Northern Ireland – Regional Electronic Patient Record for Diabetes

Northern Ireland has approximately 40,000 people who have been diagnosed with diabetes and it is estimated that a further 25,000 people are as yet undiagnosed.

The Ulster community and hospitals National Health Service (NHS) trust established a diabetes forum in Belfast, Northern Ireland in 1998. The primary objective of the forum was to advance patient care through the development of a fully integrated district wide diabetes care network. The district wide diabetes service covers 60 General Practioners (GPs) surgeries (most of which provide dedicated diabetes clinics) and four hospital/community based general diabetes clinics each week. In addition there is a weekly specialist diabetes pregnancy clinic and a monthly adolescent/young adult diabetes clinic. The service is supported by a Network diabetes facilitator, hospital and community based diabetes specialist Nurses, Dieticians, Podiatrists, Pharmacists, a Retinal screening service and a Clinical Psychologist. In order to achieve comprehensive care management, the district wide diabetes service was required to regularly collect and maintain patient data, and to share information with all appropriate healthcare professionals at all levels, working towards the establishment of a comprehensive diabetes patient register.

The rising prevalence of diabetes in the population and the increased complexity of patient care management, presented clinicians and healthcare managers in Northern Ireland with a serious challenge in the delivery and planning of care services. Dr Roy Harper (Consultant Diabetologist) was a key member of the multidisciplinary working group responsible for commissioning DIAMOND (a Hicom Technology system) into the Ulster Hospital in 1999. Dr Harper was convinced that the provision of effective care across a large patient population (catchment of 270,000 people) would be significantly enhanced when supported by a comprehensive, robust clinical information system. However, it was emphasised at an early stage that any such system would have to be configured so as to be complimentary to the clinical process and must not become an administrative burden to busy clinicians.

The rationale underpinning this view was based in the belief that clinicians can make better decisions on patient care when they have all the relevant information easily available to them at the point of care.

The first step included the installation of DIAMOND as a clinical information system followed by the transference of historic data into DIAMOND from an existing legacy system. The next phase saw the development of electronic data interfaces with the hospital’s patient administration system (PAS) and pathology systems enabling information relevant to patients with diabetes to be automatically uploaded into DIAMOND. Once full integration within the hospital environment was achieved the next objective was to roll-out DIAMOND to community and primary Care services, thereby expanding the system into a fully inclusive local register.