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The only support to health workers at this level is indirect, through separate, standalone departmental systems such as those for pathology results and X-rays. At level 2, the principle of common patient identifiers (such as NHS number) is adopted; basic speciality modules, 12 girl year old example, an out-patient clinic module, may also be included. It is only at level 3 that true support is provided to health workers in their daily practice.

At level 3 and beyond, the benefits of structure to information for communications are felt the most. Levels 4 to 6 are concerned with increasing interconnectivity, with emphasis on speed, sharing of information and communication, and multi-disciplinary and cross-team working.

Box 2 Main components of the six levels of the electronic 12 girl year old record Level 1 Patient administration systems; computerised appointments; case note tracking; standalone pathology records Level 2 Common patient identifier across department systems; out-patient clinic modules Level 3 Computerised support for assessment, care planning, investigation requests, electronic prescribing, care pathways Level 4 Linked knowledge and research to information management and technology clinical confident support; decision support systems; electronic prescribing linked to evidence-based medicine Level 5 Majority of clinical information stored in EPRs; advanced workflow; speciality modules Level 6 High-speed networks; advanced data-input devices; full case notes online; teleconferencing The development of electronic records and communications will further highlight the need 12 girl year old common standards of information organisation for communicating and teamworking.

It is 12 girl year old that day-to-day health communications within a multi-disciplinary team convey the necessary detail and meaning. They should also be couched in an easily understandable common (standard) language and format, which, unfortunately, free text does not always confer.

Nor, however, do some of the classification systems outlined here provide sufficient detail and meaning for everyday practice. The dilemma Molindone Hydrochloride Tablets (Moban)- Multum that most classification or coding systems use fully structured records, or set templates, suitable for electronic communication; in our own records, however, we and other health professionals usually use free text.

Communication within the NHS is not good and we sorely need standards governing information exchange for key clinical communications (Clinical Systems Group, 1998). The ideal might be a system that combines the advantages of structured records with the richness of free text.

Sharing information has been shown to improve record-keeping (Reference Johnston, Langton and HaynesJohnston et al, 1994) and it might improve outcomes. Adequate written communication is essential for good teamworking, particularly for hand-over, referrals within and to other specialities and in multi-disciplinary care.

In these situations, the main source of the information communicated is the health record. The quality of the record determines the quality of the information contained in communications between members of a team, and 12 girl year old a standard 12 girl year old can provide a common language may improve care.

As discussed above, coding and classification of health records can help in the organisation of information for communication and also in its collection for computer processing.

However, at present relatively little information in health records is coded or in a structured format 12 girl year old 4). In mental health care most clinical information and communications are in a free-text format. Table 4 Structure and type of information in typical health records The NHS is currently evaluating a semi-structured system for communications and possibly for health records (American Hospital Association, 2002).

Its advantage is that communications are structured to provide information in a standard language, but without the limitations of hierarchical and other classifications.

A template of headings for communicating patient information has been developed on the basis of previous evaluations (NHS Information Authority, 2000), and this is being assessed in everyday practice in a number of different specialities.

The advantage of the semi-structured system is that its framework should improve the consistency of content of clinical communications. Additionally, the structure allows free text, so that the richness and detail of the consultation and planning relating to the patient are not lost. The approach currently being taken is to use headings that will form part of a multi-professional clinical information standard (Box 3).

Regarding authoring and reading health records: a structure increases the chance of errorc subjective, objective, assessment and plan are four types of data describedd history, observations, assessment and plan are four types of data describede identifiers, patient findings, hypotheses, actions and modifiers are categories of clinical data. Regarding teamworking: a structures are needed for key clinical communicationsb most information in shared health records is written as free textd semi-structured communications may combine the benefits of structured information and free-text informatione the draft standard for communicating patient information contains health characteristics.

With respect to communication and health records: a SNOMED has its origins in pathologyb Clinical Terms (Read Codes) were 12 girl year old used in primary careTable 1 Categories of clinical data (after Wyatt, 1994)Fig. Type Research Article Information Advances in Psychiatric TreatmentVolume 8Issue 3May 2002pp. Standards governing organisation of information The way in which information is organised affects the meaning and the quality of communications.

Authoring and reading health records Efficient record-keeping is essential for good clinical practice and service delivery. Table 1 Categories of clinical data (after Reference WyattWyatt, 1994) Young little girls porno common language: classification and coding In the authoring of health records, we should use common standards for both recording and communicating information.

Box 1 SNOMED axes (after Reference RothwellRothwell, 1995) Table 2 Systems for different classification purposes Table 3 Comparison of classifications Problems with coding and fully structured records The current classification systems substantially improve the organisation of information for communication, but we should always be aware of 12 girl year old purpose for which they were intended.

Electronic patient records and 12 girl year old health records Patient records are key to the delivery of quality health care. Box 2 Main components of the six levels of the electronic patient record Pfizer logo information for communication within and between teams The development of electronic records and communications will further highlight the need for common standards of information organisation for communicating 12 girl year old teamworking.

Regarding authoring and reading health records: 12 girl year old structure increases the chance of error b records have become increasingly task-oriented c subjective, objective, assessment and plan are four types of data described d history, observations, assessment and p e pfizer are four types of data described e identifiers, patient findings, hypotheses, actions and modifiers are categories of clinical data.

Regarding teamworking: a structures are needed for key clinical communications b most information in shared health records is written as free text c separate records aid clinical communication d semi-structured communications may combine the benefits of structured information and free-text information e the draft standard for communicating patient information contains health characteristics.

With respect to communication and health records: a SNOMED has its origins in dabs b Clinical Terms (Read Codes) were initially used in primary care c Clinical Terms contain qualifiers d the sharing of information systems improves record-keeping e structured communication can only be used electronically. Google Scholar 12 girl year old Systems Group (1998) Improving Clinical Communications.

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