The new NHS information technology strategyBMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7299.1378 (Published 09 June 2001) Cite this as: BMJ 2001;322:1378
Technology will change practice
- Jeremy C Wyatt, reader in medical informatics,
- Justin Keen, visiting fellow
As a general practitioner piloting 21st century electronic links across the healthcare system, you get a thrill each time you send a prescription direct to the pharmacist. Then you find that, because pharmacists now telephone holders of uncashed prescriptions, your drugs bill is up by 20%. Equally, some of your patients send thoughtful emails, but you need nearly two hours a week to respond properly.1 You can use the new technology to collect and analyse data about your clinical practice, and the quality of the data is definitely improving. But managing information is becoming an end in itself, and you have to devote ever more time to it. You feel you are busier than ever.2 In such ways does technology change the practice of medicine.
The events in this scenario, and more, are likely to happen when the new NHS information technology strategy,3 published in February, is implemented. On balance, the arrival of networks to communicate clinical information with anyone in the NHS, is welcome. After a very slow start most general practitioners are now connected to NHSnet, the internal NHS network, and some are using email and browsing the internet. Services will be extended to include electronic outpatient appointment booking and pathology results reporting in all clinical settings. There will be more false starts, no doubt, but change starts here.
As a result, such electronic networks reduce barriers to communication, and make it easier to increase demands on for clinical the attention of clinicians. New information pressure points will appear within the NHS, as electronic networks reduce communication barriers and increase demands on our attention. Doctors may react as they have in the past and develop new ways of filtering information, ignoring some messages and delegating more work to nurses. In short, networks will change the way clinicians work.4 This would be welcome if investment in information technology improved professional productivity, but there is no positive evidence to suggest that it does.2 At the same time as welcoming better networks, therefore, we should recognise their arrival as a massive organisational development project involving the whole NHS. That beige box on your desk is the agent of fundamental changes in clinical work, whose implications have not yet been established.
The new information technology strategy also envisages that electronic patient records will be implemented across the NHS by 2005. However, it is not clear what these will look like. The main strategy document suggests that records will be shared between the patient, general practice, hospital, and other services. According to a statement by Health Secretary Alan Milburn, however, records will continue to be controlled by the NHS, with patients able to read them only on screen. 5 Again, these shared records might look like a technology problem, but the change is really far more profound.
Whatever the details, there are fundamental problems here. Consider the case of Mrs Smith, who currently lives in a nursing home. There are good arguments for sharing her health data with the social care staff who look after her.6 The government certainly expects that she will have shared multidisciplinary health and social care assessments.7 The nursing home is a private establishment, so there need to be links between NHS and private sector organisations. 6 We might add here that history tells us that scandals in health and social care have often occurred because of failure to share information, not from sharing too much. Yet there are no concrete plans about sharing information with social services, private sector organisations, or other organisations outside the NHS.
At the same time, it is important to guard against inappropriate uses of personal data. Data about Mrs Smith should be shared only with her consent and in her interests. At present, no rules for sharing Mrs Smith's personal electronic records are available, even though they are needed to implement joint assessments and other policies. The necessary guidance is not in the new strategy, and the revised Data Protection Act 1998 has not yet been fully implemented.8 The need now is to debate and understand how to trade off the benefits of sharing personal data with the risks of abuse.
Even when we have debated the issues, successful implementation will depend on major changes in clinical practice. Sharing data requires clinicians to trust one another, and non-clinical colleagues, far more than is common at the moment. Clinicians can be too cautious about sharing or relying on information generated by others. 9 This is a cultural, not a technical, issue and the pace of change cannot be forced.
Given all this, the belief that electronic records can ever precede a clear and coherent health information technology policy is misplaced. As things stand the technology will, as in earlier strategies, be imposed on the NHS before fundamental issues have been thought through. The challenge for doctors is to thrash out how networks and records should support clinical practice and better collaborative relationships in the NHS and beyond. If there was ever a time to engage, it is now.
JW holds a small fraction of the equity of Medix, an internet service provider for UK doctors.
Log in using your username and password
Log in through your institution
Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
Sign up for a free trial