Jet packsBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e8342 (Published 10 December 2012) Cite this as: BMJ 2012;345:e8342
All rapid responses
Having worked in the past 10 years as a locum consultant in over 30 different maternity units I totally agree that existing electronic healthcare systems throughout Britain far too often “look as if they’ve been created by people who have never actually set foot in a hospital”
Without any question I also agree that “there needs to be an effort, led by doctors, to create better systems.” Unfortunately virtually all NHS funding remains controlled by those who too often prioritise using computers for data collection for retrospective audit and management, budget holders who still seem to believe that computers are magic, and senior staff who have rarely had any personal experience of the cost and limitations of writing complex software code .
Despite much political rhetoric, using computers to help front-line clinicians avoid human errors, or to reduce their overwhelming form filling workload sadly remains a low priority.
Over the past 30 years I have tried at every level to overcome this chasm between the world of ‘individual care’ clinical medicine and the world of NHS ICT but with little success. In the end the only way to demonstrate the kind of open access design knowledge that the medical profession needs to provide was, on an unfunded voluntary basis, to create my own websites. At least googling “perinatal data” now usually puts www.eepd.info first out of many millions of hits, being virtually the only link concerned with the time and cost of data entry for better individual care rather that using the data entry work of others purely for retrospective analysis. A related more general initiative by clinicians for clinicians can be seen at www.wisdam.info and there now seems reasonable hope that WikiProject Medicine initiative will in time make these and similar websites more widely accessible.
In a few hospitals also there is a reluctant and slow realisation that, as has already been accepted in America, significant progress will crucially depend on developing the role of Chief Clinical Information Officer (CCIO) as a viable long term specialist career path.
Competing interests: No competing interests
I, like Oliver, bemoan the lack of hoverboards and jetpacks that were promised to me by many forward-looking films of the 1980s. I also bemoan the seeming antiquity of many hospital record systems, having spent many a frustrated hour searching amongst piles of paper around nurses stations and by bedsides for the notes for Mrs X in Bed Y. However, having rotated through hospitals with both fully computerised and partially computerised patient notes, I have also seen the frustration that can come from wanting to supplement the results of an abdominal examination with a neat and simple diagram, and being forced to use a mouse to scrawl a child-like drawing in a tiny pop-up window.
Rather than trying to come up with a one-size-fits-all solution to the computerised notes problem, it amazes me that we don't just allow healthcare professionals to document on paper, and then have those paper notes scanned in to an electronic system for all to read. We already have an open, accessible, and royalty free standard - PDF - to adhere to (1), and relatively cheap and fast sheet-feed scanners have been available for some time.
Surely that way, we get the best of both worlds? No more searching for notes, no more drawing in tiny windows. Unfortunately, it doesn't solve the problem of the unreadable management plans, but I'm sure the future holds something in store for that.
Competing interests: My previous career involved user interface design. I own one of the cheap, fast, sheet-feed scanners I mention above.
"I defy anyone to defend dead tree notes" writes Dr Ellis,and I shall. To be fair, he and I are at different ends of the IT revolution. I began my computing in 1st MB when the huge IBM machine we had access to occupied a whole room, ate punch cards and had less power than my desktop, while he no doubt can touch type with alarming speed and accuracy.
But. I was sued once, a long while ago. The patient alleged negligence in diagnosis and presented a long list of consequent disabilities. In the GP notes, of which I got a copy, was a single entry on a Lloyd George card that emphatically contradicted this.
It was just the sort of thing that one jots down as an interesting piece of clinically irrelevant information. Would one have entered it into a computer file?
Perhaps if doctors can type with the speed of light they will continue to note these interesting personal details. I doubt it, but it was the key fact that destroyed the case. Dr Ellis is right about the inefficiency of current software - which actually is not safe enough to send things by email, so my secretary types a letter, prints it, sends the hard copy by post to the GP surgery where it is scanned into another computer and then shredded. Conversely a referral (especially one through the infamous Choose & Book system) can come with reams of printout from the patient record; my record was 21 pages. Sometimes a handwritten postcard can seem both sensible and "modern"!
Competing interests: No competing interests