How to choose a general practice computing system: comparison of commercial packages.

Abstract

Correspondence to: Angela Coulter. General practitioners who consider computerising their patients' records are faced with a bewildering array of software systems from which to choose. The availability of independent advice and guidance on computer systems for general practitioners varies from region to region but on the whole is fairly poor. The Oxford community health project has developed experience in providing advice and training for general practitioners in the Oxford region on buying and using microcomputer systems in their practices. We describe how we obtained information on various systems and the facilities available in them. The Oxford community health project has been a pioneer in promoting computing in general practice since it was established in 1970 as a collaborative venture between Oxford University's unit of clinical epidemiology and Oxford Regional Health Authority. The project was originally established to provide support to about 40 practices using the regional computer unit's mainframe and to undertake collabo? rative research in general practice. The mainframe service, which is still used by 23 practices, provides facilities for registering patients, recall, and listing records of patients with chronic diseases or other problems.1 Over the past five years several practices partici? pating in the project have chosen the added advantages of on line computer time?for example, five practices shared an Alpha Micro system running British Medical Data Systems software,2 3 and others bought their own systems. In response to the growing demand for advice on microcomputing in the Oxford region the project has widened its scope to provide advice on the facilities of microcomputers and information systems in primary care. A priority was to develop a source of information on the systems available for general practitioners. The first step in compiling the fist of specialist systems and the facilities that they offered was to search reports on computing in general practice. By this means we identified 41 systems marketed by 40 suppliers that were or had been on the market in the past five years. All firms were contacted by letter and asked to provide information on their systems to help in the task of advising general practitioners. From the information received we constructed a chart to show the facilities each claimed to provide. We returned a copy of our interpretation of the system to each supplier with a request for comments, amendments, and corrections as well as details of any planned changes. We asked the suppliers to provide prices for two systems: a single user system with one printer and a 20 megabyte hard disk, and a multiuser system with four screens and four printers and a 40 megabyte hard disk. We also asked how many systems they had installed and in which areas; and whether they could install and support systems in the Oxford region. The systems We received replies from 17 suppliers. Fourteen of these were suppliers of current systems; the three others did meet the criteria for inclusion in this report (combined hardware and software packages available throughout the United Kingdom). Five systems were no longer marketed, although they may still be in use in practices. Four letters were returned by the Post Office marked not known at this and the remaining 15 companies did reply. All systems have a database that can hold such information as each patient's name, address, and title, date of birth, age, and sex. Once this information is recorded it is easy to institute call and recall systems and to compile registers of particular groups of patients. In addition, some systems offer the facility to record details of consultations, risk factors, social and medical problems, and diagnoses. Many systems can be used for prescribing and dispensing and for administrative purposes such as making appointments, doing accounts, and word processing. Some offer the addi? tional facilities of audit and analysis of the practice activities. All of the systems are protected by pass? words to ensure security of the data. Some of the main functions available in the different systems are described below. The table gives a summary of the information that we collected.