New order

Dr Andrew Harrison
Hammersmith Hospitals NHS Trust

In my previous article I wrote about my ideal hospital computer system for delivering test results. I now describe a computer system for ordering those tests.

The software being produced under Connecting for Health will not be delivered for several years and in the meantime clinicians must voice opinions about what they want. Please do add your comments and further suggestions, especially if you are a doctor frustrated with the system that you use at work.

My suggestions for an ideal system are as follows:

1. Display the cost of each test

When doctors book a test they generally have no idea how much it costs. Any hospital that wants to improve efficiency should involve doctors by providing this information.

2. Make it paper-free

All the hospital systems that I have used require the printing of a “request form”. This is a huge weakness, because printers frequently run out of paper or toner, or break down and so requests get lost without the doctor even realising. And at other times, if the doctor wants to cancel a test he needs to telephone the test providing department and ask someone there to search for the request form and rip it up – he cannot cancel it using the computer.

3. Stickers only for blood bottles

The exception to the paper-free rule is that stickers should be printed for labelling of blood sample bottles. However these labels are small, requiring a simple mini printer, one of which can be available on every ward.

4. Selecting tests

The first step in booking a test is to choose it from a list of the hundreds available. A well-designed system of menus should make this a simple task, using no more than three mouse clicks. As shortcuts the doctor should see a list of his most frequently requested tests, and also a list of frequent tests for the particular patient.

5. Freetext area for further specifications

The second step is providing information which is needed by the test provider. Many systems display a multitude of boxes for the doctor to fill in, which are unique for each test. Often these are too restrictive or ask for irrelevant information. They can be replaced by a simple text area where the doctor can type whatever he likes. For guidance the screen should display advice from the test provider explaining what information to include, and how to prepare the patient for the test.

6. Freetext area to describe the patient’s history

There needs to be a text area for the doctor to describe the patient’s illness and medical background. Having been filled in once, this history should be the automatic default on subsequent tests.

7. Options for the timing of the test

In general freetext is better than fixed options, because patients are so varied. However in some situations such freedom does need to be sacrificed in order to increase the usefulness of the software. One situation is for specifying the timing of the test. The options should be: “as soon as possible”, “on a specific date”, “on a number of dates” and “on an unspecified future date”. There is no point in options such as “urgent” or “routine” because doctors generally just choose “urgent” to prevent their patient being at the back of the queue. If the situation genuinely is urgent, the doctor can telephone the test provider.

8. Transportation

Freetext area to describe how the patient will be transported to the test provider.

9. Progress status

Having requested a test, the doctor needs to know how far it has progressed towards completion.

10. Automatic contact details

I never cease to be surprised that, despite having logged in and a system therefore knowing my name, it does not have a facility to store my bleep number. So every time I book a test I have to re-enter it. Obviously this is annoying and inefficient.

Connecting for Health needs to hear our opinions. For brevity I have tried to make my points as precisely as possible, even though there is much more to be said about each one. I hope any doctor who regularly books tests via a computer will know exactly what they refer to. If you work for an IT company and are developing software for healthcare, then I hope you do too.

(Note: The views expressed in this article are those of Dr Harrison and may not necessarily reflect those of Hammersmith Hospitals NHS Trust.)

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