How the CUI programme is helping to shape the NHS desktop of the future
When doctors, nurses and other staff log onto their computers in a few years' time, what will they see? It's not possible to say exactly. But a multi-million project led by Microsoft is providing some clues.
As part of its commitment to the NHS, Microsoft is investing £40 million in the Common User Interface (CUI) programme. This is a partnership initiative with NHS Connecting for Health, the agency in charge of `digitising' the NHS, and some of the companies that build clinical software.
As its name suggests, one of the programme's main aims is to create a more consistent "look and feel" for the systems that NHS staff use every day.
Andrew Kirby, the programme's director, says this should help NHS staff because consistent software will be easier to learn and use. It should also deliver benefits for patients, by reducing the chance that mistakes will be made because of confusion over simple things - such as how a date is displayed.
Guidelines and toolkits
However, the CUI programme is not building new clinical applications itself. Instead, it is creating a Design Guide that describes how things that often need to be displayed in NHS computer systems should be displayed.
It is also creating an NHS Software Development Kit or "toolkit" that uses this guidance to create components that NHS software developers can use, free, in their own applications.
Microsoft has built a "demonstrator" or working model to show how the guidelines and components might affect what doctors, nurses and other staff see when they log onto an NHS computer in the future, and how this might support the care they deliver.
"If somebody types in SOB, meaning shortness of breath,...a menu of expansions will come up that will allow [clinical staff] to encode that using SNOMED CT, or to add other attributes, such as how severe the condition is or how long-lasting."
The patient banner
The demonstrator works with some real-life scenarios. In one, a baby called John Evans has been admitted to a children's ward from Accident and Emergency, after suffering convulsions at home.
If a member of the ward's nursing staff logs onto John's record in a few years' time, the first thing she may see is a "patient banner" across the top of the screen, containing basic details about him.
Many clinical systems already have a banner of this kind - and software suppliers may continue to use their own styling and colours in the future.
But the Design Guide specifies the information it should contain - the patient's name, NHS number, date of birth, age and gender - and how this should be displayed. The patient's given name, for example, will always precede their surname, and their date of birth will always be in the format 09-Mar-2007.
"The patient banner is a great example of the work we have been doing," says Mr Kirby, who stresses that all these decisions have been made following extensive discussions with clinicians, NHS organisations and application providers (more than 180 clinicians and 60 trusts have been involved so far).
"The CUI programme has created 110 guidelines so far, that range from very specific things, like how individual pieces of information should be displayed, to more complicated ones, like the banner itself, and the different menus that drop down from it."
Take a note
One of the big issues for NHS computing is how to make it as easy for staff to record notes electronically as it is for them to record them on charts or sheets of paper - while improving their safety and usefulness.
The demonstrator includes space for staff to record observations. In the real world, they might do this with the notes open on a PC, a hand-held device or a mobile. The point, says Mr Kirby, is that the display allows them to enter information quickly and then prompts them to define or clarify it or code it for other uses.
"If somebody types in SOB, meaning shortness of breath, the system will capture that," he says. "But we want it to do more than that.
"If that member of staff now clicks on "SOB", a menu of expansions will come up that will allow them to encode that using SNOMED CT, or to add other attributes, such as how severe the condition is or how long-lasting."
All of these expansions, of course, will be determined by the Design Guide. As will the way that medications and dosages are displayed on screen. This might seem to suggest that clinical staff will need huge amounts of training just to use IT in the future.
But Dr Shaun O'Hanlon, clinical design director of EMIS, which is one of the first companies to start using CUI guidance and components, says the whole point is to bring help with complex issues such as clinical coding "to just one click away from the initial data entry."
The big gain, he adds, should be further improvements in patient safety, since well-kept electronic notes should be harder to misread and misinterpret than handwritten ones full of personalised abbreviations.
"We have tried to replicate the way that someone might quickly ripple through a patient's notes to get an overall picture about them, and then focus in on a particular observation or medication."
Charting the way ahead
The team behind the demonstrator has also been exploring ways of making the presentation of information more engaging and tackling some practical issues about how to display complex data on a range of screen sizes.
"We have been looking at visualisation techniques - for example, how to represent observations of critical functions on charts," says Mr Kirby.
"We have asked NHS staff what they really need to be able to find out from such charts, and created something that lets them click onto each point to find out more information, such as more detail about the observation, who took it and when.
"We have also made a point of looking at how to display information on a range of devices. Some wards might have 30 inch computer screens, so there is plenty of space to use. Other NHS staff might be working on handheld devices, with relatively small screens.
"In each case, we have tried to devise displays that indicate to people where there is more information available, even if there isn't room to show that. For example, if someone is looking at one of the medications that John has been prescribed, there will be something to indicate if he has been given other medications as well.
"We have tried to replicate the way that someone might scan a complex spreadsheet - and then zoom in on a particular element. Or the way that someone might quickly ripple through a patient's notes to get an overall picture about them, and then focus in on a particular observation or medication."
Adopting the guidelines
The first set of guidelines to emerge from the CUI programme have been sent to the NHS information standards board, which will consider whether they should be recommended for use in NHS IT systems.
It will then be up to individual systems suppliers to adopt them - and decide whether to use components such as the patient banner. John Coulthard, head of healthcare at Microsoft UK, believes that they will be adopted - and that regulators, insurers and others will demand this once the patient safety benefits can be shown.
From EMIS, Dr O'Hanlon agrees. He expects EMIS to start incorporating outputs from the CUI programme into its EMIS Web product later this year, and to incorporate other outputs as they become available.
Although this process will take time, he believes the direction of travel is clear. Although the NHS desktop of the future may not look exactly like the demonstrator, he says: "I think the long-term vision is one common user interface for the entire NHS, so that if you are looking at a patient record in any hospital, clinic or other environment, it will look the same."
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