4.1.6(b) Uses of ICT in Healthcare/ 1 Medical databases

1. 4.1.6(b) Uses of ICT in Healthcare/1Medical databases

2. Starter: Advantages/Problems with Electronic Patient Record Keeping • Easier to back up the data. • Many medical staff needed access to the same records at sometimes the same time. • Storage and retrieval problems of 100’s of records. • Only one set of data is kept so it is a lot easier to ensure the consistency of the data. • Don’t need to transfer files from place to place. • Security is improved because the data can be protected using different permissions for different staff. • Patient details can be viewed wherever there is a terminal. • Some handwritten notes were illegible. • Doctors would keep them on their desk rather than returning them to a central point • Records filed in the wrong place meant that tests had to be repeated wasting time and money. • Details are available in many different places instantly

3. Electronic Patient Record Keeping (EPR) Problems of keeping patients records on paper: • Many medical staff needed access to the same records at sometimes the same time. • Storage and retrieval problems of 100’s of records. • Some handwritten notes were illegible. • Doctors would keep them on their desk rather than returning them to a central point. • Records filed in the wrong place meant that tests had to be repeated wasting time and money. • Advantages to storing records electronically: • Patient details can be viewed wherever there is a terminal. • Only one set of data is kept so it is a lot easier to ensure the consistency of the data. • Security is improved because the data can be protected using different permissions for different staff. • Easier to back up the data. • Don’t need to transfer files from place to place. • Details are available in many different places instantly.

4. New and future developments of medical databases The NHS National Database World’s largest database containing secure information about patient healthcare (70 million patients and 400,000 registered users of the system). Quick access to reliable information on patients. Stores information on allergies, prescriptions, as well as information held by GPs and hospitals.

5. New and future developments of medical databases The electronic prescription service GPs and practice nurses send prescriptions electronically to a dispenser (such as a pharmacy). Making the process safer and more convenient. 70% of prescriptions are for repeat medication which can be time consuming using the paper based system. Saves doctors time and allows more time with patients.

6. New and future developments of medical databases Patient Identification When a patient arrives in hospital they are allocated a unique number (NHS target). It provides the key field for the patient database and is used to distinguish between patients with the same name living at the same address. Each patient is given a wristband with a bar code on it. The barcode contains the following information: • Patient names • Date of birth • NHS number

7. Blood bar coding and tracking systems Blood transfusions cause a big risk to patients if the blood is incorrectly identified. There needs to be a way of determining who gave the blood and who received it (infections can be passed through blood and if it was identified that either the donor or the recipient had a medical problem them both could be identified). Blood Bar Coding Systemhttp://www.youtube.com/watch?v=XTTYbi25HY0 Blood Tracking System http://www.youtube.com/watch?v=bVOa95sCMmw

8. Blood bar coding and tracking systems How it works? • Blood is taken from donors and is tested to determine things like the blood group. • It is stored at the National blood transfusion service. It is cross matched and bar coded. • Matched blood is sent to the hospital and kept in a fridge. The bar code is scanned. • Hospital staff remove the blood by scanning their ID card. The bar code on the blood is scanned so that it can be tracked in and out. • The patients wristband who is receiving the blood is also scanned. If it matched then the blood transfusion is given.

9. Blood bar coding and tracking systems Advantages of the tracking system: • Provides a full audit trail (identifying the member of staff, the time/date, location and time spent out of the fridge). • No need to keep paper records so saves time. • No need for space to store the records (lower costs). • Cross matching information electronically checks that patients are not given the wrong blood. • Security (only certain staff are allowed to access the blood). • Stock control • Can find the donor if there are any problems. • Bar coding is also used for: • Identifying laboratory specimens • Paper based records which contain a bar code.

10. Use of the Internet, Intranets and Extranets • Internet: • Staff can access the Internet through the organisations extranet or intranet. Firewalls are used to ensure people cannot access the hospital systems from the Internet without permission. • Used to… • Send emails to patients they find difficult to contact by phone. • Communicate with patients using a hospital website. • Allow staff to perform research. • Enable patients to communicate with friends and family. • Send information on lab tests of X-rays requested by doctors.

11. Use of the Internet, Intranets and Extranets Intranet: Only hospital staff are allowed access to the intranet. Hospitals use intranets to transfer patient data to different devices around the hospital (e.gPDAs, Laptops, Pcs). Intranet = private internal network which allows employees or an organisation to access information resources within the organisation

12. Use of the Internet, Intranets and Extranets Extranets – Extranets are networks that use the same technology as the internet but allow people who are not employees of the hospital or trust to access and exchange certain information. They must be authorised to use to extranet which is protected by a username and password. E.g. Suppliers can check that vital drugs/equipment do not run out. GPs can check the condition of their patients in hospital. Other agencies that work with patients outside the hospital Extranet – intranets opened to select groups of users outside the company such as customers, suppliers etc.

13. Distributed medical databases Distributed database – database where the data is stored on a number of servers rather than just one. These servers are often in different locations. The user will not know that data is being obtained from different servers. A collection of patient information spread over two or more servers in a network. Using internet technology it is possible to build a system that can access all the information about a particular patient even if it is stored on different servers at different locations. When a healthcare professional needs to see a patient’s medical record the distributed parts are found and merged to form a single record. • Advantages: • Security is improved as the data is not kept in one place • Speed of access is improved as one server does not have to deal with all the requests for information from users.

14. Backup and recovery procedures • Considerations for backup: • Whether any downtime is acceptable (if not then a RAID system should be used). • How much data needs to be backed up. • Where the data should be stored. • How often copies of the data should be taken. • When the data should be backed up (usually when it is used the least). It is crucial that medical databases are kept secure and backed up regularly. Recover procedures need to be in place so that staff can recover any lost data. It is essential that procedures are tested to make sure the systems can be recovered in the event of a problem.

15. Ensuring the privacy of patient records Privacy is assured by: • Access levels (controlling what a user can do, e.g. read only access would only allow a member of staff to view certain data but not copy, delete or alter it). • 128-bit encryption (ensuring that data being sent along networks is coded, so even if it were intercepted it would not make sense). • Password (users are only allowed access to those parts of the patient records needed for their particular job e.g. admin staff would not have access to medical records). • Audit trails (these are provided so it is possible to see who viewed or altered information contained in the database).

16. Worked example 2. Hospitals make extensive use of ICT systems for keeping patient records. Apart from contact details such as name, address, postcode and telephone numbers, give four distinctly different fields that would be included and describe why they are needed. (10 marks).

17. Case Studies

18. Activity Research Task - Mini site on this topic: http://www.teach-ict.com/gcse/theory/medicine/student/shome_medicine.htm

19. Plenary: Questions • Hospitals all use ICT extensively to help with administration and most use electronic patient record (EPR) systems to store details about patients. • Describe two advantages in storing patient data electronically rather than on paper. (2) • Patient identification is extremely important in hospitals. Explain how patients can be identified in hospitals so that the correct treatment is given to the correct patient. (2) 2. Hospitals have to track blood to ensure that the correct blood is given to the correct patient and hospitals use a computerised ICT system for this purpose. • Explain why hospitals have adopted a blood tracking system that makes use of bar coding (2). • Explain two ways in which hospital staff can use the Internet to help with patient care. (2)

20. Extension http://www.teach-ict.com/gcse/theory/medicine/student/s_medicine_quiz.htm

21. Past exam question (for after the next 2 lessons) 8. ICT is widely used in the Health Service. • Extensive use is made of Expert Systems. State the three main components of every expert system and then describe with examples the advantages and disadvantages of using an expert system in medicine. (7) • Hospitals use ICT to monitor and care for patients. Discuss, using examples, how body scanning, blood tracking and sensors are used in patient care. Discuss the advantages and disadvantages this technology has for patient care. (11)