Posted by: David Hogg4 April 2016
Despite good computer systems doing a lot to ensure patient safety, there are frequent occasions when it becomes a rate-limiting step to improving patient care. So it becomes eye-watering to learn of repeated expensive attempts where IT projects seem to just fritter money away.
I accept that these are complex projects to roll out. However, so often IT proposals seem to promise so much, and yet deliver so little. Or we fail to embrace the innovation available to us, instead lurching 5-10 years behind where we could be.
Here’s my top five IT fix requests:
1. Use standard usernames
Each system appears to require its own type of login. My usernames include hoggda80645, david.hogg. dhogg, hoggd, hoggd80927, DHOGG, 80927hoggd and david. Add to that inconsistent passwords (some requiring uppercase, some not allowing uppercase, others needing punctuation).
Solution: we need this to be standardised. The NHSnet email address is a good place to start for a username or alternatively couldn’t we use the registration number - GMC, NMC, HPCC? The username ‘gmc123456’ makes a lot more sense.
2. Make wifi freely available
This is a rate-limiting step for productivity. I store useful clinical files on Dropbox, I like to sort out email efficiently on my phone, I use my laptop for protocol/guideline development at work. And yet at present I need to wait until I’m home to transfer or email this work out.
In addition, wifi-calling is now available. For rural areas like ours, mobile phone reception is so patchy (or non-existent in most of the surgeries and hospital here on Arran). Let’s accept that accessible wifi is indeed established in Maslow’s hierarchy of needs, and provide open wifi (not restricted to NHS devices) to everyone who needs it to do their job effectively. Here lies a perfect example of ‘spend to save’ - spend the money, and see the returns in productivity.
3. Stop prohibitive firewalls
Each year, I probably reduce one or two shoulders, insert a couple of chest drains, and look to TED talks for work-related inspiration. There’s a load of high-quality, highly-relevant information available from blogs, social media and video sites such as Vimeo or Youtube. So I don’t understand why so many of these sites are blocked, with the undertones that I’m trying to look at something highly inappropriate for work-time.
A recent email from our health board even advised (paraphrased) ‘we encourage you to take a look at these videos, but realise you can’t do that from work computers’. We need to realise that prohibiting access to knowledge is standing in the way of personal development - and sometimes patient care and safety. Some of these sites are particularly useful - especially when I’m comparing my Kocher from my Cunningham techniques, or trying to update my knowledge from others.
4. Sort out remote access
I have recently had this made available to me, and it has revolutionised the way I can balance working at work and home, or on the train/ferry. Unfortunately we know that there are considerable delays in rolling this out to others. What remote access allows for me, is to finish up work at whatever time I have finished any physical responsibilities (seeing patients, supervising trainees/students etc.) and decide when to clear docman, email or tasks in my own time. On my phone or laptop. Without carrying around an extra ‘NHS’ device.
From a retention point of view, remote access is being hailed as a considerable advantage. It also allows for more integrated, effective care; like the patient I saw the other day who allowed me to link into his wifi connection to view his notes at home. Let’s just see this sorted.
5. Allow for a decent primary/secondary care IT interface
It still boggles me that email and letter communication with secondary care colleagues needs to go through an archaic, clunky workflow system. It’s time that integration was enabled at this interface (and let’s add social work and controlled, appropriate patient email contact to that too). There are some patients who I do communicate with by email - after thought and establishing boundaries/expectations - but the system to record this in patient notes remains clunky and 20th century. We should be able to email from EMIS/GP system of your choice and see integration from the outset - if not from patients, then at least other professionals.
We have seen eye-watering amounts of cash spent and wasted on either half-hearted IT systems, or even failed installations where the contractor still walks away with the millions, and yet no on-the-ground improvement. There are of course some great examples of where IT has worked very well. However, with ramifications for so many aspects of healthcare delivery - including retention of current staff - we need this to be better.
Dr David Hogg is a GP on the Isle of Arran, Scotland. You can follow him on Twitter @davidrhogg