See also p 202
. 2003 Jan 25;326(7382):220.
BMJ. 2003 Jan 25;326(7382):220.
Editor—Benson's article neatly summarises some of the difficulties hospital doctors have using computers.1-1 I would enthusiastically use computers in hospitals if seven points applied.
(1) Computers were readily available.
(2) Security measures were sensible.
(3) Email could be picked up both in the trust and at home or other work places.
(4) Patient details or past letters were accessible so, for example, you could see an emergency referral with some idea of what had previously happened.
(5) Pathology results could be viewed rapidly.
(6) Medical records were readily accessible.
(7) Access to the internet was good enough to allow, for example, reading of medical journals.
These measures would empower doctors and make computers useful. In the trust where I work the IT department has been starved of funds, is several hundred computers short, and is able to follow NHS guidelines only to the letter, with the following results.
(1) Seven junior doctors share one computer.
(2) Passwords are changed every 14 days. Many people forget their repeatedly updated passwords and so the IT helpdesk mainly deals with this problem (after the required form has been filled in, signed by a manager, and faxed to the desk). Alternatively, people write down their passwords.
(3) NHSnet does not enable email to be picked up at home, and external email cannot easily be picked up in the trust.
(4) Patient details or past letters are accessible only by secretaries or administrators, apparently for security and confidentiality reasons.
(5) Pathology results are on a different, inaccessible, system.
(6) Patient notes are on another, also inaccessible, system.
(7) Access to the internet is restricted.
Thus there is little incentive to use computers in this NHS trust. Disappointingly, the next tranche of investment of funds will once again be top down. Inevitably, a large information technology company will devour scarce resources to generate a system that works well for administrators and is not used by doctors because it does not do anything useful. However, I am sure that it will be secure and provide countless statistics.
What seems to be mainly lacking is resolve. The solution would be to involve doctors before designing or implementing a system. Most importantly, they should be listened to, which currently does not seem to happen.
References
- 1-1.Benson T. Why general practitioners use computers and hospital doctors do not—Part 2: scalability. BMJ. 2002;325:1090–1093. doi: 10.1136/bmj.325.7372.1090. . (9 November.) [DOI] [PMC free article] [PubMed] [Google Scholar]
BMJ. 2003 Jan 25;326(7382):220.
Editor—I am amazed by the limited and uncoordinated development of information technology in the NHS.
In our rural general practice we are computer enthusiasts and have embraced every new development. Although we have the brand leader system, EMIS, we still cannot transfer patients' old notes electronically from their former general practitioners. When a patient joins our list we simply get a huge printout, months later, from any paperless practice the patient was with before.
We can obtain limited laboratory results from the hospital electronically, but the service remains unreliable. We receive only the results for tests we have requested, not those from tests ordered by consultants. Similarly, consultants do not have access to tests requested by general practitioners, although the trust is one of the three nationwide electronic patient record sites.
When I add a vaccination to a computer record it should automatically update the health authority's child immunisation records and the local community trust's child health records. Instead I complete a paper form and waste time every quarter comparing our database manually with those of the two organisations and upgrading them both.
We are also not linked to the hospital in any meaningful way. I can email the world at the touch of a button, but I cannot find out from six miles (10 km) down the road basic information such as changes in drug treatment. We have tried to add all hospital numbers to our system as we receive correspondence, which is time consuming and inefficient. However, global data are not available to upgrade our system in one fell swoop because the computers cannot talk to each other under the Data Protection Act. The health authority database is fairly robust and has been linked to general practice systems for years, but the community trust and hospitals are unable to access it. Thus we continue to develop duplicate systems but not the long planned national database based on NHS numbers.
Primary care has generally led secondary care in computerisation, but if primary care is not joined up, how can we expect hospitals, all developing their own solutions independently, to do any better? The prospects for improved electronic communication between primary care and secondary care must be even more bleak.