Creating a patient audit trail

Health care systems are highly heterogeneous and numerous. My fix is how to store in one place, the health care data held in disparate systems, without an impossible integration task (cost, time, security, data cleansing etc).

Existing healthcare systems are central server based systems focussed on a health care professional as the user. A users data will be stored in a varying number of systems depending upon where they have had interaction with NHS services. Ultimately, the data is owned by a member of the public (MOP) who as no direct access.

If we look at the high level NHS business process. A MOP will interact with the NHS via their GP and will receive written notification of appointments and outcomes. Such paperwork is generated by a myriad of sources and each document tends to contain a mixture of static patient data and data about the transaction or event. The documents vary from the mundane (e.g. prescriptions) to summary of a treatment (e.g. a cancer patient no longer needs treatment). Apart from a MOP keeping a file of all of this paperwork, it is not normally available for a subsequent diagnosis. The various codes and formats used simply make it impossible to collate into a single form. Fundamentally, NHS systems are designed to manage a single medical case, not to keep a life time summary of everyone in the country.

A very common solution used in business is to employ a document management system to store customer correspondence so a call centre would have a view of a company’s interactions with a customer. E.g. rather than interrogate a billing system it is easier to have a copy of the last bill to hand. If we apply this logic to the NHS, we would intercept correspondence from the NHS to a MOP and load it into a document management system which would then forward it to the MOP along their preferred channel. The document management system would then have an audit trail available for subsequent diagnosis during the next medical case.

Creating a single document management system for the NHS may be impossible so we should focus on the ownership of the data to help a MOP store and retrieve their transactional data history. Such data could be stored in the NHS App and managed via the App. To avoid a never ending data modelling exercise, we would store the data in human readable form e.g. each letter is a locked pdf. The MOP could then choose to share his history when being consulted by an NHS professional who would be able to read and understand the documents audit trail.

To make a successful business case the App could allow its owner to select a preferred correspondence channel thus saving postal costs when the App is the selected channel. It is suggested that local document management instances are used in NHS premises. They could be either integrated with existing local systems or used stand alone to manually scan documents.

It is possible to extend the concept to include other events than correspondence. The user of an NHS app could be given the ability to record events using the technology available on a modern mobile device.

• QR codes which could be provided by the NHS at every point of service delivery for the MOP to scan as a record.

• Bar codes of medicine could recorded

• Blue tooth could record interactions with NHS personnel

• Blood pressure and temperature readings could be photographed

In summary, the suggestion has two components

1. Manage an audit trail of NHS interactions in the NHS app

2. Use document management systems to replace existing printed paper correspondence to input to the audit trail. It is a largely a process solution rather than system design. It would require the reader of the audit trail be able to understand what they are reading.




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