Friday, February 13, 2009

NHS computers - a record failure at the Royal Free?

BBC NEWS : NHS boss attacks e-records system: "A new NHS computerised medical records system on trial at a London hospital has been criticised by a hospital boss for causing 'heartache and hard work'.

Andrew Way, chief executive of London's Royal Free Hospital, said technical problems had cost the trust £10m and meant fewer patients could be seen."

This is not a unique failure. See here:

IT system failures continued to plague the U.K. government this week, when as many as 80,000 civil servants working for the Department of Work and Pensions (DWP) had to deal with what is being described in the local press as the biggest computer crash in government history. ..The IT failure was only the latest in a string of serious computer system problems experienced by the department. The DWP's Child Support Agency (CSA) has been struggling with a £456 million system from EDS that has made payments to only one in eight single parents awaiting them. Last week, Johnson told a House of Commons Parliamentary Select Committee that he is considering shutting down the child-support case management and telephony system, and Doug Smith, the chief executive of the CSA, resigned from his job.

Then there is the famous Wessex Ambulance Trust computer fiasco.

This all reminds me of my medical training, on the "Undhere Syndrome", where the patient says "I have a pain here, and here, and here and..." When you get that, be prepared to have a long consultation.

To avoid carrying on the list, they are all collected and docuented under the title of IT Project Mismanagement Disasters by Derek J. Smith, who is to be thanked most sincerely for his work.

Our GP practice was among the first to computerise (with a BBC computer), and we progressed to Vision, which is a good Windows based system, but a constant source of annoyance with unwanted time-wasting dialogue boxes, and a serious deficiency in the "Search" department.
If I wanted to know when a patient was first given SEROXAT (for instance) I would have to scroll down looking with my eyeballs. I mean, WHAAT!!? I asked IPS/Vision to fix it (how long would it have taken? two hours?) and they said they were too busy attending to new Government demands to meet the needs of the GPs.

We trialled the beta version of a GP email system called X400. It quickly (or should that be slowly?) became apparent that it took 13 key clicks to send an email. Not good. I phoned the local IT manager to tell him about it. With tears in his voice he said "I know, I know, please send in numerous reports, not just one, we have to kill this thing, I have told them but they
are trying to stay with it". In the end, we won, and X400 died, but it took a lot of work.

And another thing. If a patient moves from one computerised practice to another, all the records are printed off on reams of paper, and then copied out into the new system. The various GP systems cannot talk to each other. In fact, even identical GP systems cannot talk to each other. So vital data like drug allergies can be left off, or mis-copied in the transcription process.

GPs have led the way with computerisation, with the hospitals languishing about 20 years behind - understandably, because of the greater size and complexity for a hospital computer.

So what is the Government's response to all this? They have dreamed up a huge Supercomputer called "The Spine" where everything will be integrated (no doubt with the police records into the bargain). Though it may be foiled by the bank bailout.

The Spine is estimated to cost £30 billion.

What do we learn from all this? That Civil Servants are not good at purchasing good, effective mega computer systems.

I think the problem starts in the boardrooms of big software Companies, thusly:

Chair: Item 4: The Megatherian BallsUp software. Clearly a heap of dingoes kidneys, totally screwed up, we have to cut our losses and scrap it. All agreed? Yes, Smithers?
Smithers: Chair, I know a high up Civil Servant, and he has a budget of £30 billion for an new computer system. Shall I try him before we make a decision to to ditch this project?
Chair: Excellent, Smithers, well done, we will advance you £200 for a lunch with your Civil Servant friend. All agreed? Good. Next item...

Deep inside, I have a little voice screaming "B*ll*cks", but I am managing to stay calm on the surface. Medicine is hard work, but satisfying work, and I love medicine, but I do not love the managerialisationism that has dumped this heap of crud on the NHS. NHS workers are lions led by donkeys.

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