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Table 12 Examples of comments on clinical information systems

From: Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory – use of the Chronic Care Model

Weaknesses/threats (negative) Strengths/opportunities (positive)
Clinical information systems
"Running paper and computer systems together is a problem and there is no choice in this". The health centre manager wishes they were on computer entirely as "not good to have both" – preferable to have one system because the dual system makes the process longer. "The computerised system (Medical Director) is a convenient tool – the computer provides so many prompts and reminders eg if breastfeeding will give warning if medication is contraindicated; it can chart progress graphically (eg weight and BP); and the computer generates standard letters for specific appointments (eg optometrist or ophthalmologist for diabetic retinopathy patients)".
The system (CCTIS) wasn't designed for clinical needs. It takes too long to open and go through, and even to put in a diagnosis is complex and time-consuming. "Having to navigate through a maze of screens, backwards and forwards, to find information that is not collated, is counter productive and user unfriendly". "The doctor comes Monday and Tuesday each week (and does one day per week of office work in Darwin for the health centre). He generates a list of follow-ups that are necessary and faxes it through to each staff member involved and follows up when he comes. This system works very well for staff and clients".
The new computer information system PCIS was introduced in December this year. The health centre has had the version 1 and 2 of PCIS and are now waiting for the version 3. The staff appear to have little confidence that version 3 will be better. Part of the problem is that the system has been designed around data collection needs rather than their immediate clinical needs – whereas they would be able to use population statistics in the future they want a system that is responsive to their daily needs – eg for recall etc. If it stays as is, then it just won't get used. A project called Health Connect is being trialled in the region at the moment to see whether patient information can be transferred electronically between health service providers (community health centres and hospitals). In remote areas, population is highly mobile. "With Health Connect that information stays in the system wherever the person goes". The system will contain a recent medical event summary of patients, diagnostic results, pathology, x-rays and discharge summary.
There is no reporting on progress in chronic illness care. The health centre is only reporting on "the basics – the daily stats sheet". "It is more a record to provide evidence of the workload in the health centre".