Intended for healthcare professionals

Information In Practice

Why general practitioners use computers and hospital doctors do not—Part 2: scalability

BMJ 2002; 325 doi: (Published 09 November 2002) Cite this as: BMJ 2002;325:1090

Top-down IT & little investment: why hospital doctors do not compute.

This article (1) neatly summarizes some of the difficulties
hospital doctors have using computers. I would like to emphasize some issues
which I have found problematic:

I would enthusiastically use computers in hospitals if:

1 They were readily available

2 Security measures were sensible

3 e-mail could be picked up both in the Trust and at home /
other work places

4 Patient details or past letters were accessible, so you
could see an emergency referral, for example, with some idea of what had
previously happened

5 Pathology results could be viewed rapidly

6 Patient notes could be requested rapidly i.e. access to
Medical Records

7 There was good access to the Internet to allow, for
example, access to medical journals


The above measures would empower doctors and make computers

In the Trust I currently work in, the IT department has been
starved of funds, is several hundred computers short and is only able to follow
NHS IT guidelines, as a result, to the letter.

Thus, taking each of the above points in turn:

1 Seven junior doctors share one computer (the medical
students would also share this, but Trust/NHS security considerations means
that getting them logged onto the system is difficult).

2 NHS guidelines apparently require passwords to be changed
every 14 days - many people forget their repeatedly updated passwords and so
the IT helpdesk mainly deals with this (after the individual has filled in a
form, had it signed by a manager and faxed it to the IT helpdesk).
Alternatively, individuals write down their passwords - hardly secure or

3 NHSnet means that email cannot be picked up at home. Also,
whilst in the Trust, external email cannot easily be picked up, either. Hardly
an easy way of communicating.

4 Patient details or past letters can only be accessed by
the secretaries or administrators, not the doctors, apparently due to
security/confidentiality considerations.

5 Pathology results are on a different system and are

6 Patient notes are on another different system and are also

7 Access to the Internet is restricted.

Thus there is little real incentive to use computers in the
NHS trust I work in. It is also not very reassurring to hear that the next
tranche of investment of funds for this will, once again, be 'top-down'.
Inevitably, a large IT company will eat up countless scarce resources to
generate a system that works well for administrators and is not used by doctors
as it does not do anything useful. However, I am sure that it will be secure
and provide countless statistics.

So what could be done? Clearly, many of the above issues are
easily solvable, given resources, an understanding of security issues and some
resolve(2). What seems to be mainly lacking is resolve - the system operates to
deliver administrative/managerial data, which it does, to an extent. Therefore,
the clinical aspect - providing a better service for the patient - is not seen
as an important issue. The solution, therefore, would be to actually involve
those 'on the ground' before designing or implementing a system. Most
importantly, it would be to listen to them. This currently does not seem to happen.

(1) BMJ 2002 Nov 9;325(7372):1090-1093. Why general
practitioners use computers and hospital doctors do not-Part 2: scalability. Benson

(2) I currently also work at a university where security is
an issue, yet I can work securely from home, access work server folders and
pick up my email anywhere – security details at:

Competing interests:  
None declared

Competing interests: No competing interests

13 November 2002
Jan K Melichar
Clinical Lecturer
University of Bristol BS6 6JL