Simon Pearson (left) and Dr Tom Kennedy describe the development of a locally managed, clinical information system now used by more than 300 GPs countrywide

The need to improve the communication of current research evidence and clinical practice guidelines is growing. Path.Finder is a clinically led, locally managed, healthcare information system, which was created at the Wirral Hospital NHS Trust in 1994, in response to this need.1 The aim of this system is to improve patient care by providing easy access to up-to-date clinically useful information which is relevant locally.

Path.Finder began as a pilot project.2 Consultants, clinical nurse specialists and managers in the trust provided information that GPs had expressed an interest in. This was structured into a number of databases or 'books' using a hypertext software package. Each book was subdivided into chapters. The software was finally installed onto laptop computers, which were given to 25 GPs in the district.

The GPs used the laptops for 6 weeks and then scored the value of the information on a scale of 1 (no value) to 10 (extremely valuable). Their mean score was 7.41.

They were also asked whether using the guidelines had changed their clinical or referral practice: 44% said they had changed their clinical practice, and 26% said they had changed their referral practice. After these promising first results the project was expanded to a further 34 GPs in the district.

The project continued to expand until late 1996, when a National Path.Finder Consortium was established. This currently comprises 14 member trusts (Table 1, below). Consortium members are committed to developing and promoting the Path.Finder system. Administrative support, involving the secretarial and financial functions, is provided by the British Association of Medical Managers (BAMM).

Table 1: Consortium membership

Central Manchester Healthcare NHS Trust
Countess of Chester Hospital
Glany Y Mor NHS Trust
Huddersfield NHS Trust
King's Mill Centre
Loddon NHS Trust
Mid Staffordshire General Hospital NHS Trust
Ulster and Community Hospitals Trust
Queen Mary's Hospital
Sandwell Health Care NHS Trust
St James' University Hospital Leeds
Taunton and Somerset NHS Trust
Thanet Healthcare NHS Trust
Wirral Hospital NHS Trust

Today the Wirral Path.Finder system consists of nine books (Table 2, below). The book that is used most frequently is 'Guidelines' which contains 279 referral guidelines.

Table 2: Wirral Path.Finder library

Book Source Content Used by
Guidelines Consultants, Nurse specialists, Managers Guidelines, Service, Information, Patient information sheets GPs
Radiology Royal College of Radiologists Protocols to deal with most X-ray needs Hospital staff especially A&E
GP X-ray Dr ME Lipton

Guidelines to support GP referral

GPs
Home oxygen Paediatric nurse, Jane Webster

Advice on use and obtaining oxygen at home

GPs and ward staff
Asthma National Asthma guidelines

Diagnosis and treatment of asthma

GPs and ward staff
Travel immunisations MIMS update by Huddersfield Trust Immunisation for travel abroad Community nurses and GPs
Patient Patients and patient support groups Benefits, Support groups, Travel information, etc GPs and ward staff
A&E Senior A&E consultants How to deal with most A&E situations Junior A&E doctors
Ward Ward managers and senior nurses Protocols and patient information for specific wards Doctors and all ward staff

Generally, the guidelines have a uniform structure, with each condition defined either by diagnosis or symptom. This allows users to determine which consultant to refer a patient to for a particular condition. Information provided includes referral criteria together with the appropriate investigations before referral and first-line management of choice.

This information is also linked to a description of the local services available for management of the condition and to the relevant patient information sheets, which can be printed and given to the patient.

The book contains information on waiting times, a hospital telephone/1facsimile directory and educational timetables.

The system also has in place a 'patient' book, which has been written primarily by patients with a variety of conditions, supported by healthcare professionals and/or social services (Table 3, below).

Table 3: Contents of the patient led book
Amputation
Diabetes
Arthritis
Disabled school leaver
Autism
Respiratory care

This book contains descriptions of the conditions, drug management including side-effects, information on coping at home, benefits, local leisure activities, support groups, and travel.

Wirral Trust is working with the Clatterbridge Centre for Oncology and with The Wirral Palliative Care Service to develop this book further. We are also working with The West Cheshire and Wirral Community Trust to develop a chapter for those caring for elderly patients with psychiatric disorders.

On joining the Consortium, members receive all of Wirral Path.Finder as the 'Wirral Starter Pack'. Consortium members then use this information as a template to be adapted with their own information. This is specifically to encourage local ownership.

Increasingly, access to other information sets will be available as members generate their own data. Each member is committed, through the terms of the consortium framework, to sharing information with other consortium members.

A central index of all information held by consortium members is being developed. This currently contains more than 1000 guidelines relating to 963 separate conditions. This central index will enable members to identify easily both the subject area and the type of information available.

As part of the research function of the consortium, it is intended that guidelines will be compared and best practice identified using the principles of evidence-based medicine.

Membership of the consortium currently costs £10 000 for a 3-year period. Thereafter there will be a yearly membership fee, yet to be determined. Both of these sums are subject to an annual review.

Software is not included in these costs as it is important that trusts wishing to join the consortium fully involve their IT department from the outset. In this way future support can be negotiated, and compatibility with the trust's IT systems assured. It can be an expensive mistake to purchase the licences necessary to publish with a commercial software platform, only to discover shortly after that the trust is moving to an incompatible system.

Many of the trusts, including Wirral, are currently moving to an internet compatible software platform, based on HTML or XML (Figure 1). With the advent of the NHS Intranet, this will enable a greater volume of people within the member trusts to have and those who provide and edit the information.

Figure 1: Home page for Wirral Path.Finder
screenshot of web page

This has raised concern among some consortium members as to the security of the information. To this end, safeguards are to be put in place, to ensure that access is limited to the member trusts.

Using this new software, Wirral plans to make Path.Finder available throughout the trust in Autumn 1999, allowing access via each of the 1200 PCs that make up the trust network. In some member trusts Path.Finder is already being used by GPs to book appKintments with consultants and even to schedule minor surgical procedures.

The project encourages efficient referral between the various parts of the NHS. It also reduces the risk of duplication of effort, in addition to enabling local modification and ownership of information.

As the project grows it will allow the content of Path.Finder databases from different trusts to be compared to identify common, and eventually best, practice. Furthermore, a project is under way to link information from the evidence-based literature to the Path.Finder clinical headings.

From its beginnings as a research project involving 25 GPs, Path.Finder has grown over a relatively short period of time, and with a minimal amount of funding, into an effective communication tool used by more than 300 GPs across the country.

In addition, it is increasingly being used in hospitals to support the management of ward information, such as care protocols and patient information sheets.

  1. Kennedy TD, Maxwell M, Charnley P, Spours A. Implementing effective clinical systems. Br J Healthcare Comput IM 1997; 14(2): 38-40.
  2. Buchan IE, Kennedy TD. Path.Finder: an interactive clinical information system. Int J Health Care Qual Assur 1995; 8(7): 32-5.

 

 

Guidelines in Practice, July 1999, Volume 2
© 1999 MGP Ltd
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