Electronic patient records have advantages for STI clinic

Electronic patient records can be successfully introduced into a sexual health clinic, leading to an improvement in patient care, according to an article published in the April edition of Sexually Transmitted Infections. The authors report a high level of staff satisfaction with the new electronic notes system, which was introduced without any major glitches.

However, the clinic deferred the implementation of electronic record keeping for their HIV-positive patients. There is no information on the reaction of patients to electronic records, but previous research suggests that many patients are concerned about who has access to electronic notes. The authors also write that there was a need for considerable staff training and that substantial IT support was required.

There is an increasing trend for patient records to be stored digitally and it is expected that in the future it will become the norm for all UK NHS medical records to be held electronically.

In recent years there has been a significant increase in demand for sexual health and HIV services in the UK. Some clinics have experienced problems storing and accessing paper notes for an ever-increasing number of patients. Staff at the Patrick Clements GUM Centre at the Central Middlesex Hospital in north west London anticipated that electronic patient records would overcome these problems of space and access and have other advantages, including uniformity of data collection on patients. They therefore decided to implement a system of electronic patient record keeping.

The centre offers a walk-in, open access service and there are in the region of 14,000 attendances each year, three-quarters of which are for reasons of sexual health.

Implementation of electronic patient records was well-planned in a series of defined stages, the first of which involved six months of planning.

Staff purchased the “off the peg” Blithe Lilie patient management system and ensured that there were enough computers within the clinic for staff to access records (approximately one per individual). Although the system came equipped with electronic patient record templates, a team of core staff, including three consultants, a nurse, health advisor, and a clinic manager decided on information that needed to be obtained in a number of different clinical scenarios and developed additional templates to match.

Clinic staff were regularly consulted. It was decided to initially confine electronic patient records to sexual health patients, and to consider the system for HIV patients at a later stage.

Templates allowed information to be entered in one of four ways: text; single answers from a drop-down list; dates; and numbers.

A two-month training phase was an opportunity for staff to familiarise themselves with the system.

The system was introduced over a three-week period. During this period there was the option to revert to paper notes if problems with electronic records developed. Clinical staff also had the option to request paper notes for three months after implementation. But this was not needed as the templates provided enough information. At the time of writing, the clinic had been operating an exclusively electronic method of patient record keeping for three months.

During this period the templates were revised to reflect staff comments, and now include more room for text entry.

Reported advantages of electronic record keeping include faster booking of patients at reception, “much more rapid” contact with patients following a positive test result (now just one day, previously three days), and increased possibility for searches.

But the authors also feel that electronic recording keeping has some disadvantages including less eye contact and rapport with patients. They also note that “substantial” training resources were required, that high level IT support was needed, and that staff were required to make a “conceptual change” from paper records to electronic notes.

An audit showed that staff entered correct information 95% of the time, and a survey showed that 21 of 23 staff at the clinic (91%) preferred electronic records to paper notes.