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Five IT fixes we desperately need

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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

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Readers' comments (8)

  • 'I am a name, not a number!!' That aside, it's all too easy to mis-transcribe numbers, with all sorts of unpleasant IG consequences if you get it wrong by transposing even a single digit. By comparison, it's much easier to pick up a potential error in a name.

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  • I can't think why they have over complicated the IT procurement and therefore bu**ered it up!
    Surely all they needed to do is set the standards/formatting and insist any company supplying it to the NHS follow this standard a bit like the web, then it is down to individual companies to invent the front ends that will compete for our custom!
    Any file produced by any system would the be readable in any other!

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  • As a guy working for the NPfIT said to me years ago "Not in my lifetime love"

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  • GPs were Independent, so there are any number of systems with any number of different languages.
    They spent 13 billion trying to sort this = went to the computer whizkids and they could not. Took the money though [ I know one ]
    I sit on one of these committees, we are trying and it is trying, believe me.

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  • GP medical software. ...have a monopoly on over complicated poor clunky design. I hope eventually to retire before RSI gets me and I lose my hair from trichotillomania

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  • The NHS has to spend money on the lessons learnt from successful and unsuccessful IT programmes, so that we don't make the same mistakes over and over. What would we do differently if we had to do it all again.

    It should be documented as we go along and really allow us to leverage the learning. Instead we have the same issues again and again. National money for templates and learning points that were learned the hard way.

    The templates used and lessons learned should also be referenced. Then if any project was proposed we should be able to search for similar projects and learn from them, rather than keeping the information private.

    Of course this idea would be seen to be too expensive, but it would save a lot of heartache and expense in the long run.

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  • Dropbox? You do, I am sure realise that Dropbox has the right to access this data and use it for any purpose it sees fit. I am sure your SIRO and IG team are ok with that (not.

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  • David Hogg

    Just a note about Dropbox - I agree not appropriate for patient data so I keep all this restricted to work servers or NHSmail. Good to point that out though... thanks.

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