6th European Conference - Academic Conferences

Shada Alsalamah et al.
for Health Improvement and Audit Commission (CHIAC) (2001) revealed audit and anecdotal
evidence of problems in inter-professional communication and a failure to plan care in a systematic
way between the different professionals involved. Such problems have been linked with complaints
and litigation (NICE, 2002). For example, GPs sometimes lose track of patients during the treatment
period or become unable to discuss the diagnosis and prognosis with patients due to lack of
information from consultants. Furthermore, primary personnel can be unaware that a patient has been
discharged, sometimes without necessary services or equipment being arranged. It can be unclear
whether the GP or consultant is responsible for patient follow-up after treatment. Furthermore, the
HISs are poor in their support of day to day working arrangements, including communication,
appointment systems and shared protocols (CHIAC, 2001). Indeed, even if the care team is ready to
share medical information (CHIAC, 2001), the current HISs are not supporting this sharing of
information (CHIAC, 2001; Skilton et al., 2009). Finally, although many trusts do not have agreed
policies for the management of cancers, where policies do exist, it is unclear whether they are
followed because practice is not audited (CHIAC, 2001). Furthermore, formal policies and plans
cannot ensure that services are provided in a patient-centred way, without a change in the attitudes
and behaviour of those working with patients (CHIAC, 2001).
5. Discussion and future work
These results identify the different roles of MDT members involved in the treatment of patients with
breast cancer in Wales, the HISs involved, the types of health records created in these systems, and
medical information stored in these different records. This information helped the development of an
understanding of the emerging need for the SCE for MDT members involved in treating patients with
breast cancer. For example, some of the tasks carried out as the patient proceeds through the breast
cancer’s ICP show a clear redundancy in some of the information collected, including, but not limited
to, a clinical assessment and patient history check. It can save time and resources if this information
was available for the healthcare professional in charge at the point of treatment. In addition, data
redundancy can cause data inconsistency issues and having a single shared data record (i.e. patient
history) guarantees the availability of up-to-date information for all MDT members. Another example is
that GPs should support patients undergoing diagnosis, treatment and follow-up leading either to cure
or to eventual death. This means GPs should follow patients from the very start of the ICP. Although
patients may start their ICP at different stages, the GP should have direct contact with other breast
cancer MDT members treating the patient in order to be informed about all of the patient’s current
relevant medical information at all times. This would enable effective consultation and follow-up. In
addition, there can be different professionals playing the same role and also one professional playing
different roles. Furthermore, privacy violations can be expected if all of the members can see every
patient’s records (Anderson, 2008). This emphasises the need for effective SCE with systems that
can ensure the availability of life-critical information about the patient’s medical condition based on the
professional’s role at the time of treatment. Also, the breast cancer MDT checks 100 patients
annually. Each of these patients will be following different directions in the same ICP, and in some
cases, following multiple ICPs as well, if the patient suffers from more than one disease. This will be
difficult to manage without the support of an HIS that considers the patient condition as a whole.
Therefore, good inter-professional communication is essential to co-ordinate the activities of all those
involved, and ensure effective communication between professionals working in the primary,
secondary and tertiary sectors of care. For that reason, the breast care MDT must develop and
implement systems that ensure rapid and effective communication between all healthcare
professionals involved in each patient’s treatment management. This would facilitate the provision of
adequate means for communicating information on referral, diagnosis and treatment, follow-up, and
supportive/palliative care throughout the stages of the ICP.
The HISs identified in this research can be studied to identify the IS issues in these systems that
hinder inter-professional communication. This can be achieved by investigating the IS rules applied in
these HISs to protect medical information. This is an important step to take before speaking to all
involved parties in order to know their IS needs to facilitate the SCE with others involved in the
treatment. This can help identify and define the best way to have persistent control over the
information accessed in a distributed environment when it will be moved outside the HIS’s locally
controlled environment. This can be achieved either by agreeing on a set of common rules for all
involved HISs to apply in a neutral administrative domain used for the sharing process, or by
changing the way they work internally by standardising the IS rules. It may be that sharing in either of
these ways is not possible at this point in time. The main aim of this research at the moment is to
facilitate an SCE that can support collaboration among MDT members while guaranteeing persistent
283