Patient Viewer Application

Separate to our augmented-reality neuro-navigation system, I have developed a bespoke lightweight basic EPR application to try to minimise the impact of having to juggle nuermous existing systems to obtain patient information and ultimately improve clinician efficiency and patient safety.

Background

Over the past two decades, there has been a transition from paper records to electronic systems to record and present clinical information, and this has brought clear efficiency and safety benefits. Sheffield Teaching Hospitals NHS Foundation Trust is typical of most NHS trusts, with patient observations, investigation results, medications, imaging, operation notes and staff handover notes now all stored electronically. Unfortunately however, the information is stored across multiple independent applications. In order to review all information relevant to a single neurosurgical patient, the clinician often has to navigate through 6 or more clinical applications, each with its own user login, unique interface design and patient selection process. This is clearly inefficient, wasting clinician time and reducing the time available for decision making.

The multiple applications required for clinical information on a single patient:

Pre-Solution Analysis

An average surgical patient ward round consisted of reviewing 30 patients and was allocated 1 hour of ward staff time, giving an average of 2 minutes per patient. For each patient seen, users followed a process of: select the necessary clinical application, search for the required patient, review the results. For each patient across 6 applications, this comprised of a minimum of 20 key presses and 17 mouse clicks. For a ward round this totalled 600 key presses and 510 mouse clicks, excluding those required to log in.

When, as was often the case, clinical information was required in an adhoc fashion, the ward round would be delayed as the user would have to swtich between the necessary applications.

Selected quotes from users include:

“The difficulties and delays in accessing accurate information is a risk to patient safety and a waste of staff time.” - ST1

“Using multiple systems is time consuming and unwieldy, you often only have time for a glance at each.” - ANP

“The difficulties and delays in accessing accurate information is a risk to patient safety and a waste of staff time.” - ST1

New Patient Viewer Application

The new system was designed entirely around the requirements of the principles users - ward-based junior doctors and advanced nurse practitioners - and refinements and improvements were made from direct feedback received. An effort was made to unify the user interface where possible, eliminate steps of duplicate patient searches, and bring all relevant clinical information under the control of a single umbrella application.

The application use centres on patient selection as the first step, with patients being identified based on ward location, or on a clinic or theatre list. From a single patient selection all information can be viewed in a simple tabbed view.

All cinical information is available from a single patient selection made from a structured ward list, clinic list or theatre list:

Technical Implementation

Given the lack of current interoperability between systems, a novel approach was taken to semi-automate instances of the existing clinical applications using a lightweight umbrella application.

The application only stores minimal information itself. Patient location information and details are extracted from the eWhiteBoard intranet site and displayed in an intuitive format to enable the user to find and select patients easily. On patient selection, instances of existing clinical applications are then controlled through script injection to display their respective information about the patient.

The application is developed in Microsoft Access. This provides a standard, familiar user interface, and as a Trust-approved Microsoft Office application, requires no input from Trust IT for its deployment.

Post-Implementation Analysis

Following initial implementation, the system was revised 8 times over a 3 month period. It was deployed to 42 users in the Neurosciences Directorate.

To review all information for each patient on a ward round using the new system, the minimum key presses required was reduced from 20 to 0, and mouse clicks from 17 to 6. This equates to a 100% reduction in key presses, and 65% reduction in mouse clicks.

Estimated time saving per day by the users on the new system was 20 minutes.

Selected quotes from users include:

“Really useful application, has made the ward round slicker and much less time required updating the handover list.” - SHO

“Great system, efficient especially with bed moves...” - ST3

“Handy to have everything needed in one software, helps make ward round more efficient. ” - FY2

“The implementation has significantly decreased the amount of time I spend accessing patient information (such as medication and blood results) on ward round. This had led to faster decision making with more information available to make clinical decisions. ” - ANP

“On the whole a much better system than having all the separate apps open... overall much more efficient and user friendly.” - ANP