Doctors and computers
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7382.220/a (Published 25 January 2003) Cite this as: BMJ 2003;326:220All rapid responses
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Reading the article by Benson again and the responses by Melchiar and
Bland, I wondered if the problem could be solved with current technology.
Perhaps some of the problems encountered by hospitals would be solved by
using a geeral practice system for each department, and linking the
servers.
If you were in Acident and Emergency, for instance, you would have
automatic access to the Accident and Emergency server. Only if you held
appropriate access criteria could you access the servers for other
departments.
Within our Practice EMIS system, access can be resticed to some parts
of the system to those with prior clearance.
It seems to me that until hospitals start using some clinical system
which requires the clinician to make their records electronically, no
progress will be made.
Andrew Sanderson
Competing interests:
None declared
Competing interests: No competing interests
At the Veteran's Administration Hospitals in Southern California we
have a wonderful computer system that meets all 7 of Dr. Melichar's well-
thought-out criteria. The word "user-friendly" comes to mind, and patients
have benefitted, too.
Tom Bohr, MD
Neurology
Competing interests:
None declared
Competing interests: No competing interests
Having worked in a centre of excellence for the past 16 months I have
come to appreciate the value of access to a high grade IT system.
Currently I work in a hospital which supports a free ISP service to all
empolyees, with a charge should it be via cable modem. However, despite
this there is a 24 hour help desk staffed by up to 80 people that also is
accessible from anywhere to help people with their home PC if necessary.
The 'microcomputer education service' offer several free classes on how to
get the most out of commonly used software packages (for example, there
are seven one hour classes on how to use Microsoft word, each is slightly
more technical than the last).
In addition, every on call room has a computer with access to the
electronic patient record, the pathology results and all aspects of
patient care. All terminals also have access to the internet and to
internal and external email. There are several terminals also scattered in
corridors, often next to telephones to allow individuals walking from one
area to another to check results etc whenever necessary.
It is very clear that part of the philosophy of this institution is
that investment in the IT infrastructure with adequate backup means that
the people who do the work feel supported. Thus, make better and more
efficient workers.
Having made the committment to return to the UK to work, this is one
of the most daunting features. The lack of investment in IT in many trusts
is a major hindrance to progress. It is unfortunate that the 'short-
termism' in health related politics precludes the ability to see the
things that may really improve efficiency in the workplace. If less time
were spent on the phone chasing up pathology results, finiding lost notes,
correspondence and so on.
The place I currently work in is clearly an exception and the UK is
decades behind, but if money is to be spent in the NHS, then IT
infrastructure should be near the top of the list.
Competing interests:
None declared
Competing interests: No competing interests
Pathetic for a Big Rich Country
For the past 10 years I worked in a District General Hospital in New
Zealand. As in Britain the Public Health system in New Zealand is under
constant pressure from inadequate funding, understaffing and escalating
demands from patients, politicians and others. Unlike Britain, New
Zealand has a very small population which generates miniscule GDP, in
global terms. Most indices of health and income for N.Z. have declined
relentlesly in absolute or relative terms for decades.
Yet despite this my little hospital, and many others like it, managed
to find the funding and determination to invest in a modern IT system.
For years it has been possible to dictate letters over the telephone onto
a digital system for typing or storage. From any of the numerous terminals
located on wards, in clinics or in clinician's offices, all
correspondence, lab results, images, patient details, and administrative
matters (dates of attendances past & present etc)could be found within
seconds. Clinicians could simply connect with the main system from
terminals at home or from distant sites. Radiology and histopathology
images were in the process of being incorporated into the system.
When I returned to work in the U.K. it was like a return to the
technology found in New Zealand ten years ago or longer. Speaking to
colleagues from around the country it appears that there has been little
investment and almost no training of (medical, nursing, allied or
clerical) staff in the use of even the most basic areas of IT (such as how
to send or recieve an e-mail how to make a file, how to use a modern
Windows program).
The most depressing thing of all is the dogged attitude with which
all this is tolerated and endured. Facilities which would not be put up
with for one moment at home seem to be acceptable in the work-place. I do
not know the solution but I wanted to illustrate that the current
situation need not be so. Other countries in far worse financial straits
than Britain have managed to address the problem.
Competing interests:
None declared
Competing interests: No competing interests