My vision for Clinical Genetics database software; or, why can’t paperlessclinicalgenetics be more like an iPhone?

I well remember Steve Jobs holding up the new iPhone in front of his adoring audience in January, 2007.  The presentation he gave is a masterpiece and well worth another look.  

The iPhone is a masterpiece too, and also worth another look: 

A big part of the design genius, IMHO, is the fact that no matter which application you wish to use, the way of accessing it is always the same.  You locate the icon; tap on it with your finger; and internet, email, texting, photos, notes apps, calculators, iPods, calendars, weather forecasts, angry birds or whatever open up before you. What could be simpler than that?

Here are some ‘applications’ that feature in the world of the clinical geneticist: 
  • patient demographic data, contact details etc
  • referral letters
  • the much-beloved pedigree (see my post of February 14th)
  • record of clinic bookings
  • hand-written clinic notes
  • correspondence
  • consent forms
  • genetic test results
  • other laboratory results
  • X-ray pictures and reports
  • clinical photographs
  • relevant articles from literature
  • and so on
The picture below attempts to display my vision for a fully iPhone-ed up Clinical Genetics database software <sigh>.   You get to all of these places by a single touch or mouse click. The bits in red at the bottom of each icon show how that particular function is accessed currently in our department.  We already have an attempt at an electronic patient record in our department, through a database software called Trakgene.

OK, it lacks the style of an iPhone, but still: how much better would it be if all of these information sources were accessed in exactly the same way, like an iPhone, by a single mouse click or stylus touch?  Currently, the information is in lots of different places, and accessing them in their separate ways is a serious pain. For example, handwritten clinical notes, genetic test results and individual hospital records are all in paper files.  I wrote about pedigrees last month. Clinic bookings are currently stored in no fewer than three places:  the ePR, the main hospital system called PAS, and in a paper diary. And so on.  It’s a little messy, isn’t it?  

My vision for the whole process is as follows:  We take our tablets with us to the clinic, from which direct access to the database is of course available.  The referral letter is reviewed electronically.  The pedigree is viewed, edited and saved electronically and in realtime (see previous post here).  Access to the individual patient hospital file is likewise available electronically.  The handwritten clinical notes are made with tablet and stylus, using NotesPlus or something similar.  New clinic sheets are automatically pre-populated with the patient’s name and date of birth,  and the clinic location, together with the date.  The clinical photographs are taken with the tablet, naturally, and are saved directly to the correct location within the database.  Pre-populated consent forms for clinical photography and genetic testing are likewise accessed from the database.  They are completed by the clinician, signed by the patient using tablet and stylus, and saved directly back.  The genetic test request forms likewise (do they have to be printed?). Back in the office, images can be accessed directly from the database without need for logging on to a separate system.  Relevant journal articles can be saved directly to relevant patient’s location within the database.

One point about these disparate information sources, all accessed independently, is that all (or most of them) require separate usernames and passwords. Just to get onto my laptop I have to enter two passwords.  I have to enter two more passwords to get onto Trakgene.  I enter a password to access email.  Further password for accessing the imaging software system, PACS.  Password for individual hospital eNotes. Password for laboratory data.  Passwords to access journals.  Yes, it’s fair to say that we all spend a lot of time entering passwords.  Could we do a bit of iPhone-style integration and cut the number down?  We might visit more places if we didn’t have to go through so much security.

I know fixing all this is hard and expensive.  But really, nothing that I have suggested actually requires the development of any new technology. It’s all out there already, and just needs to be brought together.   Steve Jobs has already shown us what we need. All we have to do is copy it.  
Categories: Blog.


  1. Hi Charles; at least some of the cross platform password functionality you mention is currently brought together in the Northern Ireland Electronic Care Record (NIECR) which is based on Concerto by Orion Software. At present the NI system is read-only, but we're working to extend its functionality. It brings appointments, clinical letters (read), labs, PACS (currently reports only, but images to come) together to a single portal, operating regionally across Northern Ireland. Although all these systems are available singly, this dramatically speeds up access, allows better monitoring and security, and improves the sheer value the patient gets from the consultation.

    However you make some great points; we need easy access systems which allow us to record information in clinic and then have that available for whatever use we need to put it to. My view is that we should not shackle ourselves to trying to replicate the entire paper notes experience in silico. Paper notes suck, not just because they're paper, but in terms of the structure they impose also. So let's use the potential of electronic records to redesign the clinic experience (and sometimes even do away with it altogether!). These are great ideas; I'm going to see if we can get some more engagement by tweeting links to your blog; hopefully we'll get some more folks coming on over 🙂

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