Implementation of a clinical workstation for general practice

It is now well recognized that achieving international best practice in the primary health sector will require the development of methods based on a fundamental integration of communications and information technologies with clinical practice. This will have far reaching effects, both on the pattern of medical practice and domiciliary care and on patient outcomes. In the past, information and communications technology has been presented as a tool for management, rather than as a tool for supporting, improving, and making more efficient the professional practice of medicine and the delivery of health care to the patient and the community. In this paper, we propose that an essential element for the achievement of international best practice in the health sector is the development and widespread use of information, measurement, and communications technology targeted towards the clinical practice of medicine, the provision of health services and domiciliary care in the community, and the analysis of morbidity patterns and health care outcomes. A key element of this strategy is the development of an integrated Clinical Workstation specifically designed for the general practitioner, practice nurses, and domiciliary care nurses in their professional tasks of measurement, diagnosis, management, and delivery of health care to the community. We will present our work on the design of an integrated Clinical Workstation for Primary Health Care. The Workstation is Windows based, has a sophisticated user interface, and supports a wide range of computing platforms, from desktop to laptop to hand-held notebook computers. The Workstation will be modular and expandable, both in its software and hardware components, so that users may select only those modules appropriate to their own roles, clinical practice, and levels of expertise. The design will focus on the provision of clinical services and will integrate the following key components: Patient records and basic practice management; Clinical records. Based on ICD10, ICPC, or Read Code classifications; Clinical measurements. Blood pressure, spirometry, ECG, and basic hematology and biochemistry; Clinical decision support. Based on epidemiologic data, protocols, and medical expert systems; Domiciliary care and evaluation of the functional health status of the elderly; Communications and networks. Wireless LAN, modem, and fax; Clinical reporting. Morbidity profiles prescribing profiles, and laboratory services and procedures. Implementation of these requirements will ultimately take the form of an untethered, portable notepad computer supporting a communications link via modem, LAN, or wireless LAN, and removable instrumentation and clinical measurement modules.