NHS's chances of getting world's best IT: 80% ... maybe*

The NHS has possibly an 80 per cent chance of having the world's best IT in healthcare in 10 years, its CIO Katie Davis told the 2012 Health Informatics Congress. Meanwhile Sir Muir Gray, director of NHS National Knowledge service, blamed the managerial culture of Blighty's health service for previous technology fiascos, and …

[Anonymous Coward]

unfortunately

That means a 'world's best' as compared to 10 years ago, i.e. in 2032 we have an 80% chance of having what would have been the best today. I expect things will have moved on a bit between now and then (not least the project expenditure).

PS. The 80% is only 'possibly' - so what is the probability that the 80% is correct, as this needs to be taken into account. :-)

[SJRulez]

8 in 10 chance of being the best, 2 in 10 chance of it working.

[Great Bu]

Disunity

"There are so many examples of GPs and hospitals doing different and innovative things with IT, all with the patient at the core and all about using information in the proper way."

Whilst this is true, what it fails to reflect is the fact that although the NHS is perceived as one huge organisation with united leadership (like some other huge organisations like McDonalds) it is actually a collection of thousands of individual organisations with only broad goals laid down by the central organising authority.

The many examples of clinician-led IT implementations in the NHS are for the most part very good but unfortunately almost never able to be integrated with any of the other systems in use (without some horrendous cobbled together interface system coded by the lowest bidder).

For example, as part of my day-to-day work* I use our electronic patient record, A&E information system, legacy library system (for locating case notes), electronic radiology system, internal data collection and warehousing system, internal reporting system, outsourced reporting systems for public data and all the regular office type software**. All of these are separate systems have different usernames and passwords (with enforced password rotation at different times and periodicity) and none of them communicate to each other at all - to the point where I sometimes have to literally cut and paste information from one system display window to another.

There have been attempts in the past to unite all this under an all-consuming NHS IT system but these have fallen by the wayside when faced with the immense cost and complexity of what is actually required. The only real solution would be such a system but any such project must come with the understanding of, and commitment to, a humongous price tag.

* I am a nurse, I work at a normal hospital (DGH) involved in both the clinical treatment of cardio-respiratory patients and the collection and processing of data relating to that treatment for research and performance monitoring, so I have some experiance in both clinical requirements and IT realities.

** Still on MS Office 2007 and IE (gasp!) 6 (although I did have to install firefox on my own PC (IT don't support it and won't install it for me) as some of the external database provider web interfaces do not render in IE6).

[John G Imrie]

Re: Disunity

You don't actually need some big NHS IT system. You just need to get top management to stop looking for large vanity projects and start laying down minimum interoperability specs.

Then as new kit is bought to replace the old systems make sure that it meats or exceeds the standards.

Oh, and sack the manager of every IT department which does not support and will not install any modern software that meets the interoperability specs.

To those of you about to complain that it costs too much to support two or more different versions of software think of the benefits of allowing users to chance to actually do their jobs efficiently rather than allowing the IT department to wallow in it's own nostalgia.

[Rob 5]

Re: Disunity

"You just need to get top management to stop looking for large vanity projects and start laying down minimum interoperability specs."

Exactly! It's hardly Rocket Surgery, after all.

[Nick G]

Re: Disunity

"Oh, and sack the manager of every IT department which does not support and will not install any modern software that meets the interoperability specs."

Unfortunately, this doesn't account for the oodles of software purchased by the various departments without IT's involvement who then have to try & make work with what they have.

(And this isn't just an NHS issue - had exactly the same problem in the private sector...

[Rob Davis]

Re: Disunity

+1 on interoperability.

And to further support the point, different systems is a fact of life and this is not a problem if they can interoperate electronically (APIs etc) and automatically (if required) to achieve what is required.

[MrZoolook]

Re: Disunity

"Whilst this is true, what it fails to reflect is the fact that although the NHS is perceived as one huge organisation with united leadership (like some other huge organisations like McDonalds) it is actually a collection of thousands of individual organisations with only broad goals laid down by the central organising authority."

My understanding of McD's is that each outlet (or at least a good proportion of them) are seperate entities that merely are licensed (franchised) by McD's to use the name and brand. This makes it exactly like the NHS by your description.

(just saying not criticising)

[BoldMan]

> This is about getting young people involved, with the older guys standing aside

What makes him think that "young people" will do a better job of understanding the complexity than "the older guys"? Is he talking metaphorically or should we get the age discrimination people involved?

[Anonymous Coward]

"These are clinical systems, not information systems, and clinicians have to take responsibility of stewardship of these resources."

And that's generally a major issue, you try getting Doctors and Nurses to take a brake from mountains of useless paper work and very important task of caring (which they get ever less time to do due to the mountains) to help test and plan a decent IT system.

My old dear helped test a system, said it was very good but nobody else seemed bothered most of them viewed the PC as a rather large paperweight.

Another thing;

"This is about getting young people involved, with the older guys standing aside"

Isn't that ageist, and therefore illegal?

[Great Bu]

Two different languages

Ironically, the mountains of paperwork that we would not have to do if the IT system were in place to do them automatically (I actually sit and watch nurses filling in paper referral forms with patient details which they are reading from a computer screen and then sending the forms physically down to the x-ray department for someone else to enter on to the radiology computer system) - all because apparently it would cost money to get an electronic referral system that speaks to both the patient record system and the radilogy system.

One other problem that occurs as part of getting clinicians to take on board IT projects is one which does not nescessarily arise in other IT projects - normally you have an IT proffessional (who speaks an english-like language known as ITenglish as well as his second language - english) asking for specifications from someone who speaks english and then explaining how the system works (or why it doesn't work) back to them. In NHS type clinical situations, you have the same ITenglish (with english as a second language) speaker trying to communicate with someone who speaks another english-like language Clinglish (and also has english as a second language).

Instead of communicating with eachother in their shared second language (english), these two groups of people will try speaking slowly in their own language in the hope it is sufficiently similar to be understood (IT Guy : "It won't work on account of it's all in an SQL database that's held externally and I don't have access permissions", Doctor: "But although the patient was FAST positive his CT showed a space occupying lesion, not a haemmhorage" *).

As they both think they are speaking the same language, much time and effort is wasted in misunderstandings to the point where the IT people give up hope and the medics go back to good ol' dead tree records......

*Actual conversation....

[Vic]

Re: Two different languages

> much time and effort is wasted in misunderstandings

That's a comparatively simple problem to solve, in fact: you just need to make sure each side has a rudimentary grasp of the other's language.

That's expensive on the clinical side - consultants really aren't cheap, so paying them to learn about IT is probably a non-starter - but IT bods can learn enough about what their medical colleagues are up to that the problem is soluble.

But that would require IT staff to be a part of the NHS, which means manglement won't be able to outsource it and claim some sort of cost-saving.

Vic.

[Rob Davis]

Re: Two different languages

+1 Good point. This seems to be a common problem in my experience of working in 5 organisations. For example, different departments have a different name for the same thing.

Wasted conversations clarifying things, confusion among new hires, poor training. At best people agree at worst people don't get this, let alone a solution.

There needs to be a recognised job function - "master term dictionary" maintainer or something.

Content management systems can help like the open source Drupal provide taxonomy (category) management, including synonyms. Another example is the stackexchange.com sites - see how tags for things are well managed here.

[John Rose]

US Veterans System

The solution to the primary admin & clinical system has been around for years, namely the US Veterans System.

[mark 63]

5th largest ?

I heard the NHS was the 3rd largest employer inthe world , behind the Chinese Army and the Indian Rail & Post service

[John A Blackley]

80% chance 'possibly"?

Hello, William Hill?

[RIch 24]

having had the (dis)pleasure of

having to work with the hopeless blaggers who are CfH for a couple of years, I would loose the 0 off that 80.

[TobyJ]

Ageist?

"This is about getting young people involved, with the older guys standing aside"

The old fella better watch he doesn't become the first casualty of his ageist comments.

Wonder how much more money they want to waste on the NHS vanity project?

Was £6,500,000,000 not enough?

[Displacement Activity]

Bollocks

If that's their analysis of what's wrong with the system, then nothing will have changed in 10 years, except that we'll have spent another £10B.

I've had the pleasure of developing some software for a small corner of the NHS over the past couple of years. Here's what I've found out, to save you all going through the same pain. Nobody bothers asking the actual end users - clinicians or management staff - what it is that they actually need, or what would make their lives easier. On the odd occasions when they do ask, they ask the wrong people, or they ignore the answer. "Interoperability", for one, is just irrelevant. I've never *once* met anyone in primary care who has any interest in this, and I've never found a significant problem that could be solved by better interoperability. Some of the big-ticket stuff - SUS and C&B - is important, but almost all the other issues are local.

The real problem is the vast army of no-hopers running the system, from top to bottom. Everyone from the lowly guy in IT governance whose only purpose in life is to stop you getting any useful information about your patients, by ignoring your emails for 2 months at a time and then making up totally spurious rationalisations and justifications, to the IT director who pisses away 750K by buying in software which I told him was going to be totally pointless, and which everyone now agrees is totally pointless, and which never had a specification or even potential users. I wouldn't have employed this guy as a cleaner - how did he ever become IT director at a PCT?

Their analysis is just stupidly irritating. We don't even need a "world-beating IT system", by any stretch of the imagination. We don't need younger programmers (WTF?!). We don't need "hack days". The "stewardship" stuff is just patronising right-on nonsense. If these people want to make a difference, they should move on and make way for people who know their asses from their elbows.