AU2018101782A4 - Arrangements and processes for an electronic clinical record - Google Patents

Abstract

A method of record management for use in a medical records creation and updating arrangement having two or more records to be made available to the user for review, the method comprising the steps of: obtaining at least two records, displaying the obtained at least two records, maintaining the at least two records, creating a new record, making available the at least two records and the new record to the medical records creations and updating arrangement.

Description

FIELD [0001] The field of the disclosure is in the practical operation of a medical practice and in particular the method and arrangement of the way in which patient records are collected, sorted and saved for future retrieval by the medical practitioner.

BACKGROUND [0002] Medical practitioners are expected to deliver the highest standards of care: they are highly regulated and scrutinised by their peers, the medical professional standards boards, medical care administrators and legal advisors, insurers, and of course their patients.

[0003] It is also expected that regardless of the very real individual responsibility each medical practitioner has towards a patient, the overall care that a patient receives, is the result of a team effort, involving nurses, other medical practitioners, care facility support staff and the administrators of those care facilities (e.g. hospitals, hospices, medical consulting rooms and groups, etc.) and numerous other entities and persons.

[0004] Although not necessarily the primary vehicle for communication between the various members of the team, the written word has an important role to play. By way of non-limiting example, the written word becomes the way in which a medical practitioner communicates: to themselves in the future (by way of creating a medical history of the patient); to a future medical carer of he patient (medical practitioner, nurse, etc.) to provide assistance in the treatment ofthe patient; to define or recommend a medical procedure (involving medication, physical therapy, surgery, etc.); to refer and define the issues to a medical expert in a particular medical field who can assist the further treatment of the patient; to define the prescription of one or more drugs to be prepared and supplied by a pharmacist; and generally contribute to the medical and sometimes psychological well-being ofthe patient by communicating with them and others.

[0005] Therefore, it is integral to the performance of the medical practitioner, to create many of these communications' during or soon after consulting the patient.

[0006] As critically important this step is, there is and continues to be many adverse issues with the process of creating written records that will serve the many purposes required, some of which are described earlier.

2018101782 13 Nov 2018 [0007] The most well-known issue is the legibility of the hand written record of a medical practitioner. Bad writing is often quoted as being the realm of doctors, requiring pharmacists and nurses to either, recognise and decipher the hand written instructions; make and educated guess; or enquire with the medical practitioner to check especially when the matter is critical to the care of the patient.

[0008] The difficulties of others in deciphering a medical practitioner's hand writing is not generally an issue for the practitioner themselves or anyone familiar with that hand writing, since they are used to the script, they can recognise the abbreviations, they can understand the term and the scribble that represents a term, they know the expected order of terms, and they fill in the gaps that the medical practitioner themselves assumes everyone else should know.

[0009] However, studies also indicate that handwritten notes provide a greater cogitative impact on the writer. That is the writer recalls much more when they write information that they have listened to or generated them selves. The latter statement means that the writer is capable of remembering much more of what they have written and the context of what they wrote, than if they merely copied the notes or only created a part of the notes by typing them. The process of creating a medical record can be critical to the quality of the information that is recorded; what it will mean to the writer in the future; and thus the value of hand written information to the creator/writer is well in excess of what is delivered by alternative methods of recording medical information about patients.

[0010] In particular, studies show that typing information is dealt with as a rote exercise lacking in the same cognitive processing as handwriting involves. The typing process is not in most cases, a natural process for medical practitioners and the mental challenge of typing instead of natural writing changes the key thought processes in the mechanics of medical patient record recording.

[0011] However, digital recording of patient records by way of typing is becoming the expected form of recording the patient medical records. The digital form of recordal of the patient medical record is promoted as being: accurate; suitable for safe keeping; easily digitally audited for legal and technical reasons and requirements; easily and securely stored and distributed locally as well as within networks (including externally where required using the Internet); and a means to enforce consistency and repeatability in medical record keeping by using a mix of predetermined/preformatted fields and to in some cases restrict free text fields.

2018101782 13 Nov 2018 [0012] These systems are designed by programmers who are well versed in the technical details of data base entry, database management and information distribution, the administrative needs of such a system, and the legal requirements of the collection and security of what should be considered very sensitive medical information, but programmers are not familiar with the working day of a medical practitioner who is the very human interface between the digital record system and the patient.

[0013] Studies indicate that the majority of digitally created medical records are a copy and paste of prior recorded data with minor amendment, if any. That the spelling errors are maintained; that the information value of the records are marginal when compared with prior hand written records. That the productivity of the medical practitioners with regards the number of medical records produced is reduced by a factor of greater than half because of multiple factors including the slowness of data entry and the laborious nature of the typing of information when their typing skills are poor. That there is a lack of a medical dictionary in the software that is up-to-date and accurate for the required medical terminology, or which is ignorant of medical abbreviation's and capitalisation, which the referenced dictionary then automatically creates an annoying error message. Consequently, the errors which are inadvertently included in the text, because of predictive text, will leave erroneous uncorrected but correctly spelt text and the potentially serious consequences of that incorrect text; with the consequence being that records are often incomplete or simply copies of prior entries that lack important details and can contain incorrect details.

[0014] Indeed, the slow pace of data entry, compulsory fields to fill-in and navigation of the forms, takes up valuable time that the practitioners are not paid for or recognised for, to the extent that working hours are being extended merely to fulfil a thankless and difficult task. The working life of a medical practitioner is being complicated when technology should be improving their lot, which is unfair and a poor utilisation of the skills of the medical practitioner and ultimately a contributor to poorer patient care, despite the best efforts of medical practitioners.

BRIEF DESCRIPTION OF ASPECTS OF THE DISCLOSURE

A method of record management for use in a medical records creation and updating arrangement having two or more records to be made available to the user for review, the method comprising the steps of:

a) Obtaining at least two records

2018101782 13 Nov 2018

b) Displaying the obtained at least two records;

c) Maintaining the at least two records;

d) Creating a new record;

e) Making available the at least two records and the new record to the medical records creations and updating arrangement.

[0015] Throughout this specification and the claims that follow unless the context requires otherwise, the words 'comprise' and 'include' and variations such as 'comprising' and 'including' will be understood to imply the inclusion of a stated integer or group of integers but not the exclusion of any other integer or group of integers.

[0016] The reference to any background or prior art in this specification is not, and should not be taken as, an acknowledgement or any form of suggestion that such background or prior art forms part of the common general knowledge.

[0017] Suggestions and descriptions of other embodiments may be included within the disclosure, but they may not be illustrated in the accompanying figures or features of the disclosure may be shown in the figures but not described in the specification.

[0018] It should be appreciated that the present disclosure can be implemented in numerous ways, including as a process, an apparatus, a system, or a computer readable medium such as a computer readable storage medium or a computer network wherein program instructions are sent over wireless, optical, or electronic communication links. It should be noted that the order of the steps of disclosed processes may be altered within the scope of the disclosure.

[0019] The use of e.g., etc., for instance, in example, and or and grammatically related terms indicate non-exclusive alternatives without limitation, unless otherwise noted. The use of optionally and grammatically related terms means that the subsequently described element, event, feature, or circumstance may or may not be present or occur, and that the description includes instances where said element, event, feature, or circumstance occurs and instances where it does not. The use of attached refers to the fixed, releasable, or integrated association of two or more elements and/or devices. Thus, the term attached includes releasably attaching or fixedly attaching two or more elements and/or devices. The use of diameter refers to the length of a

2018101782 13 Nov 2018 straight line passing from side to side through the center of a body, element, or feature, and does not impart any structural configuration on the body, element, or feature.

[0020] A detailed description of one or more preferred embodiments is provided below along with accompanying figures that illustrate by way of example the implementation of those embodiments. The scope of the disclosure is limited only by the appended claims, and the disclosures encompass numerous alternatives, modifications, and equivalents. For example, numerous specific details are outlined in the following description to provide a thorough understanding of the presented implementations. The present disclosures may be practised according to the claims without some or all of these specific details. For clarity, technical material that is known in the respective technical fields has not been described in detail so that the present disclosure is not unnecessarily obscured.

BRIEF DESCRIPTION OF FIGURES [0021] Figure 1 depicts a prior art arrangement useable by the medical practitioner to access various information sources and record their consultations;

[0022] Figure 2 depicts a pictorial representation of the prior paper based forms being made available in digital form;

[0023] Figure 3 depicts an embodiment of an arrangement useable by the medical practitioner to access various information sources and record their consultations;

[0024] Figure 4 depicts an embodiment of the information entry screen useable by the medical practitioner to access various information sources and record a consultation as well as access to external links;

[0025] Figure 5 depicts the patient demographics made available to the medical practitioner in the screen depicted in Figure 4;

[0026] Figure 6 depicts the data (consulting information to be recorded) input options made available to the medical practitioner as presented in the screen depicted in Figure 4;

[0027] Figure 7 depicts examples of the data input options and possible others made available to the medical practitioner as presented in the screen depicted in Figure 4;

[0028] Figure 8 depicts the location in the screen depicted in Figure 4 of the continuous clinical record for that patient as made available to the medical practitioner;

[0029] Figure 9 depicts examples of a clinical summary of the clinical record that is available and can be updated by the medical practitioner;

[0030] Figure 10 depicts an example screen for automating the synchronisation of patient data with other systems;

2018101782 13 Nov 2018 [0031] Figure 11 depicts the scanned version of a handwritten consultation record, as well as tablet input and free text input;

[0032] Figure 12 depicts the external links that are available for the medical practitioner to access while within the screen depicted in Figure 4;

[0033] Figure 13 depicts a simplified block diagram of some of the components of an embodiment of the arrangement supporting the screen presented in Figure 4;

[0034] Figure 14 depicts a simplified block diagram of the flow of vital information that results from the interaction of each of the human and computer elements of an embodiment of a clinical record arrangement;

[0035] Figure 15 depicts example XML code used to record the consultation record;

[0036] Figure 16 depicts an illustration of the interaction of the various networks of a dispersed medical information and medical image repository with the medical practitioner's office environment; and [0037] Figure 17 depicts an embodiment of the various elements of a clinical record collection and medical records and associated medical information enquiry arrangement.

DETAILED DESCRIPTION OF EMBODIMENTS OF THE DISCLOSURE [0038] Figure 1 depicts a prior art arrangement useable by the medical practitioner to access various information sources and record their consultations. In this example, the medical practitioner 10 is conducting a consultation with a patient llduring which the practitioner will need to review and use one or more of the services 12 to 17 or require the patient to have samples taken at the service provider's location, and have tests conducted to determine the makeup of the sample/s, have a scan of some kind in relation to a particular part of the body, and then the practitioner will need to access the results of those test and scans. Hence, there are a large number of arrows indicating the flow of people movement, and information movement, all centered on the practitioner, who directs which samples are taken and which parts of the patient's body are scanned and then who ultimately reviews the results, which in some cases include an accompanying report from the service provider all of which takes time and sometimes required multiple patient visits to the medical practitioner.

[0039] Central to the process flow is the written communications' which accompany the flow of requests and reports, many of which are generated by the medical practitioner. Computer based form generation is well known and the inputs of patient names, addresses, identification details are in the main obtained from the non-medical electronic patient records (held in the medical practice

2018101782 13 Nov 2018 records system 12) which are extracted and used to auto-fill the majority of the communication. Certain medical information can also be supplied and included by electronic means, but the exact tests and types of scans and where on the patient's body a scan is to be conducted is a case by case detail that is manually provided by the medical practitioner. Typically, the medical practitioner will electronically type those details, since the final form of the communication is to be sent electronically or printed off and sent with the patient to deliver. In many cases, the patient subsequently returns with the results.

[0040] The medical practitioner also needs to make a record of the consultation, and that is typically entered into the medical practice records system 12, which may also require the practitioner to type those details, as is depicted in Figure 2. The electronic records system may include fields to be filled-in and by way of predetermined drop-down selections, tick/cross boxes, and free text input. It is, however, not uncommon for the the quality of the records to fall (that is the faults identified previously to befall the new system) so that although the electronic record is more legible, it soon becomes less-complete when compared to prior record keeping arrangements. This reduction in recorded information is not unusual, mainly because of the resistance of many medical practitioners to do the additional work and the awkwardness they experience using electronic/digital means to enter information, and furthermore the need to open multiple files to review the situation relating to just one patient. Medical practitioners (young and older) will often resort to having a paper based system working in parallel with the electronic medical practice records system. Such manual hand written systems were once the only record types made, stored and retrieved when required but still appear more natural to create in the work flow associated with consulting with a patient.

[0041] Thus as shown at 13 in Figure 1 those hand written records made by the medical practitioner are then manually stored for future reference and updating, relying on the legibility of the records to provide their usefulness to the medical practitioner that made them or to others involved in the care of the particular patient.

[0042] Figure 3 depicts an embodiment of an arrangement 13' useable by the medical practitioner to access various information sources and record their consultations. The embodiment is arranged to accommodate and match the work flow of the practitioner. Thus, for example, if the medical practitioner prefers to write their consultation notes on a piece of paper or note pad, then that is accommodated. If the medical practitioner prefers to use a tablet computer and hand write on its

2018101782 13 Nov 2018 surface, then that is accommodated. If the medical practitioner prefers to dictate their consultation record, then that is accommodated. If the medical practitioner prefers to type then, that is accommodated by the embodiment. The work flow of the practitioner is accommodated by the variety of applications and devices that are compatible with the executable program.

[0043] In one embodiment, there is a program executable on a computer which is additional to that held in the medical practice records system 12. In an embodiment, the program is executable on the medical practice records system 12, and in yet another embodiment the program is executable in a remote server, and a client program is executable on a computer device located next to the medical practitioner. Examples of suitable computer devices include: laptop computer devices; so called tablet computer devices; and in certain configurations even a dumb terminal device controlled by the server. Details of the types of peripheral devices or functions required of the computer device can include a camera, document scanner, electronic hand writing recorder, voice recorder, and associated applications which can transform scanned hand writing, recorded hand writing and recorded voice to text or even store the hand written text and recorded audio. The computer device may also receive and catalogue, store, and make available various files, such as, for example, image files, text files, database files, audio files, and video files. The range of file types not being limited for any particular reason since they will generally be provided by external sources. There exist standardized ways to store the information describing an image in a computer file.

[0044] A medical image data set consists typically of one or more images representing the projection of an anatomical volume onto an image plane (projection or planar imaging), a series of images representing thin slices through a volume (tomographic or multi-slice two-dimensional imaging), a set of data from a volume (volume or three-dimensional imaging), or multiple acquisition of the same tomographic or volume image over time to produce a dynamic series of acquisitions (four-dimensional imaging). The file format describes how the image data are organized inside the image file and how the pixel data should be interpreted by software for the correct loading and visualization. Such file types include but are not limited to Dicom, Analyze, Nifti, and Mine, JPEG, JPEG-LS, JPEG-2000, JPEG-XR and MPEG (numerous varieties).

[0045] Figure 4 depicts an embodiment of an information entry screen useable by the medical practitioner to access various information sources and record a consultation. The screen is generated by the executable program and data entry into the screen is received as input to the

2018101782 13 Nov 2018 executable program. Each part of the screen has a purpose, and each of those purposes is described in greater detail later in this document.

[0046] Figure 5 depicts a representation of the patient demographics made available to the medical practitioner in the screen depicted in Figure 4. In general, this data is made available by the medical practice records system 12 (Figure 3) to the program executing the information entry screen processes. The fields are populated with, in this embodiment, the Surname and First name of the patient; their Identification number within the medical practice records (or it may be a universal patient identification code) of that patient; the Sex and Date Of Birth (DOB) of the patient; the date of the consultation; the time of day of the consultation; the name or an Identification of the medical practitioner conducting the consultation and entering the consultation record; and the version of the executable program (this latter information could be hidden and included in associated metadata not seen by the user).

[0047] Figure 6 depicts the data (consulting information to be recorded) input options made available to the medical practitioner as presented in the screen depicted in Figure 4. The options provided are considered to be the most popular, but others may be made available as alternatives or additional to those indicated in this embodiment. The Free Text option allows for typed text to be used; the Template option provides for a predetermined array of fields to be provided, some of which can be prefilled, others to be filled-in by way of typed text, pull down menu options, etc.; the scan option allows for a hand written page to be input via an associated peripheral device, such as one of those described previously, but typically a single of multi-page scanner; the Dictate option allows for an audio recording to be made and saved, or converted to text, etc.; the tablet option provides for hand written text or typed text or an audio file to be provided from a handheld computer device; the letter only option allows for a pre-formatted letter to be filled-in, including Attention To addressing, and free text or pull-down options to complete a letter to a medical specialist, a imaging service, a testing service, another medical practitioner, etc.; and a request for an eCR (electronic Clinical Record) summary to be provided from a source of such information, which may be obtained from an external database or from locally held information in the medical practice records system 12 (Figure 3). Figure 7 depicts pictorial examples of the data input options made available to the medical practitioner as presented in the screen depicted in Figure 6 and described above.

2018101782 13 Nov 2018 [0048] Figure 8 depicts the location on the screen depicted in Figure 4 of the continuous clinical record for that patient as made available to the medical practitioner. Figure 9 depicts examples of the continuous clinical record for that patient as made available to the medical practitioner. A linear array of documents that make up the medical record can be used to quickly scan them, to choose one or more of them and expand them for closer review. The linear array can be ordered but is generally most usefully arrayed in date/time order, but there could be a re-arrangement according to a tag/classification system, where like documents are grouped, so for example, all test reports, or all test reports from a particular supplier, or reports from a particular medical specialist, or documents that contain a particular term, of documents that are classified, as being classified or unclassified, or earlier versions when an audit trail is available, etc. Even the way in which the documents are displayed, such as cascading them to allow quick visual review of some of their content by the busy medical practitioner, is superior to having to individually completely open multiple documents one after the other, typically vainly looking for the relevant document. A computer software tool usable to query the one or many databases that contain the documents or a document filing system can include the use of Structured Query Language (SQL) or any suitable searching tool depending on the structure of the file type.

[0049] Whenever a change of a document is made, then the sorting of the list will take into account the date and time of update.

[0050] Figure 10 depicts an example screen for automating the synchronization of patient data with other systems such that it is possible to synchronise documents in external records, so that the information contained in disparate locations or stored separately, are maintained in a manner that is useful for all the users of those documents, even if the change is only to summary information which provides a link to a source document that contains relevant detailed information. The type of summary information is understandably going never to be complete and cover all situations regarding patient ailments, but the breadth is changeable and can be arranged to suit the particular environment, for example, as may be encountered with the difference between a psychological/psychiatric treatment environment to that of a purely medical treatment environment.

[0051] The process of data synchronisation with external health care summaries, using any of XML, HL7, SQL, FHIR or other data interchange language.

2018101782 13 Nov 2018 [0052] XML is an extensible Markup Language that defines a set of rules for encoding documents in a format that is both human-readable and machine-readable.

[0053] Health Level-7 or HL7 refers to a set of international standards for the transfer of clinical and administrative data between software applications used by various healthcare providers. These standards focus on the known computer application layer, which is layer 7 in the OSI model. The HL7 standards are produced by the Health Level Seven International which is an international standards organization. The HL7 standard has been adopted by other standards issuing bodies such as the American National Standards Institute and International Organization for Standardization. Hospitals and other healthcare provider organisations typically have many different computer systems used for everything from billing records to patient tracking. All of these systems should be able to communicate with each other (or interface) when they receive new information, or when they wish to retrieve information, but not all do so hence the increasing use of standards. The HL7 International standard specifies the number of flexible standards, guidelines, and methodologies by which various healthcare systems can communicate with each other. Such guidelines or data standards are a set of rules that allow information to be shared and processed in a uniform and consistent manner. These data standards are meant to allow healthcare organisations to easily share clinical information. Theoretically, this ability to exchange information should help to minimise the tendency for medical care to be geographically isolated and highly variable.

[0054] FHIR (Fast Healthcare Interoperability Resources (pronounced fire) is another option for information exchange which is attempting to be an interoperable healthcare system standard for exchanging information between separate healthcare systems. At this time it is a draft standard describing data formats and elements (known as resources) and an application programming interface (API) for exchanging electronic health records. The standard was created by the Health Level Seven International (HL7) health-care standards organization. FHIR builds on previous data format standards from HL7, like HL7 version 2.x and HL7 version 3.x., moreover, intended to be easier to implement, because it uses a web-based suite of API technology, including an HTTP-based RESTful protocol, HTML and Cascading Style Sheets for user interface integration, a choice of JSON or XML for data representation, and Atom for results. One of the FHIR goals is to facilitate interoperation between legacy health care systems, to make it easy to provide health care information to health care providers and individuals on a wide variety of devices from computers to tablets to cell phones, and to allow third-party application developers to provide medical

2018101782 13 Nov 2018 applications which can be easily integrated into existing systems. FHIR provides an alternative to document-centric approaches by directly exposing discrete data elements as services.

[0055] XDS-I is a reference to a registry file format useable in the field of electronic health records (EHR), Cross Enterprise Document Sharing (XDS) and there exist a system of standards for cataloguing and sharing patient records across health institutions. XDS provides a registry for querying which patient records are in an Electronic Health Record (EHR) repository and methods for retrieving the documents. The XDS system of registry and repository is termed an integration profile and was created by Integrating the Healthcare Enterprise. XDS uses structured EHR standards such as Continuity of Care Record (CCR) and Clinical Data Architecture (CDA) to facilitate data exchange. The registry stores metadata about each document stored in a repository, including its source or location. There may be multiple repositories of documents indexed, but only one registry per clinical domain. XDS provides a Patient Identity Service for cross-referencing patients across multiple domains. Conceptually, patient health record data is classified as Longitudinal Records (EHR-LR) and Care Records (EHR-CR). Longitudinal records describe the basic patient health data across clinics and over the lifetime of the patient. Care records describe specific clinical data contained within a clinical domain. There have also been XDS standards XDS-I and XDS-b developed for electronic imaging records. The extensive use of XDS-1 in the radiology and pathology environments ensures compatibility with the seamless sourcing of information from those environments.

[0056] Figure 11 depicts the scanned version of a handwritten consultation record, as well as tablet input and free text input. As chaotic and as illegible as the writing may seem to anyone other than the writer, the volume of information and recall capability of that person required to review their hand written record is still far superior to the typed text forced in systems that only provide for such input. Indeed, skilled medical practitioners are so familiar with text and pattern recognition when dealing with medical terms, symbols and abbreviations the level of recognition is higher for that subgroup than a person not skilled in such matters.

[0057] The information being communicated in the hand writing example of a clinical note by the medical practitioner provided in Figure 11 is as follows:

[0058] Upper Screen

Deltoid tick degrees ER

2018101782 13 Nov 2018

Plan CT

See one 1/52

This would be interpreted by the actual practitioner making the note and by most colleagues as:

• deltoid muscle functioning and contracting normally.

• Shoulder exhibits 30 degrees of external rotation on examination • The plan is to order a CT scan of the shoulder • Review patient in one week.

[0059] Lower Screen

This is a nondescript graphics capture from a writing tablet, showing a stick figure and an arrow indicating the area of pain. The example text is attended today with more pain - operate [0060] The continuous medical record is searchable by way of text searching, tabs, bookmarks, and many other automatically created and manually created search tags using simple search tools, and the records (one or groups of them) are exportable in a pre-selected format (for example PDF format) or a format chosen from a drop-down list of pre-selected formats.

[0061] Regardless of the method of information input used by the medical practitioner, there is, in an embodiment, a saving locally and/or remotely, of the two previous (date/time measure) clinical records, so as to prevent data loss should the program or memory failure (crash) on the local or remote devices during updating of the record/s by the medical practitioner. As a document needs to be opened as part of the process of creating additional clinical data, that means that the file or files being worked on could be corrupted or lost, if there is a software, hardware failure (crash), or power outage before a manual or timed save step is initiated and completed. By retaining two previous versions, only the latest additions to the working copy will be lost. This approach is also useful when considering the medical professional liability processes that require the utmost care with the content of consultation records as file integrity, and file security can also be dealt with by hashing and encryption as required.

[0062] Figure 12 depicts the external links that are available for the medical practitioner to access while within the screen depicted in Figure 4. In accord with the needs of the one more standards and protocols described by way of example earlier in this document, as well as any security protocols, access can be made for the purpose of updating an existing file, synchronizing with an existing file, creating a new entry in another system [eCR], obtaining a summary from another file or system

2018101782 13 Nov 2018 [Documents], obtaining a file, such as: a radiology scan [Radiology]), a test result [Pathology], or one or more of many other types of information useful in the consultation work flow of a medical practitioner. There can also be a need to conduct searches of one or more databases external to the local clinical records system, s search and search clear function is available.

[0063] Figure 13 depicts a simplified block diagram of some of the components of an embodiment of the arrangement supporting the screen presented in Figure 4, the mechanism behind them having been described previously in this document. The meaning of some of the titled boxes in this diagram has not been described, such as the My Health Record, which is a Clinical Information System is used by a healthcare provider to manage patient and practice records. It may include a software component connected to the My Health Record system. A healthcare organization that is participating in the My Health Record system is required to comply with a range of obligations set out under legislation relating to records (what, how and why they are made and kept, destroyed and who can access them); rules associated with the steps described, and regulations for administration of the oversight of the systems, entities and persons involved.

[0064] Figure 14 depicts a simplified block diagram of the flow of vital information and the patient that results from the interaction of each of the human and computer elements of an embodiment of a clinical record arrangement. The patient is the reason all else exists, and their flow through the consulting process begins when they converse with the medical practice receptionist who has organised the availability of the medical practitioner and ensured that the time of attendance is suitable. The Receptionist will ensure that the relevant information is up-to-date in the medical practice management system and that the patient is comfortable while waiting for the medical practitioner. The medical practitioner is the recipient of all relevant information, and their work flow is assisted if the record collection and information enquiry system do not hinder their task/s. In the embodiment or embodiments described herein, the arrangement and the various functions are usable to adapt to the workflow used by the medical practitioner. If the outcome of a smooth workflow for the medical practitioner is the ability to have them consult more patients, particularly be less stress and time poor due and at the same time maintain a more accurate and expansive record of the patient consultation, and also more easily interact with other medical professionals and information sources.

[0065] Figure 15 depicts an example of the form of code (in this embodiment using XML coding language) used to record the patient data while being capable of integration of the functionality of

2018101782 13 Nov 2018 importing image data from remote databases for display of clinical information to facilitate the efficient delivery care to the patient.

[0066] Figure 16 depicts an embodiment of the various elements of the potential to incorporate the provision of central management and registration of patient diagnostic imaging to provide and allow access for suitably authorized practitioners to review the critical diagnostic imaging information for the benefit of patient care which may have been ordered and conducted by a variety of diagnostic imaging health care providers. Many of the required file exchange standards are described in this document, and the automation of that access and presentation adds to the convenience for the medical practitioner and thus more readily assists rather than hinders their work flow when consulting with a patient.

[0067] Figure 17 depicts the central focus of the workings of the application being the workflow of the medical practitioner, which allows them to primarily interact with the patient. This focus is provided by providing a single interactive application that seamlessly accesses critical clinical record data, diagnostic information (both radiological and pathology), as well primary practitioner referral details, previous communications and records, a wide variety of other data in a form that facilitates truly interactive patient care and consultation. The described embodiments provide tools and access to information to ensure patient care that is not disrupted by data centric systems requiring more attention and care to use than the patient, and thus the embodiments described are usable within the workflow environment of the medical practitioner providing patient care and treatment.

Claims (1)

1. Provisional claim

   1. A method of record management for use in a medical records creation and updating arrangement having two or more records to be made available to the user for review, the method comprising the steps of:

   f) Obtaining at least two records

   g) Displaying the obtained at least two records;

   h) Maintaining the at least two records;

   i) Creating a new record;

   j) Making available the at least two records and the new record to the medical records creations and updating arrangement.