A patient information system for mental healthcare:
A patient information system to support mental healthcare, (the Mentcare system), is a medical
information system that maintains information about patients suffering from mental health problems
and the treatments that they have received. Most mental health patients do not require dedicated
hospital treatment but need to attend specialist clinics regularly where they can meet a doctor who has
detailed knowledge of their problems. To make it easier for patients to attend, these clinics are not just
run in hospitals. They may also be held in local medical practices or community centers.
The Mentcare system (see below):
This is a system that is intended for use in clinics. It makes use of a centralized database of patient
information but has also been designed to run on a laptop, so that it may be accessed and used from
sites that do not have secure network connectivity When the local systems have secure network access,
they use patient information in the database, but they can download and use local copies of patient
records when they are disconnected. The system is not a complete medical records system and does not
maintain information about other medical conditions – however, it may interact and exchange data with
other clinical systems.
The system has two purposes:
1. To generate management information that allows health service managers to assess
performance against local and government targets.
2. To provide medical staff with timely information to support the treatment of patients.
Patients who suffer from mental health problems are sometimes irrational and disorganized so they
may miss appointments, deliberately or accidentally lose prescriptions and medication, forget
instructions and make unreasonable demands on medical staff. They may drop in on clinics
unexpectedly. In a minority of cases, they are a danger to themselves or to other people. They may
regularly change address or may be homeless on a long-term or short-term basis. Where patients are
dangerous, they may need to be “sectioned” or confined to a secure hospital for treatment and
Users of the system include clinical staff such as doctors, nurses and health visitors. Nonmedical users
include receptionists who make appointments, maintain records, and other administrative staff.
The system is used to record information about patients (name, address, age, next of kin, etc.)
Consultations (date, doctor seen, subjective impressions of the patient), conditions, and treatment.
Reports are generated at regular intervals for medical staff and health authority managers. Typically,
reports for medical staff focus on information about individual patients, whereas management reports
are anonymized and are concerned with conditions, cost of treatment, etc.
Key features of the system:
1. Individual care management. Clinicians can create records for patients, edit the information in
the system, view patient history, and so on. The system supports data summaries so that
doctors who have not previously met a patient can quickly learn about the key problems and
treatments that have been applied.
2. Patient monitoring. The system regularly monitors the records of patients that are involved in
treatment and issues warnings if potential problems are detected. Therefore, if a patient has
not seen a doctor for some time, a warning may be issued. One of the most essential elements
of monitoring in the system is to keep track of patients who have been sectioned and to
ensure legally required checks are carried out correspondingly.
3. Administrative reporting. The system generates monthly management reports showing the
number of patients treated at each clinic, the number of patients who have entered and left
the care system, the number of patients sectioned and the number of drugs prescribed and
their costs, etc.
Two different laws affect the system: the laws on data protection that govern the confidentiality of
personal information and mental health laws that govern the compulsory detection of patients deemed
to be a danger to themselves or others. Mental health is unique in this respect as it is the only medical
specialty that can recommend the detention of patients against their will. This is subject to strict
legislative safeguards. One aim of the Mentcare system is to ensure that staff always act in accordance
with the law and their decisions are recorded for judicial review if necessary.
As with all medical systems, privacy is a critical system requirement. It is essential that patient
information is confidential and is never disclosed to anyone apart from authorized medical staff and the
patient themselves. The Mentcare system is also a safety-critical system, meaning that some mental
illnesses cause patients to become suicidal or a danger to themselves or others; when possible the
system will warn medical staff about potentially suicidal or dangerous patients.
The overall design of the system must consider privacy and safety requirements. The system must also
be available when needed – otherwise safety may be comprised and it may be impossible to prescribe
the correct medications. There is a potential conflict – privacy is easiest to maintain when there is only a
single copy of system data, however, to ensure availability in the event of server failure or when
disconnected from a network, multiple copies of the data should be maintained.
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