The potential of networked local NHS communities is being demonstrated in Oxfordshire by the Oxford Clinical Intranet, which uses easy-to-use Internet technology to make test results electronically available to GPs.
Where in the past getting test results depended on doctors making time-consuming phone calls or awaiting paper results by mail, the new system — developed by Oxford Radcliffe hospitals together with health IT specialists CSW Health — provides secure access to lab test results as soon as they have been completed, cutting paperwork and speeding up referrals and exchange of information.
Development of the system began in the mid-1990s when the pathology department at the Oxford Radcliffe Hospital wanted to find a way to pull together different departmental systems and provide easy, standard computer reporting to junior doctors, consultants and other authorised staff.
"Lab reports have been computerised for a long time, but come in a wide range of formats and media, so we set up a departmental website for reporting from multiple systems," explains Dr Jonathan Kay, Consultant Chemical Pathologist at the Oxford Radcliffe Hospital.
Dave Nurse, Research Director with CSW Health who led technical work on the project adds: "A key part of the project was to hide the differences between different systems from users".
This led to the development of a web-browser system to provide clinicians with a standard way to access information from different systems. Guidelines and protocols have also been built into the system, enabling clinicians to reference supporting information at the same time they access results.
With the development of NHSnet from 1999 the system began to be extended to GPs. It is now used by 70 of the 98 GP practices in Oxfordshire, and forms a key part of the local information strategy for the NHS in Oxfordshire.
Both hospital doctors and GPs have direct electronic access to test results from the full suite of hospital service departments, covering radiology as well as labs. GPs, once securely signed in, have the same electronic access to their patient’s test results as their hospital-based colleagues.
Every individual junior doctor, consultant or other authorised user is given a unique individual password, ensuring security and an audit trail of information accessed. Hospital doctors only have access to information for patients they are treating while GPs only have access to information on patients from their practice.
“Using this business technology now means that GPs get results an hour after they come off the analyzer rather than days later,” says Dr Kay. "GPs can now see investigations they called for in the surgery, providing a much more patient-centred approach."
One local GP using the Oxford Clinical Intranet is Dr Andy Chivers. Where paper test results could take many days to reach him, meaning he often didn’t have results back before he next saw the patient again, he now has access to his patient’s test results as soon as they are completed.
Dr Chivers says the ability to view results on screen during a patient consultation is invaluable. "It gives a much better opportunity to discuss the results and future treatment options with the patient."
A range of further developments of the Oxford Clinical Intranet are now underway to allow a much wider range of information and clinical correspondence to the sent electronically and shared with GPs, including discharge summaries, out-patient letters and clinical correspondence to be sent to GPs electronically.
All of the items of patient data are automatically linked to the individual patient, forming the nucleus of an electronic patient record (EPR).
Another module planned for the near future is a GP Referral Management System, which will allow GPs to sign in to the network and look up details of appointment bookings made for their patient.
According to Dr Chivers, the real value of the Oxford Clinical Intranet is that it provides him with direct access into the hospital information systems, creating much more of a partnership between the hospital and GP.
"This is pointing to a future where much more clinical information is transmitted in this way. It’s a stepping stone towards the Nirvana of a community-wide Electronic Patient Record," says Dr Chivers.
More than 3,500 GPs, hospital doctors and authorised administrative staff are currently using the system to view test results. The roll-out of making electronic test results available to all Oxfordshire GPs using the Oxford Clinical Intranet is due to be completed later in 2002.