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LETTERS: P V Gardiner, Ray Jones, Robert Thomas, and Ken Campbell Evidence based patient information BMJ 1999; 318: 461 [Full text]

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"IT has a healthy future?"

Mark Duman   (13 February 1999)

Re: "IT has a healthy future?"

Peter Davies   (23 February 2000)

Re: URL glitch

Midgley   (17 March 2000)

"IT has a healthy future?" 13 February 1999
Mark Duman, Project Manager, Health & Relationships BBC Education, London. Send response to journal: Re: "IT has a healthy future?"	IT has a healthy future? Davinda settled down in the sofa ready to watch the world cup final. She wasn’t much of a football fan, but after such a huge dinner just didn’t have the energy to take Spinky, her chihuahua, out for a walk. As the whistle blew, she felt a twinge of pain in her chest. Nothing too severe but enough to make her take a sharp intake of breath. At half time she realised that although the sharp pain had gone, she still had a dull ache above her breasts. She picked up the remote control, browsed through the electronic programme guide and flipped to the health channel. The broadcast was about passive smoking but had subtitled banners listing health web addresses. With another few clicks, Davinda logged into the world wide web and selected both her preferred language and mode of delivery. She had always found it easier to listen to Punjabi than to read it. She was so glad that she attended the community college class on how to get the best from her integrated PCTV. After entering her unique NHS number she got into her own medical records and quickly highlighted her signs and symptoms from the web-based medical interview. A few seconds later she saw that all she had was a mild case of dyspepsia. Pleased that it was nothing too serious, Davinda changed back to the football. There was still another five minutes before the second half. She thought for a moment then decided to make sure that her ache was really OK. Her uncle after all, had had heart problems. She picked up the phone and dialled the NHS Direct freephone number. An automatic switchboard listed possible language options. Scared she’d miss the start of the football, Davinda didn’t wait to hear the Punjabi option and settled for English. A friendly voice asked which service she required and soon connected Davinda to a triage nurse. The nurse checked the NHS number that was automatically displayed was the correct one for Davinda, asked her to explain her symptoms and after consulting her software reassured Davinda that she just had a case of heartburn. The nurse suggested a number of treatments and said that if she was still feeling pain after 48 hours she should see her GP. A few days and 250 mls of antacid later, Davinda felt another twinge just after lunch. She went to the nearest phonebox called NHS Direct and at the prompt entered her personal number and PIN code. Once in her own health record she was able to hear her own GP’s next available appointments. By pressing the right button she was able to book herself an appointment for that afternoon. The GP pulled up Davinda’s medical records and noted her recent NHS Direct calls and antacid medication. The doctor checked the latest clinical guidelines which accounted for local practice variations, via his PC. He assured Davinda that according to her past history it was unlikely to be anything other than a mild case of reflux which should resolve itself in a week or so. Remembering some of the lessons from his health care partnerships evening, he asked Davinda whether she minded taking medicine and if so, where she would like them dispensed. He prescribed her a 5 day course of the latest NICE-approved H2 antagonist and electronically sent the prescription to Davinda’s choice of pharmacy. The GP then printed off an information leaflet on stomach complaints that matched his practice guidelines and provided contact details for appropriate local voluntary health organisations. At the pharmacy, after ensuring no interactions nor contraindications, the medication was dispensed in seconds. The pharmacist presented Davinda with an ‘original pack’ of tablets, printed off her personalised patient information leaflet and spent considerable time discussing this in detail, paying particular attention to the dosing and side-effects sections. After 5 days Davinda still felt unwell. She called her GP practice and 30 minutes later received a return call from the receptionist to inform her that she had been given an appointment to visit the endoscopy clinic in her local day surgery unit. Details of the investigation itself and how to prepare for it, how to get to the hospital, what to bring, and the expected recovery time were sent to Davinda prior to her appointment - again in the language and mode of delivery of her choice. Arriving early at the unit, Davinda checked in and waited for her appointment. During this wait a nurse obtained consent for the procedure only after she was sure that Davinda had received her background information and understood all that was to happen to her. Davinda noticed from the surrounding TV screens highlight that her consultant was running twenty minutes late. He had been providing remote telemedicine advice for a distant road traffic accident. She took the opportunity to visit the hospital’s patient information centre without fear of losing her place. ‘Be prepared’ posters around the hospital provide patients with questions to ask their clinicians and make suggestions for healthier living. Davinda took particular interest in The NHS Charter which outlined both her rights and responsibilities as a patient. She even completed one of the questionnaires and placed it in one of the survey boxes strategically sited throughout the waiting areas. All went smoothly with the endoscopy and results were electronically sent to her GP as soon as they were available. Davinda chose to visit her GP to be informed of the results and both agreed upon an appropriate treatment option. All within 48 hours of her initial visit. Mark Duman (931 words) December 1998
Re: "IT has a healthy future?" 23 February 2000
Peter Davies, G.P.principal East Kilbride Send response to journal: Re: Re: "IT has a healthy future?"	I am sure I.T. does have a healthy future and that before long we will be consulting frequently by phone or via email, and that skills in these media will be as necessary as face to face skills are now. I am launching my own practice's website on Thursday 24/2/00. ( www.alisonlea.co.uk) I am hoping it will improve information availability to patients and increase communication between our practice and our patients. I do not know if there is an evidence base for this but I believe that better comunication will lead to better health outcomes. Yours sincerely
Re: URL glitch 17 March 2000
Midgley , GP etc Send response to journal: Re: Re: URL glitch	That should be http://www.alisonlea.co.uk/ There is a glitch in the URL pointing it at cgi I think Practice websites are an important part of a Practice Homesteading the Noosphere http://www.tuxedo.org/~esr/writings/homesteading/homesteading.html Mine is at http://www.swis.net/midgley/homefld.htm and has accumulated sections based on my information needs for _my_ patients, and questions they ask me. One of the disadvantages of NHS Net as presently conceived is that it isolates Practices from their patients as far as the Web goes.