The Prescribing Information and Communication System - PICS – is a rules-based clinical decision support system developed in the health service for the health service. From its inception, PICS has been subject to continuous multi-professional clinical feedback and development. The result of this is an excellent track record of stability, safety and usability. In addition to a highly regarded electronic prescribing and medication administration capability it incorporates various patient management facilities including laboratory/radiology ordering and results reporting.
PICS has been developed at University Hospitals Birmingham NHS Foundation Trust and provides key benefits in the quality and safety of patients’ care. Available at the bedside there are a wide range of modules within one application which allows all healthcare professionals to move easily between job functions with clinical information needed in decision making being readily accessible.
PRESCRIBING
Patients’ diagnoses and co-morbidities are recorded within PICS and together with laboratory results they drive electronic decision support for prescribing. PICS provides real-time decision support in terms of drug interactions, contra-indications, dose limits and in a wide range of other clinical areas linked with prescribing. Advanced functions include an infection control module, drug-laboratory warnings / prescription-driven test requests, and thrombosis risk assessment and management. More recently, the PICS team has worked closely with the British National Formulary to further develop intelligent decision support and to modify the PICS drug dictionary into a resource with widespread applicability.
INFORMATION
PICS allows the management of diagnostic investigations and the real-time recording by doctors and nurses of the relevant data required to support the clinical management of patients. The rapid retrieval of medication data, medical conditions, diagnoses and investigation results has minimised the time spent by clinicians searching for and assembling patient information, and thereby increases the time that clinicians have with their patients.
Information entered into PICS is capable of interrogation for other secondary uses such as audit, academic research or management reports. Making data capture mandatory in some circumstances can facilitate organisational change and produce instantaneous operational benefits in order to monitor specified quality measures. A hospital-wide PICS implementation will quickly establish extensive information which can be stored in a local data warehouse that will prove invaluable to the organisation for performance monitoring and quality improvement purposes.
COMMUNICATION
Facilitating information flow into other systems and to users is key to providing high quality communication to support patient care. A number of functions and interfaces have been developed that allow transfer of information from the simple ‘pop-up’ windows to bi-directional mobile email communications with defined users. An example is the communication of critical physiological deterioration of patients to the critical care outreach nursing team. Every set-up in PICS can be user defined and this is important to ensure that the right message is getting to the right user at the right point in the clinical workflow. Role-based access also defines the privileges and configures the user interface that each user sees within the system.
Order communications allow investigation requests and patient referrals to a wide range of service departments, all of which are configured in terms of ‘intelligent forms’ and methods of communication. The screen-based dialogues are specific to each investigation, ensuring that where necessary mandatory information is passed with the order but also sharing common data thus obviating a need to re-entry in multiple forms. The frustrations due to incomplete information experienced by service departments using traditional paper-requesting as well as the delays to patient care are avoiding by using the PICS electronic order communication module.
INTEGRATION AND IMPLEMENTATION
Integration into existing Patient Administration Systems, as well as other key clinical systems (such as laboratory and radiology), is all possible through the use of standards based interfaces. Providing a strategy for interoperability is key to our implementation plan when working with individual Trusts or groups of hospitals. CSE Healthcare Systems will provide all of the deployment, integration and support services in order to implement PICS working closely with local implementation leads.
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