As a junior doctor a considerable amount of my time is spent with lists. Writing, editing, and consulting lists. They’re how an under-slept, overworked, and considerably over-caffeinated junior remembers who they’re looking after, and what needs to be done for them. Everything important should first and foremost be written in a patient’s notes, but a doctor’s list a sacred thing and an important backup if anything goes awry. In general the primary purposes of the list are:
- Identify which patients are under your/your Consultants care
- Contain a brief medical overview of current problems and relevant co-morbidities
- Keep track of blood results and imaging reports
- Has a list of jobs that have been/need to be done
Yet like most things in the day-to-day healthcare world, they’re low tech and inefficient. The vast majority take the form of MS Word documents scattered throughout the hospital; if you’re lucky they’re on a shared drive so you’re not chained to a single computer. Some attempt at version control/organisation is made, but take my hospital for example, and desktops are littered with various versions dating back several years. As is probably apparent, I have a number of issues with this as a system.
Sometimes patients are deleted accidentally, or or you want to see patients who’ve previously been discharged. The MS Word method falls down here as the only real option is to go trawling through previous versions of the list.
Accessibility. It’s often only possible to access lists on a particular computer, or through a particular login. One way used to circumvent this is to email lists to yourself/your own team repeatedly, but this has its own set of issues.
Formatting. There’s no real way round it, lists are highly information dense, but the current methods of relaying this information extends to tables and rows.
Cumbersome. Although by nature word documents are highly flexible. Doing what amounts to basic data entry to input blood results several times a day is tiresome. There’s also a vast duplication of effort as each team maintains their own list, often with some overlapping patients, and the nurses maintain their own lists as well.
One possible alternative could be a web app solution, as is already used for reviewing and requesting results. However, it’s difficult to advocate for yet another system, with yet another set of logins and issues. Therefore, it would be necessary to have in mind the potential benefits of such a system and to avoid too much added complication. I would consider the following features to be important in an initial version:
- Be a permanent record - no information deleted, but for example statuses changed, and easily query-able.
- Afford some context to the contained information - such as linting for blood results indicating severity of change
- Ability to modify with minimal friction
- Paper to be a primary medium - such a system would be useless unless its easy to print from
- Allow exchange/sharing between teams
- Flexible enough to cater for doctors, nurses, and all manner of health professionals
Despite potential benefits, the state of regulation surround hospital IT systems makes it difficult to see such a system gaining support. Added to this, its possible that the eventual shift to EMR may contain similar functionality. However, standing where I am today, it’s difficult to imagine a shift away from paper on a completely national level.