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RESEARCH: Jane Hendy, Naomi Fulop, Barnaby C Reeves, Andrew Hutchings, and Simon Collin Implementing the NHS information technology programme: qualitative study of progress in acute trusts BMJ 2007; 0: bmj.39195.598461.551v1 [Abstract]

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Is the tail wagging the dog?

Peter H Sonksen   (1 July 2007)

Unexpected benefit of Choose and Book

Paul E Shannon   (11 October 2007)

Is the tail wagging the dog? 1 July 2007
Peter H Sonksen, Emeritus Professor of Endocrinology, St Thomas' Hospital, London Retired Send response to journal: Re: Is the tail wagging the dog?	It is clear from this evaluation of the NHS IT Programme that this massive project is driven by management for management and will fail. The primary aim should have been to support clinical practice and obtain management information as a TRUE by-product of patient care. By introducing useful clinical information systems 'on the shop floor' and ensuring that these are valued and adopted by the clinicians (NOT just doctors) because they enable care, the management information obtained would be accurate, timely and FREE rather than flawed, late and VERY EXPENSIVE. No competent analyst 'computerising' a production line would start anywhere other than at the shop floor level because it is here that the true benefits of modern information technology are found. By supporting the 'lowest level' (in hierarchical terms) it increases productivity and quality control while simultaneously reducing costs and providing timely and accurate management data. This model has been successfully transferred into clinical information systems although it has not been easy and has taken time and a lot of patience. The necessary lessons have been learned and should have been used as the basic building blocks of the NHS megasystem. Sadly the same mistakes have been made yet again by politicians and top level managers - the system is primarily designed to meet the needs of managers rather than to support patient care. I speak as a (retired but not brain-dead) clinician with more than 30 years experience in this field, having built (obviously with a great deal of help) a working clinical information system that was and still is integral to the management of diabetes and endocrine patients initially at St Thomas' Hospital (1) but later extending not only to Guy's but also to many other hospitals throughout the UK and abroad. It has successfully 'spun out' from academia into the commercial world where it thrives (2). It has done this because it works - it supports (genuinely makes easier and better) clinical care delivered not only by doctors but by nurses, specialist nurses, dietitians, podiatrists, ophthalmologists, psychologists as well as the administrative staff and secretaries of the department. It is 'flexible' and can be readily adapted to different models of practice. It can be linked to Primary Care and other NHS information systems. It can produce accurate and timely management information FREE! I am surprised that these points have largely been ignored in this evaluation. Politicians and NHS management should be aware that they are wasting tax payers money if they continue to ignore these simple principles. Professor Peter Sonksen MD FRCP FFSEM(UK) Emeritus Professor of Endocrinology St Thomas' Hospital and King's College, London Visiting Professor Southampton University Medical School 1. Sonksen, P.H. and Williams, C. Information technology in diabetes care "Diabeta": 23 years of development and use of a computer-based record for diabetes care. Int J Biomed Comput 42:67-77, 1996. 2. http://www.hisvector.com/Vector/ Competing interests: None declared
Unexpected benefit of Choose and Book 11 October 2007
Paul E Shannon, locum consultant anaesthetist Doncaster Royal Infirmary, DN2 5LT Send response to journal: Re: Unexpected benefit of Choose and Book	As an ex-National Clinical Lead for Choose and Book, I am well aware of the benefits that the system provides for clinicians. One unanticipated benefit is the avoidance of using Royal Mail during strike action! Outpatient appointments and referral letters are made electronically and so are not subject to the vagaries of the postal system. Let's hope that this strike action will encourage colleagues to look afresh at Choose and Book. Similarly, letters to the editor of the BMJ are unaffected when utilising Rapid Responses. However, who knows if readers will see this before the strike ends? Competing interests: None declared