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In this paper I consider ways of organising this information to enhance its meaning and thus to improve Pyrimethamine (Daraprim)- FDA quality of communication. I concentrate on aspects Pyrimethamine (Daraprim)- FDA communication, l thyroxin sanofi electronic advances in engineering software paper-based, related to the delivery of care and examine ways of using a common structure for the collation and presentation of information.

Organising information improves the consistency and quality of communications, which may have a direct impact on clinical outcome. Existing standards, which pre-date the widespread adoption of electronic communication of information, developed to facilitate sharing of information between individuals at various discrete levels. Papain and Urea (Accuzyme)- FDA example, at one level are the doctors, nurses, social workers and others dealing directly with patients; at a higher level, are the departments within an organisation; above them are organisations communicating between themselves; and communication Pyrimethamine (Daraprim)- FDA also Pyrimethamine (Daraprim)- FDA between these levels and the service users (the patients, their families and supporters).

Good communication is clearly essential for good practice. If coordination and communication within different parts of the National Health Service (NHS) and between the NHS and other care providers such as social services breaks down, the consequence is inevitably poorer care for the patients affected (Department of Health, 1998).

The growing national emphasis on the information technology necessary for rapid and efficient communication demands excellent organisation of information. The way in which information is organised affects the meaning and the quality of communications. Standards already exist within health care to facilitate information-sharing. De Moor et al (1991) define these standards as a Pyrimethamine (Daraprim)- FDA set of rules, conditions or requirements concerning definitions of terms, classification of components, performance, delineating procedures, or measurement of quantity and quality in describing practice, service or systems.

With insufficient organisation, key information can be lost. Furthermore, insufficient detail within the framework related to the information in a communication may prevent the recipient from making an appropriate and fully informed clinical decision. Taking again the example of schizophrenia, under the framework heading of past history, recording the number of previous episodes of schizophrenia is more useful for communicating the prognosis to other professionals (and the patient) than is stating only that the patient has a history of the disorder.

The need for common standards governing the communication of information applies even more to electronic communication. The NHS Executive (1999) has identified a number of areas of particular importance to the meaning and quality of communication within health care: authoring and reading health records; a common clinical language; and communicating information within and between teams.

Efficient record-keeping is Pyrimethamine (Daraprim)- FDA for good clinical practice and service delivery. With the move towards electronic communications, electronic health records (EHRs) and electronic patient records (EPRs) have become more common. However, our paper-based records are still Emapalumab-lzsg Injection (Gamifant)- FDA important, especially as electronic information systems have yet to be Pyrimethamine (Daraprim)- FDA adopted in everyday mental health practice.

When making decisions about individual patient management, the clinician must know the clinical data specific to that individual: information held in the health record. Thus, patient-based data Pyrimethamine (Daraprim)- FDA essential and the way in which information in Pyrimethamine (Daraprim)- FDA health record is organised is important. Poor organisation of a health record increases the chance of error.

Studies on medical records have shown that the absence of information or inaccurate information adversely affect information retrieval and, probably, patient care (Reference Tang, Fafchamps and ShortliffeTang et al, 1994). Clinical information has been included in the paper record for many years and the way in which it is organised has developed from a simple chronological listing to a more structured and problem- or task-oriented presentation (Reference TangeTange, 1996).

For example, Weed (1968) suggested that clinical information in health records be organised into four different types: subjective (what the patient has told us), objective (what we have observed), assessment (our interpretation of these findings) and plan (the management plan).

He suggest the acronym SOAP (subjective, objective, assessment, plan) as a useful mnemonic for this structure. Donnelly et al (1992) later modified this framework, offering HOAP: history (what the patient has told us), observations (what we have observed), assessment (our interpretation of these findings) and plan (the management plan).

Wyatt (1994) added patient identifiers and expanded the structure to include actions performed by the health worker (such Pyrimethamine (Daraprim)- FDA therapy initiated) and to combine assessment and plans into hypotheses. Table 1 gives a modified summary of the categories of clinical data proposed by Wyatt. Table 1 Categories of clinical data (after Reference WyattWyatt, Pyrimethamine (Daraprim)- FDA In the authoring of health records, we should use common standards for both recording and communicating information.

To achieve this, health and social care professionals need a common clinical language that includes systems of classification and coding. In classification systems, groups of words or terms are collected together and organised. Each of these terms will be associated with a particular concept. For example, a depressive episode may be mild or moderate and may occur with or Pyrimethamine (Daraprim)- FDA somatic symptoms.

Each concept within a classification system can also be given a numeric or alphanumeric code. The more extensive the coding system, the more detail it can represent.

Therefore a code is simply the numeric or alphanumeric system used to specify a classification or hierarchy. Classification can therefore be used as another way of organising information and can act as a common language between health professionals, Pyrimethamine (Daraprim)- FDA the quality and usefulness of the communication. It Pyrimethamine (Daraprim)- FDA interesting to note that the original purpose of the ICD was to allow the WHO systematically to collect morbidity and mortality data from all over Pyrimethamine (Daraprim)- FDA world for statistical analysis.

Diagnosis-related groups (DRGs) are a system for organising information for use by mental health service managers rather than by clinicians. Their purpose is to produce codes that can be processed for cost analysis, thus enabling resource utilisation to be measured (Reference FiensteinFienstein, 1988).

Further grouping Pyrimethamine (Daraprim)- FDA codes according to such factors as length of stay and age are then made, after which a DRG is generated. A problem with relying on coding alone Pyrimethamine (Daraprim)- FDA communicate clinical information is the size and complexity of the coding system needed to convey sufficient information. Classification systems for clinical use continue to Pyrimethamine (Daraprim)- FDA that attempt to provide the detail of information required by health professionals and to facilitate communication by creating a common language (through standardised organisation of information).

The increasing emphasis on electronic communication in health care in the UK (see below) has resulted in the additional requirement that the information must be in a format amenable to computer processing. Two systems in current use that try to meet Pyrimethamine (Daraprim)- FDA requirements are the Systematized Nomenclature of Human and Veterinary Medicine (SNOMED) and Clinical Terms.

The SNOMED has its origins in Pyrimethamine (Daraprim)- FDA. It is a general medical terminology developed to as glucophage events in the patient record (Reference Cote, Rothwell and PalotayCote et al, 1993).

It is designed to be computer-processable and easily translated into different languages (Reference RothwellRothwell, 1995). Its classification is based on 11 axes, or modules (Box 1), given an alphanumeric code.

Each of the Pyrimethamine (Daraprim)- FDA modules contains thousands of individual descriptive terms. Terms or descriptions are combined from the axes to give a clinical description from a particular code (the combination of qualifiers).

Earlier versions were hierarchical, but this format could be inadequate for reflecting the true clinical picture. Pyrimethamine (Daraprim)- FDA than relying on axes of classification (the branching roots concept), with each la roche grey belonging to a particular Pyrimethamine (Daraprim)- FDA, the latest version allocates a unique code to each concept. Individual terms (words or phrases) describing a particular condition are combined with qualifiers.

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