uadez Computers in diabetes care

The use of computers in diabetic clinics is of rapidly growing interest. There are already several systeps of vary- ing degrees of complexity and sophistication being used in hospitals throughout the country. However, for those at- tempting to develop diabetic clinic management systems, there are many pitfalls for the unwary. Although it is clear that certain basic essential information has to be recorded, that this is best computerised, and that there are a number of essential functions that a clinic management system should perform, reaching a consensus on the precise infor- mation and functions required may prove more difficult. This became apparent at a recent workshop (Refl, attend- ed by physicians from three London teaching hospitals and from Nottingham, Glasgow, Bromley, Derby and York, with Sir John Nabarro representing the BDA. Above all, the ultimate aim must be to improve patient care.

First, simple registration of patient details is complicated by the fact that, following the Korner report, the recording of certain information will become a statutory requirement; this will have to be taken into account when developing clinic management systems. The Korner data set (Table) is

‘able. Korner minimum data set

IP OP

Sex Sex Post code Post code Date of birth Date of birth Marital status Marital status GP code GP code Category of patient Category of patient Date of admission Date of all appts. made Method of admission If appt took place &

reasons, if not Source of admission Source of initial

attendance Need to admit date Consultant i/c clinic code Management intention Code location of clinic

Date discharged from

On admission - District patient no.

clinic At start of each ConsultantlGP code Name of clinic episode (specialty) Number of clinics which

took place in each period

cancelled in each period

Ward stay Ward code Number of clinics

Discharge Date of discharge Number patients seen: Method of discharge (a) Referrals Destination of (b) Consultant initiated

discharge No. private patients No. DNAs

End of consultant Codes of diagnoses episode Codes of operations

essentially anonymous demographic data, which is really in- tended to provide meaningful information for district managers to enable them to improve the district service. It will also produce information of value to the region and infor- mation for statistical analysis by the DHSS.

The question of data input needs to be carefully con- sidered. The most efficent way, in terms of minimising errors and clerical time, is for the doctor to make the data input directly at a terminal in the clinic. This, however, could pro- ve threatening and distracting to the doctor, to the detriment of his relationship with the patient. Those with experience of actually using terminals in clinics, as at St Thomas’s and

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St James’, notice that patients find the process quite fascinating and may regard information presented by the computer as more authoritative than that provided by the doctor! Such a system requires several terminals and may be correspondingly more expensive and complicated to set up.

When the data input is made by a clerk or secretary, fur- ther risk of misunderstanding or misinterpretation arises and there is a risk of the system generating more work than it saves. The forms used must be carefully designed to maximise ef- ficiency and minimise errors and ambiguity. For example, layout and wording should match exactly what appears on the VDU screen.

If data input increases the workload of the doctor or secretary or necessitates employing extra clerical staff, the system must provide some services which compensate or, ideally, reduce overall workload. Such service functions may include: letter and clinic list generation; running an appoint- ments system; and producing reports to go into the patient’s medical record. It is even possible to economise on postage, if the system can produce a letter to the GP which the patient can deliver by hand - another advantage of using the com- puter ‘live’ during the clinic.

The systems demonstrated to date record information about the existence of complications and screening checks. This particular aspect of patient care is of major concern to the BDA, which is working to develop a system that will specifically try to improve the recall and follow-up of patients for regular screening. It is anticipated that ultimately all diabetics in the district should be included in the computer in use for the diabetic clinic. This will make it easier to keep a check on whether the diabetics who remain under the care of the general practitioner are being seen regularly and be- ing screened, particularly for eye complications. Since diabetes is the major cause of blindness in this country, any improvement in screening or review has to be an eminently worthy aim.

In addition to making clinic management more efficient and thereby improving standards of patient care, computeris- ed systems can also have wide-ranging applications in clinical research, as well as being capable of providing statistical and audit data. The latter applications could be extremely valuable if, for example, justification is needed for additional staff, services or equipment.

Introducing a computerised clinic management system almost inevitably changes working practices. Sometimes this leads to the realisation that all that was needed were changes in working practices, and that these could have been achiev- ed without the use of a computer. It is, however, generally agreed that a well-designed computer programme should help to achieve major improvements in clinic management. Designing such a programme, which stores all the essential information, incorporates all the essential functions and is affordable, remains a challenge for the future.

Marilyn Charlesworth Peter Sonksen

Charles Williams

Reference Sonksen P (Chairman). Computers in diabetic clinic management. Seminar, Lilly Research Centre, Windlesham, May 1986.

Practical DIABETES SepVOct 1986 Vol 3 NO 5