Analysing XML health records   Table of contents   Indexes   XML for discharge summaries, clinical coding &, bronchoscopy reports
 

The Path.Finder project

Pearson, Simon
 
 Simon  Pearson
 Technical Advisor and Path.Finder Author
 CPRU
Merseyside
 United Kingdom 
Upton
Wirral
CPRU,  Arrowe Park Hospital
Upton  Wirral Merseyside United Kingdom  CH49 5PE
Phone: 0151 604 7201 Fax: 0151 604 7191 email: SNPears@aol.com web site: www.pfconsortium.com
 Biography
 Simon Pearson - Simon holds a university degree in Medical Biology and has frontline experience as a Phlebotomist. Simon has been involved with the Path.Finder project for two years, originally working with proprietry systems and HTML, he is now a proficient user of XML to support a comprehensive 'one stop' health information system.
 In addition, as webmaster, he maintains the Consortium website and provides technical support, advice and training to the 14 UK Trusts which make up the National Path.Finder Consortium. As the joint Coordinator of the Path.Finder Consortium, he has experience in workshop and consortium organization, communications and administration, and has proven communications skills.
 Abstract
 Wirral Hospitals NHS Trust, a 1200-bed general hospital with 90 wards, created the Path.Finder healthcare information system in 1994 to share research and clinical guidelines among healthcare professionals both within the Trust and the wider healthcare community. Recently the Trust has replaced the first version of Path.Finder, which ran on proprietry hypertext technology, with a solution based around XML.
 Data formatted using XML is delivered through a browser inteface, which has enabled the Trust to roll Path.Finder out to a wider audience. In addition XML allows the Trust to incorporate a greater range of media types and link Path.Finder guidelines to web-based information provided by other healthcare organisations. Working with the Software company Graphnet, the Trust has been able to create a publishing tool which allows staff to create and maintain XML documents.
 

The situation

 The Path.Finder project began as a local initiative at Wirral Hospital NHS Trust in 1994, with the Trust initially providing guidelines for GP's on topics in which they had expressed an interest. A hypertext package running on laptops was used to structure and display information, and the system was piloted with 25 GP's. Most of them found the system very valuable, improving their clinical practice and the way they referred patients. The Trust the decided to roll out the system to other GP's and began to develop further books for use within the Trust. These were made available on PC's in around a dozen wards. The Trust also joined forces with a number of other Trusts in 1996 to create a Consortium to develop and promote the Path.Finder system.
 The first incarnation of Path.Finder provided significant benefits to both clinicians and patients. However as the scope of the application grew, software constraints became apparent. XML offered a way around these constraints by supporting complex images and digital photography, an important aspect of medical information tools. It also allowed tables and links to external applications. The major benefit though was the automation of the maintenance of the guidelines. With 3500 pages of information within the Wirral alone, it was nearly impossible to keep track of which pages had passed their expiry date and to make sure that the authors reviewed them.
 

The solution

 To provide it with the expertise to kick start the project, Wirral decided to work with an extrenal consultancy called Graphnet. A key element of the solution was an interface that would allow users with basic word processing skills to create and manipulate XML documents. Graphnet used Visual Basic and C to develop a publishing tool that allows users to enter text directly or to draw on existing word processing files. All data is saved on a SQL database.
 The flexability of XML allows Wirral to deliver Path.Finder on a number of platforms including over the NHSnet to standalone PC's running older web browsers and on touchscreen patient information kiosks which are soon to be deployed around the Trust. The XML version of Path/Finder is available on more than 300 PC's around the hospital, users outside the Trust such as GP's are initially accessing a standalone HTML version of Path.Finder until the local Health Authority sets up a secure server.
 

The benefits

 Xml has allowed Wirral to solve the issues it faced with the Non-Web compliant version of Path.Finder. Guidelines can be managed and maintained more easily, while new data types such as digital images can be incorporated. In addition, the widespread availability of the webbrowser interface means Path.Finder can be rolled out to a much wider community of users.
 Using XMl has brought other benefits as well. For example, because Path.Finder data is now stored in a dtabase rather than as pre-constructed pages containing metatags, users can perform more powerful searches and link directly to relevant paragraphs. Also because XML sends only unformatted data access times for staff working remotely are comparable to staff using a locally stored proprietry system.
 

The future

 The Path.Finder project represents just the first step in Wirral's plans for XML. Because XML are inherently compatable with database technology, the Trust is now exploring the possibility of providing referral forms online. These forms are initially being coded in HTML for evaluation but when the fina version is decided upon, they will be converted to XML allowing the patient data to be sent directly to a referral database at the Hospital
 In addition the Trust is beginning to develop EPRs using XML, the structure provided by XML will allow Wirral to link patient and Path.Finder records together. For example a clinician will be able to use the clinical codes for the diagnosis in the patient record to jump to the relevant clinical guidelines for that condition in Path.Finder.
 Other projects now being planned include the delivery of education modules which will allow staff to test their knowledge in around 50 clinical areas with the ability to make greater use of guidelines developed by other healthcare providers.
Analysing XML health records   Table of contents   Indexes   XML for discharge summaries, clinical coding &, bronchoscopy reports