What clinical information do doctors need?BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7084.903 (Published 22 March 1997) Cite this as: BMJ 1997;314:903
IT supports clinical decision making
- TD Kennedy, Directora,
- S Magennis, General practitionera,
- Cathy Harris, Path.Finder coordinatora
- a Clinical Practice Research Unit, Wirral Hospital Trust, Wirral Hospital, Upton L49 5PE
- b Sequoia Hospital, 170 Alameda de las Pulgas, Redwood City, CA 94062-2799, USA
- c 27 Monckton Road, Gosport, Hampshire PO12 2BG
- d Associazione per lo Sviluppo della ricerca in FarmacoEpidemiologia, Viale Certosa 148, 20156 Milan, Italy
- e Doctorline, c/o Medical Economics Italia, Piazza Esquilino 5, 20148 Milan
- f UVA-HSC, Department of Family Medicine, Box 414, Charlottesville, VA 22908, USA
- g Harrisburg Family Practice Residency, PO Box 8500, Harrisburg, PA 17105-8700
- h Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Republic of Ireland
- i University Library, PO Box 559, 9700 AN Groningen, Netherlands
Editor–Richard Smith paints a challenging scene for clinical information systems.1 For many years, Wirral Hospital Trust's information technology strategy has been to support clinical decision making. Wirral is one of the two national pilot sites for the electronic patient record. Junior doctors use the system daily, and requesting pathology and radiology is done through the computer, as is inpatient prescribing.
Two approaches have been adopted. Firstly, we provide information to the clinician when tests are ordered. We have adopted many of the Royal College of Radiology's guidelines and these have been shown to reduce the number of requests for radiology. Using the computerised pharmacy system, we have altered prescribing behaviour and stabilised the drug budget despite an increase of 14% in FCE (finished consultant episode) activity. With the Wolfson Institute in Birmingham we are developing a rules based prescribing system to search the patient's record for specific data and inform the doctor on the safety of the prescription.
The second approach is to deliver structured information to the clinician by using the Path.Finder system, a locally developed information system for general practitioners and hospital clinicians. It has been shown to influence both clinical and referral practice.2 It, rather than the Internet, was chosen as the most efficient means of delivering targeted information to the clinician as the information can be structured and condensed for rapid assimilation and yet reflect local cirumstances. The information is often referenced as evidence based or consensus based and has been mostly derived from colleagues on the Wirral, who have been most generous in their support.
The project is now being developed by 10 other trusts, under the auspices of the British Association of Medical Managers. Each trust will share the Wirral set of information, adapt it to reflect local circumstances, and then report …