Information systems introduced carefully can aid clinicians

Editor—The article by Simpson and Gordon on clinical information technology is free of jargon and relevant.¹ It is also realistic. I have seen three software systems come and go in the trust where I am based. All were management tools; clinicians were merely encouraged to believe in them. Then four years ago I had the opportunity to purchase an early version of a medical information management system (the Advanced Medical Information Guidance and Organisational System manufactured by AVC Multimedia, Norwich); this system essentially duplicates case records in an electronic form and allows users to search for information throughout the system. Soon the whole of our large inner city psychiatry directorate (which is spread across four sites) will be on one network.

The essence of good psychiatric practice is multidisciplinary teamwork. With our system I can view the records of other members of the team, some of whom have stopped using paper records. My laptop computer contains my entire caseload. I take it with me to meetings with representatives of social services, to day centres, and to local general practitioners’ surgeries to discuss clients who we have in common. Before the current system it would have taken a secretary several hours just to list all of a local practitioner’s patients, now it takes a minute. Care plans are updated weekly, directly on the system.

It is important to know why one system works and another fails. The key is, as Simpson and Gordon say, to keep it focused on the patient. Clinicians intuitively feel ownership of a “bottom up” approach. However, there also needs to be a financial commitment as terminals have to be available throughout the various clinical environments and offices. Also, enthusiasm is no substitute for proper management of the system. Our information technology manager is a clinician (nurse): “street credibility” is important if professionals are to be convinced that the initial pain of introducing information technology is worth the long term gains. Of course, staff must be properly trained. We have found that a “cascade” approach works best ²; we identify one person from each clinical area or discipline and train him or her. This person trains another group of staff and they, in turn, train another group.

Clinicians need to see instant benefits from the system and must not be asked to enter data twice. Lastly, software development is vital. Like Simpson and Gordon we have been able to generate information of relevance both to clinicians and managers from one system.