Select Committee on Science and Technology Minutes of Evidence

Memorandum by Dr James Henry Paton

  I have been Consultant Microbiologist at Queens Hospital, Burton upon Trent, since 1988. After five years as Medical Director for the Trust, I became Director of Clinical Informatics for Queens Hospital in 2002. As well as involvement in the clinical IMT developments in the local South Staffordshire health community, I have been assisting the NHS Information Authority for the last 12 months in a number of projects, including evaluation of the pilot integrated Electronic Health Record programme and the development of Pathology Messaging between hospitals and GP surgeries.

  Queens Hospital, Burton, although a smallish district general hospital, has been at the forefront of NHS acute IMT for the last 10 years, including being one of two national pilots for the Electronic Patient Record. The strength and commitment of the IMT culture amongst the local hospital staff is well recognised and the operational breadth of its hospital-wide electronic patient record remains a model for others in the NHS.


Surveillance of Infection

  Surveillance of pathogenic organisms isolated in microbiology laboratories has been maturing over the years, and there is now a well-used electronic route to communicate results to regional and national centres in a timely fashion.

  Surveillance of the occurrence of clinical infection episodes is much less mature. In hospitals, any recording directly by clinicians onto electronic systems of symptoms, syndromes or disease due to infection is in general very limited.

  There is no timely national system of transmission to a central point of such data—the data reported via the Hospital Episodes Statistics route is limited to impatient data, eg diagnoses, which are a year out of date and do not provide information on emergency department attendances or outpatient consultations. A national hospital acquired infection surveillance scheme is now in operation, but relevant data has generally to be collected in a separate exercise from routine operational data collection on patients.

  In general practice, the situation is a little better, with electronic reporting from spotter practices to the Royal College of General Practitioners surveillance scheme. In addition, surveillance of certain infection syndromes in callers to NHS Direct has commenced within the last year or so.

  Evidence about the extent and effectiveness of operational electronic systems in the NHS has been limited to date. However, the Audit Commission are carrying out an audit of acute hospitals during 2003 in which they will assess hospital doctors perceptions of the usefulness of their current systems. In addition, the Royal College of Physicians, along with the British Society of Gastroenterologists and the NHS Information Authority, are planning to produce a checklist for hospital clinical electronic systems which should clarify where gaps remain.

  Electronic recording of infection related data is essential, in providing early warning of local or widespread increases in infectious diseases, in allowing the analysis of trends in infectious disease and in promoting the monitoring of antibiotic usage. Such recording has a number of prerequisites, including:

    —  commitment by clinicians to record relevant findings electronically;

    —  easy access to suitable PCs, including mobile equipment;

    —  high quality software which supports rapid and intuitive recording of clinical data;

    —  nationally agreed datasets for infectious diseases and symptoms which should be recorded and transmitted for central analysis;

    —  systems which ensure that the gathering of infection-related data is embedded in the routine operational collection of information about the patient;

    —  an agreed national clinical terminology which ensures data are consistent across organisations and professions;

    —  systems which support local data analysis by local clinicians in auditing the incidence and outcomes of infections;

    —  electronic prescribing systems which allow easy collection of antibiotic usage and trends against particular diagnoses;

    —  well-motivated software suppliers developing effective systems in partnership with clinicians; and

    —  interoperability of clinical information systems across and between health communities.

  The National Programme for implementing the NSH IT Plan, including the proposed Integrated Care Records Service, is intended to address much of the above, in providing the technical infrastructure of IT equipment and high bandwidth networks. The development of suitable systems, software and datasets for effective infection recording, reporting and analysis requires to proceed in parallel.

Access to Knowledge

  Resources on infection management are increasingly available on the World Wide Web. The National electronic Library for Health, and in particular its National electronic Library for Communicable Diseases sub-library, are excellent examples.

  Access to the internet in clinical facilities has been steadily improving, with specific targets having been set nationally for staff access. In Queens Hospital, for example, all staff have access to PCs in wards and offices, and have access to, amongst much else, antibiotic prescribing guidelines on our intranet and the internet.

29 April 2003

previous page contents next page

House of Lords home page Parliament home page House of Commons home page search page enquiries index

© Parliamentary copyright 2003