Best test

Dr Andrew Harrison
Hammersmith Hospitals NHS Trust

I qualified as a doctor four years ago. Medicine is my second career. Prior to that, I was a computer programmer.

Having worked in the IT sector, I’m astounded by how clumsy some hospital computer systems tend to be. Many do not seem to realise that the healthcare industry is far behind many others in this regard.

There are a number of key tasks that a hospital computer system should perform. These include:

• Delivering results of tests;
• Taking orders for tests;
• Holding summaries of medical history for each patient;
• Manage where patients are located within the hospital;
• Manage the booking of appointments.

I have worked in over ten hospitals. They all have different systems and I believe none of them performs these tasks particularly well.

I have listed what I believe are some requirements for an ideal system that delivers test results. Every junior doctor looks up results every day, and so a good system would be a boost to hospital efficiency. Results that need to be delivered include those from blood test laboratories, reports of X-rays, and information discovered during special procedures such as angiograms.

1. Login

The system should have a fast login procedure. Many systems I have used do not. Doctors generally use a number of different computers during the day as they move around the wards, and if the login process is slow,a considerable amount of time is wasted. As a result passwords can become meaningless because doctors try to avoid logging off – they leave terminals logged on to speed things up later, for themselves and for their colleagues.

The login procedure should take less than five seconds – as fast as a Google search. If the system cannot achieve this, it is no good.

2. Patient selection

Having logged in, it should take less than five seconds to select a patient and bring up their results. Many systems involve going through a sequence of slow menus to select a patient, or the doctor is required to type in the patient’s identification number. Often these steps could be bypassed if the system simply presented a list of the most recently viewed patients. If a system does not do this, it is poorly designed.

3. Clarity of display

All results for a patient should be displayed on a single page; there should not be one page for the haematology results, one for biochemistry and so on, otherwise time is wasted switching. The single page should also include buttons that give access to results that consist of a written report (such as the description of a CT scan).

4. Filtering relevant results

There should be a simple option to turn off the display of results that are unlikely to be relevant. Irrelevant results clutter the page and take up valuable screen space. For example, a doctor might want to turn off the results for individual types of white blood cell, and just view the total. Furthermore he should be able to choose the order of rows in the table of results, so that he can put the most relevant ones to him near the top.

5. Historical data access

It should be simple to scroll back in time to old results, perhaps by using a horizontal slider.

6. Flag abnormal results

Abnormal results must be displayed in red. There is no need to waste screen space with a list of the normal ranges, because doctors generally know these. There should be an option to turn on such a list if required.

7. Arrangement by date

The results columns should be according to date, rather than time (in hours and minutes). For example, haematology results should be in the same column as biochemistry results from the same day, even if the time of processing these is different. However there may be days when one laboratory processes two or more samples a few hours apart and so these do indeed need different columns. Results from other laboratories should be aligned into the column which has the closest time.

8. Information frames

A region of the screen that can display paragraphs of text would be useful. As a default this could display a list of samples that are in the laboratories waiting to be processed. It could also be used to display any notes about the samples and reports from investigations such as CT scans (in response to pressing the buttons mentioned above in point 3.)

9. Notification of new results

Many tests require several days of processing, so when results are eventually entered into the system they may no longer appear on the screen because the column for the day from which they were commenced has been pushed off. A message should be displayed to say that results are available from a test from a few days previously. There should be a check box so that a doctor can turn off this message when he has read it.

10. Printing

Patient medical notes are paper-based, and may continue to be so for many years. Therefore it should be simple to print reports from the computer on to paper, so that they can be included in the notes.

If a system was written to do all of the above it would be a joy to use compared to what I’m accustomed with. Please add your comments if you agree, disagree or would like to make additional recommendations.

Hopefully, the combination of what I write and any comments generated will provide a valuable check-list for anyone assessing a new hospital computer system prior to purchase.