This paper describes, from a practitioner’s point of view, the concepts, methods and tools involved in the design of a practical and potentially low cost distributed information system, with web-based capabilities, for monitoring glaucoma.
Our experience with existing Hospital Information Systems (HISs) found them unsuitable in the very important monitoring process of patients with glaucoma. Actual Electronic Patient Record (EPR) schemes are more to do with management and appointment simple aspects than with clinical and decision-making processes. In a closer relationship to the specific of the affection, we found that demographic patient databases, usually known as Patient Administration Systems (PASs), have not been designed for being shared or concurrently exploited by different programs or even several replicas of the same program.
Many of the early deficiencies in the process of following-up glaucoma patients by dozens of different ophthalmologists in many independent offices from different clinics (with heterogeneous information recording, not very well managed by the existing office capabilities) could only be solved by specifying, designing and implementing a new EPR scheme in a mixed distributed environment, based on a distributed database as a demographic core (or PAS) of patients with glaucoma. A specialized health record management system, with core functionality in monitoring glaucoma, and core data organized as a distributed database system, has been designed in a bottom-up manner to meet the immediate needs. Its pilot implementation was intentionally kept flexible, taking in account developing standards, to accommodate any anticipated future requirements. Among many other benefits, the new EPR allowed medical doctors (ophthalmologists) to view and modify patient information and records in a safe, flexible and efficient manner. Improvements in all the managerial and decisional aspects (regarding costs and time delays) could also be remarked rapidly.