Clinical Review ABC of health informatics

Communication and navigation around the healthcare system

BMJ 2005; 331 doi: (Published 01 December 2005) Cite this as: BMJ 2005;331:1325
  1. Jeremy C Wyatt, professor of health informatics,
  2. Frank Sullivan, NHS Tayside professor of research and development in general practice and primary care
  1. University of Dundee


    However good a doctor's clinical skills, record keeping abilities, and mastery of evidence, before they can start work they need directory information. This is the information patients and professionals use to find their way around the healthcare system. Different grades of staff have different demands for this information, and all staff are often interrupted by colleagues' requests for this information.

    Embedded Image

    A hospital switchboard in 1995—shows the operators' directory and temporary notes. With permission from Martin Loach

    You are a general practice locum and need to fix an outpatient assessment for Mrs Smith's bronchitis. The receptionist mentions that before you organise the assessment you need to book certain tests that vary according to which chest physician you refer Mrs Smith to. The receptionist does not know the names of local chest physicians nor their investigation preferences. You spend 15 minutes trying to call the chest clinic in the nearest hospital before discovering it moved six weeks ago to another site 15 miles (24 km) away. Your phone is not cleared for long distance calls, and the practice manager is not around, so you wait to use a colleague's phone. Mrs Smith takes umbrage at the delay and walks out while shouting across the waiting room, “Call yourself a doctor. You don't even know what goes on in the hospitals round here.”

    Directory information

    Directory information includes information about local services, how to book them, contact details, and specialists' preferences for tests that they need patients to have had done before they see them. Variations in stationery, laboratory and therapeutic services, and how those services are organised (including what type …

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