts and the standards of HL7 and RSS we could get a long way towards a solutions.
2 – sketch
I’m thinking of somethings that Keeps It Simple, Stupid. How about building an HL7 –> RSS feed tool. This would allow for structured information inputs from clinical/administration systems (iSoft, Cerner) or from existing integration systems (Mirth, Ensemble). And RSS is Really Simple Syndication. This would allow us to code the ‘app-end’ of things (re)using existing code/methods. HL7–>XML with an HTTP service to publish to clients. With a bit of ACL/RBAC we could get this ready for production use.
For example : http://www.gliffy.com/publish/3510098/
3 – code
HL7 – there are lots of resources on HL7. We should look at hapi on sourceforge for a test panel to produce the messages. Mirth would give us the tools to receive and transpose the HL7 –> XML to slap into a datastore. We could use something relational (MySQL) or something document based (Couch/Mongo). Then we need to query the datastore to build RSS feeds. The webservice would allow clients to subscribe to the RSS.
Links:
HAPI http://hl7api.sourceforge.net/
Mirth http://www.mirthcorp.com/products/mirth-connect