Doctor's Research gets a Boost

Patients' case histories used to be a closed book for the Wakefield Orthopedic Clinic in South Australia, but several years ago an orthopedic surgeon installed ISYS and everything changed. Using ISYS, the clinic has developed an effective way to perform comprehensive research and audits on the clinical records of the thousands of patients that come through the door each year, without compromising their usual way of recording information or coding results.

The clinic started saving their patient records in Word documents in 1991 and they have been running ISYS since 1994. In that time, they have collected records for over 40,000 patients. Doctors at the clinic regularly engage in research on issues related to orthopedics, and often have guest researchers attend the clinic for a while. "ISYS is wonderful for research," said Dr. Peter Dobson, a surgeon at the clinic. "It makes retrospective research easy and draws many more results in a lot less time than more conventional methods."

As an example, Dr. Dobson cites a medical student doing a small project who was trying to look up all patients with a certain unusual condition. "We suggested that he use our database, but also recommended that he use the Royal Adelaide Hospital database as well as the Women's & Children's Hospital database," said Dr. Dobson.

"The results were astounding," said Dr. Dobson. After going through a considerable amount of hassle and obtaining ethical approval to use the database in the Public Hospital system and looking for the particular condition, the public hospitals were unable to find a single patient that matched that condition. In the Wakefield Clinic's database, ISYS picked out about 250 patients in a few seconds.

Dr Dobson suggests that one of the reasons for the difference in results is that public hospitals have to code diagnoses in order to be able to find them again. With time restraints and cost issues, the hospitals tend to only code conditions that they consider most important, or that will be required to substantiate funding requests.

"The beauty of the ISYS system is that the doctor doesn't need to change his habits," said Dr. Dobson. "You can dictate your letter and dictate your notes as you ordinarily would. The typist types them up and then ISYS adds them to your database."

ISYS works so well because it provides the staff at the clinic with unlimited applications for their information. There is no limit to what can be searched and what knowledge can be accessed. "With ISYS, you can find anything you need and you're not restricted to predetermined fielded or coded searches."

Most coding and database systems are designed for prospective research. A doctor decides on a research project and designs a way of collecting relevant information. It could take five years or so before results start to become useful and often at the end of that time additional factors emerge that could impact the results, but the database hasn't collected any data on those factors, so the project has three options - to start again, to admit its limitations or to stop entirely.

This process also requires forethought about what a doctor anticipates he/she will be researching. With ISYS, because all patient information is in the one place and you have access to all the details, research can be spur-of-the-moment or analysis can be started as soon as an issue becomes evident. "As an example," said Dr. Dobson, "Lets say we get a case of a neck injury from a game of football and it seems that we've had a lot of them recently. A simple search on neck and football with ISYS will tell us how many of those injuries we've had since 1991 and we can easily start to see if they have increased dramatically in the past year. If such a thing were to happen, it might be important to make this information available to the sporting body and start widening our research."

"ISYS is perfect for retrospective research. All our clinical reports contain case histories; operation details and complication notes, all in standard Word documents. When we index these reports with ISYS, we can search the last five years for a word, disease, age or anything else and get immediate findings."

The second way that Dr. Dobson and his colleagues use ISYS is for auditing. Increasingly, doctors are required to audit and report on all aspects of their performance and their patients' clinical information. This is called a peer audit and ultimately, doctors will need to provide these reports regularly in order to be recertified.

The audit involves presenting all sorts of statistics on their patients' age groups, types of injuries, operations and complications. It is important information in identifying trends and medical issues within the community. It is also used as an indication of whether a doctor is performing well enough and regularly enough to continue practicing. "This type of credentialing is becoming increasingly important," said Dr. Dobson. "More and more doctors are going to need a system in place that will provide them with this data regularly and easily, without increasing work loads."

Dr. Dobson created his own system to categorize the information in the Word documents that didn't impact on his way of recording this information, (via dictation) or adversely affect the benefit of full text search provided by ISYS.
ISYS is very effective in the auditing process. With Dr Dobson's identifiers, the clinic can quickly pull up a category for all patients within any calendar period.

The doctors at Wakefield Clinic find ISYS extremely beneficial to their patient record keeping, research and audits. "I've made converts of many of our visiting doctors," said Dr. Dobson. "ISYS is so easy to use and so much more effective than other available methods."