The main goal of the PROtocols for Medical Procedures and Therapies (PROMPT) project was to develop the components of a clinical care station (centred on electronic patient record and decision support technologies) in order to provide relevant and timely support for clinical decision making at the point of care.
Most western countries are having to undertake major restructuring of their health-care systems to achieve more effective and efficient provision for their citizens. Computers are at the heart of these changes. Computers are already widespread in the healthcare sector but currently offer mainly administrative support. Developments in health services will see the introduction of clinical systems to provide vital components of the clinical infrastructure, helping hospitals and community health centres, pharmacies and laboratories to work together more effectively. These technologies include intra/extranets, electronic medical records and guideline-based clinical decision support systems. Electronic guidelines and protocols are increasingly being recognised as the means by which best practice can be translated into effective routine health-care, thereby improving consistency and quality of care and reducing costs. PROMPT technologies, centred on guideline-based decision support, electronic patient record and health care network technologies are one means of realising these changes.
PROMPT technologies, largely based on prototypes built in the EU Third Framework DILEMMA project, form the components of an integrated care station: multimedia electronic patient record, decision and protocol support software, multimedia knowledge reference systems and telematics communications technologies. The care station is designed for use by the full range of health professionals in different clinical settings, principally primary care, shared care and specialist inpatient hospital cancer care The technologies have been designed to support a wide range of healthcare services covering the routine care cycle: patient data acquisition, medical record keeping and review; clinical decision making (e.g. diagnosis, therapy decisions); execution of care plans (e.g. scheduling of clinical acts, reminders); therapy monitoring (e.g. toxicity alerts); co-ordination of patient care between clinical professionals in a care team, both locally and across sectors; follow up (e.g. patient recall); recording of outcome data for clinical audit and research.
Results and achievements
The PROMPT multimedia electronic patient record has been designed to be at the centre of a pilot regional shared care health information network (Aquitaine Cancer Network) developed in S.W. France. The network aims to decentralise, expand and improve the co-ordination and quality of continuing care (particularly in cancer) at regional and local levels. A communications infrastructure based on the EDIFACT standard messaging format for electronic data interchange is being used to link hospital, primary and shared care sites on the network. PROforma technology for capturing clinical guidelines and delivering decision support at the point of care, developed at the ACL, is based on techniques from mathematical logic and Artificial Intelligence. It encompasses the lifecycle of clinical guideline computerisation, from design and implementation to execution. The technology comprises a formal knowledge representation language, a graphical editor and the PROforma engine (which tests and executes guidelines). Both the electronic patient record and PROforma technology have been shown to offer state-of-the-art functionality in the field of healthcare telematics products, and validation activities undertaken by the project have highlighted their potential for impact on the process and quality of healthcare. Studies carried out to evaluate PROMPT applications include CAPSULE, a system designed to provide advice on prescribing in general practice. This study resulted in a 70% improvement in the prescribing behaviour of GPs. A pilot study of the impact of a disease management guideline for dyspepsia carried out in a primary care setting produced significant reductions in medication costs and numbers of consultations, and an increase in the number of referrals. In the Delft region of Holland, a controlled randomised clinical trial to evaluate the impact of 'Bloedlink', a system for GPs providing decision support on the use of clinical laboratory diagnostic blood tests, produced a 20% reduction in the number of tests ordered, as well as an improvement in the quality of test ordering.
The official launch (by Integrated Care Systems France S.A., Bordeaux) of the PROMPT EPR as a commercial product took place in June 1999. The EPR conforms with a number of European technical standards. XML technology is being adopted by PROMPT, in compliance with recommendations published by CEN TC 251, to support EPR data communications. A WWW version of the EPR is now being implemented. The 'Aquitaine Cancer Network' has been awarded significant French national and regional government funding to implement a shared patient record for cancer care, based on the PROMPT EPR. This work forms a part of a national government initiative to develop shared care networks in France. PROforma technology and healthcare applications are being developed and marketed by InferMed Ltd, London. These include the largest PROforma-based application built to date, the MACRO Clinical Trials Manager, which has been adopted by the EORTC and the MRC Cancer Trials Office. A major contract with a multinational pharmaceuticals company for the development of a clinical guideline has been completed. PROforma is currently being web-enabled: the generic user interface provided by the WWW will facilitate guideline authoring and Java technology is being used to support guideline execution over the web. the consortium plans to submit PROforma as a standard language and method for authoring and enacting clinical guidelines.
John Fox, Richard Thomson, Jean-Louis Renaud-Salis, Johan van der Lei. PROMPT - Protocols for Medical Procedures and Therapies. Internal Report. 1999.
Richard Thomson, John Fox, Jean-Louis Renaud-Salis, Johan van der Lei. PROMPT - Final Report. Project report. 1999.
PROMPT (project no. HC1041) was supported under the European Commission 4th Framework Telematics Applications Programme (1996-8)