In tandem with the introduction of PACS and the adoption of an EPR system at St. James’s hospital, there has been a 237% increase in the number of patients being managed through Breast MDT meetings between 2005 and 2010.

Methodology: This study forms part of a long-term ethnographic study at St. James's Hospital. Data are gathered at MDT meetings.

Due to increased numbers of women attending breast triple assessment clinics, and awareness of breast complaints, coupled with new protocols and amended local hospital policies, new strategies were required to be implemented to cope effectively with the increased demand. Strategies include grouping and prioritizing of cases, increased formalisation, and the incorporation of real-time electronic record-keeping at meetings (as opposed to note-taking).

The Electronic Patient Record (EPR) system allows access to all laboratory test results and the final written pathology report if required during discussion. PACS implementation facilitates direct access to digital radiological imaging such as Mammograms, Breast Ultrasound, Breast MRI, Body CT and Bone Scans. The increase in the number of patient presenting to the breast care services has resulted in more selective use of illustrating images. It is no longer practical to conduct a routine review of all images as may have happened in the past.

In 2010 a ‘computer-on-wheels’, connected to the hospital wired-network, was introduced to enable real-time data entry of the decisions of the MDT. The lead clinician, at the end of the meeting, validates entries and the report from the MDT discussion is then available in the individual patient record.