back to article Inadequate IT partly to blame for NHS doctors losing 13.5 million working hours

As the UK's National Health Service strains under the burden of the winter crisis, a new study has revealed that more than 13.5 million working hours are lost yearly in England's health service alone due to inadequate IT systems and equipment. The research [PDF] by the British Medical Association - the doctors' union with …

  1. Andy 73 Silver badge

    Confused..

    The problem appears to be interoperability and availability of services that handle existing workflows (i.e. not some new innovation being needed, simple stuff like coordinating documents between GPs and other care providers). The statement is *it stops us doing our job*.

    So how do we go from that to a diagnosis of underfunding? This is like going from a diagnosis of kidney failure to the conclusion that you don't have enough kidneys. The problem is that the ones you do have don't work, not that you need twelve kidneys to function.

    This is a perennial problem reported in The Register - public services struggle to build scalable systems. Even when they do deliver something, it usually involves a team of hundreds, enormous consultancy fees and delays of years.

    By now, as a Doctor, we've seen the patient turn up with the same symptoms every six months for the last two decades. Yet the prescription - that demonstrably doesn't work - remains the same.

    1. Binraider Silver badge

      Re: Confused..

      We can't expect reasonably medical staff to be informed buyers with regards specifications for complex IT programmes.

      Thus it falls on the project management in between to try and backfill that gap - not helped by multitudes of organisations in duplicate e.g. each NHS trust doing it's own thing and then likely conflicts between silos within trusts too.

      It absolutely IS possible to get these things right, but I would argue it desperately needs a far leaner management system overall, and laser-focus on the important issues. I'm not naive enough to believe that one-solution to rule them all would ever happen.

      Pragmatically speaking, if Jeremy *I can't use his surname in polite company* gets his way, this stuff will be turned over to the private sector entirely creating a whole set of other problems. I'm alright, Jack; but a lot of other people won't be.

      1. Andy 73 Silver badge

        Re: Confused..

        The same problem happens in schools. In the name of "competition", the lowest people in the IT food chain are left to make key buying decisions with minimal training and no information. That means there's no consistency, no support they can turn to and no economies of group buys.

        That in turn means the suppliers can gouge the whole system by asking each GP/teacher/police officer/whatever for just a little over the asking price. A 40% premium might mean just a few hundred pounds for each site, but then nationwide we're paying 40% over the odds for national infrastructure.

        Why anyone thinks a GP needs to have an IT expert on their staff (they don't - it's usually assigned to someone who didn't dare say no) is beyond me. But yet, here we are...

        1. Anonymous Coward
          Anonymous Coward

          Re: Confused..

          did letting schools opt out of the local educational authority in the name of academies help or hinder?

          Pitting the ideology of LEAs are run by Labour councils therefore bad against the economy of larger grouping with buying power and commonality of support.

          Individual schools get freedom to find best solutions for themselves but fall prey to the suppliers?

          1. Andy 73 Silver badge

            Re: Confused..

            There is an argument that even LEAs are too fine grained - in the case of schools, if every school needs a pencil, why do you need a hundred different departments in charge of buying pencils? It's not as if centralising purchasing necessitates using only one supplier - but it would potentially allow a group of people to fully understand and address the common need.

            This is a technocratic approach, of course - you can paint it as being political if you wish (and people will when it upsets the status quo for their favoured parties). The problem with technocratic approaches is that they usually start from a position of over-simplifying a problem in order to select a simple solution. The question is - what real world complexities and unintended consequences need to be accounted for, and where are the evangelists for making the bold decisions? Usually government selects for political rather than technocratic leadership.

            1. Alan Brown Silver badge

              Re: Confused..

              LEAs have a fundamental failing inasmuch as poor counties are poorly funded.

              The same applies to local NHS funding and housing

              National bodies are vastly more efficient and not as subject to local politics (which is VASTLY worse than national level stuff due to so few people taking an interest in the antics of their elected local officials)

              Don't take my word for it, look at how well national level education, health and housing departments do in places like New Zealand (the isolation and low population density there, with high costs of keeping offices interconnected demonstrates economies of scale quite well: It IS more efficient - and when politicians threaten an national service more people take note. Localism is a path to privatisation and carving up for profit)

      2. SloppyJesse

        Re: Confused..

        > We can't expect reasonably medical staff to be informed buyers with regards specifications for complex IT programmes.

        Well, if you set the expectation that low you're not going to get much useful input from the highly qualified professionals you're expecting to use the system. These are the same medical professionals that specify highly complex medical equipment balancing functionality, interoperability, servicing, upfront versus ongoing costs, etc.

        Why would you think they cannot provide insight into an IT purchasing decision?

        1. Anonymous Coward
          Anonymous Coward

          Re: Confused..

          1. You've changed the argument. Poster said 'specifications', you said 'insight'. I would expect medical staff to provide insight into the user need like any user, but above that? Leave it to the experts.

          2. Medical staff specifying interoperability, servicing and capital / operating expenditure?! No. Or whilst they're at it they can evaluate the optimal hybrid cloud solution, security, etc

        2. Andy 73 Silver badge

          Re: Confused..

          Let's be clear here - in most of the cases, the medical staff are not specifying bespoke data management systems, they're deciding which PC and networking equipment to buy, and then which software to manage the PC and networking equipment. Knowing your knee bone from your ankle bone has absolutely no relevance to the choice between a Wifi N or mesh router, does it?

          The vast majority of time lost is not because the medical requirements weren't understood, but because the network went down again and no-one knows how to reset it without disconnecting the printer. Or simply because - for no apparent reason - sending a document from one Teams account to another requires that someone with administrator privileges unlocks the sender's account.

          Yes of course, when specifying big IT systems, we must capture the workflow that is to be supported (and then largely ignore it because it turns out that rigidly implementing a workflow is almost always a mistake). We should absolutely extract every insight possible from the end users - whether they're Doctors, teachers or exhaust replacement mechanics. But the job of IT is to make as much of the IT part as possible invisible. It should just ***ing work, not require that the highly skilled and much overworked end user has to suddenly find time to train themselves on the intricacies of yet another system that only does half of the job.

          And it's a constant source of irritation that people think "because I'm a highly trained X, I should be able to provide meaningful insight into Y". Why? There is a significant difference between "being smart" and "having knowledge and experience". I sat on a train next to a teacher the other day who blithely said, "I'm going on a two week course to learn to write Apps". Seriously? If I walked into a Doctors surgery and started trying to treat patients on the grounds of a short course and Google, how would they react?

      3. LybsterRoy Silver badge

        Re: Confused..

        -- We can't expect reasonably medical staff to be informed buyers with regards specifications for complex IT programmes. --

        And there it all goes wrong - lets not blame the people who SHOULD know what they need/want to do their job - its someone else's fault!

        OK a good systems analyst should be able to get the information from the future users of the system but don't put all the blame onto them when those users hold information back, or think something isn't important.

        As said above - stop repeating the diagnosis when its been proven wrong - to which I'll add even if you're right stop just bloody moaning about it and do something to fix it eg train medical staff to do systems analysis (should be easier than teaching IT specialists to do medicine).

    2. Anonymous Coward
      Anonymous Coward

      Re: Confused..

      That report conflates 2 things. Asking the leading question 'do you have completely the necessary equipment to perform their job role' and getting 11% say yes - well who has 'completely the necessary equipment'? Then the other question, which unless the Doctors are now magically enterprise analysts they're not especially well qualified to answer, is that digital transformation will fix everything. 57% reckoned improved IT would have a significant impact in sorting backlogs from Covid - how exactly?

      Having spoken to a fair few NHS professionals lack of seamless NHS interoperability is an issue very rarely (when someone with a complex condition goes out of area and then needs treatment) and for the most part details are to hand.

      If I walked down the street and asked 100 random people if their IT was not completely 'good', I'd be surprised if 11% said yes.

      Usual crock from the BMA.

      1. kwlf

        Re: Confused..

        You're correct in everything you say, but I would still argue that NHS IT is worse than the BMA realises, because most doctors have neither the expertise nor the imagination to imagine how it might be better. I'm not talking about clever stuff like AI, but basic things like making sure that every test that is requested gets seen and acted on in a timely manner - or at all. Every day, our junior doctors spend their first half hour checking where patients actually are. There's no way to make sure that every patient in the hospital is being looked after by a consultant, so if there are misunderstandings it can be a few days before the nurses notice that nobody's come to see them on the daily ward rounds... All these things could be taken care of by IT systems and it would make doctors' lives easier and patients' lives safer, if they were.

        1. LybsterRoy Silver badge

          Re: Confused..

          I have a heretical idea - the problem isn't not enough IT or even not enough of the right IT its to much IT and not enough competent organisation.

          1. Anonymous Coward
            Anonymous Coward

            Re: Confused..

            This - and nicely summed up. (As one MP said yesterday the 'S' in NHS stands for service, not shrine).

        2. Anonymous Coward
          Anonymous Coward

          Re: Confused..

          "There's no way to make sure that every patient in the hospital is being looked after by a consultant, "

          Seriously? The NHS has never achieved this? This isn't an IT thing, its a do your bloody business thing. This is not unlike the removing the wrong kidney / chop off the wrong leg incompetence. Simple paper checklists (bought in as best practice from the air industry but strongly resisted by some medicos) helped prevent this - it doesn't need billions in IT to solve what should just be being done.

          1. kwlf

            Re: Confused..

            It is just 'being done' - but badly and in a time consuming way.

            Let's say for the sake of argument that a patient is admitted after a fall and a broken arm. The cardiologists say the fall wasn't due to the patient's heart stopping. The orthopaedic specialists say that the patient needs to come back in two weeks to have the plaster checked. The patient can't go home because they can't look after themselves. Very easy for both teams to cross her off their list, without realising that she is no longer being looked after by the other team. A week later, the nurses notice that nobody has been coming to see her. She is getting drowsy because she also hit her head when she fell and has a slow bleed to the brain. But it is now too late, and she dies.

            Or a doctor is admitting a man with a foot infection. Prescribes antibiotics. There is an emergency that the doctor is called away to, and he forgets to add the man to the list of patients he is responsible for. Two weeks later after moving beds several times, the nurses notice that nobody has come to see whether the antibiotics were working... Luckily they are.

            Nurses take blood tests for a patient who has a chest infection. Had a bit of chest pain so as an afterthought they also add on a troponin test, which takes longer than all the others to be reported. A moment's thought. A tick of a box. Doctors see, discharge. Patient dies at home of a heart attack. Troponin comes back moderately abnormal, an hour after the patient has been sent home. The doctor doesn't look at it, because he didn't know that it had been requested and there is no log of whether results have been looked at.

            Updating the 'list' of where patients are and who is responsible for them, takes a long time and is currently very error-prone. Come on people, these things shouldn't be rocket science. Sure, you can run any computer program by 'doing your job' and copying lists on bits of scrap paper. But people aren't very good at being computers.

      2. ManMountain1

        Re: Confused..

        True. I suspect if you asked any profession if they had completely the necessary equipment etc, you'd get more than 11% saying no. It actually sounds quite low. I work for an IT company and that question is the one that always gets a hammering in the annual survey.

    3. Mike 137 Silver badge

      Re: Confused..

      "The problem appears to be interoperability and availability of services that handle existing workflows"

      The problems can be really simple. When working as infosec manager of a UK hospital trust, at one hospital I found the outpatients reception staff had to use two entirely separate computers about a couple of meters apart for some of their appointments management. They literally had to shunt their chairs sideways across the floor between the two machines. Apparently nobody had heard of a KVM switch. I recommended one but as far as I know nothing was done to obtain or install one.

      Fortunately this setup was not in an emergency context, but it's worthy of note that in 2002 the very same setup contributed to the fatal Überlingen air disaster (admittedly for different reasons). And in the context of the hospital this might have contributed to accidents if it had been the A&E admissions desk.

  2. Primus Secundus Tertius

    What is the problem?

    Surely things must be easier if they are exchanging Word documents rather than doctors' handwriting?

    1. heyrick Silver badge

      Re: What is the problem?

      Isn't Word the one that's famously incapable of reading it's own files? Not exactly a step forward then, is it?

      1. Primus Secundus Tertius

        Re: What is the problem?

        It's still a lot easier than so-called plain text, which can be ASCII, UTF-8, EBCDIC, ...

      2. Fruit and Nutcase Silver badge
        Joke

        Dr Clippy will see you now

        Office 365 with and cloud stuff - Probably Microsoft has a better knowledge of a patient's health record than the Doctor.

    2. NeilPost

      Re: What is the problem?

      Some of it is even simpler than that.

      Can you e-mail anything to your (independent private contractor - boo/hiss - doctor/dentist ??

      No you need to phone - and struggle to get through - to some dragon on reception who will make you come it with a physical letter asking for sonething or print some results from one part of the NHS so they can add something to your health record.

  3. Bogle
    Go

    NPfIT

    What we need is some kind of National Programme for IT, surely?

    1. Roger Greenwood

      Re: NPfIT

      That's crazy talk, next you will be suggesting they involve the staff a bit more before they implement changes....

    2. Anonymous Coward
      Anonymous Coward

      Re: NPfIT

      They should first start in a single region of the NHS in England to get things started. Perhaps Wessex?

      1. Fruit and Nutcase Silver badge
        Joke

        Re: NPfIT

        How many NHS Trusts covers the Wessex region?

        In England alone it runs over 200.

        https://en.wikipedia.org/wiki/List_of_NHS_trusts

        https://en.wikipedia.org/wiki/List_of_primary_care_trusts_in_England

        icon: You can't make it up

        1. graeme leggett Silver badge

          Re: NPfIT

          "Primary care trusts were abolished on 31 March 2013"

          Their replacements, the CCGs merged until there were abiut 100. They were replaced this year by ICBs such as - in that area someimes called Wessex - the NHS Hampshire and Isle of Wight Integrated Care Board

          1. Fruit and Nutcase Silver badge
            Trollface

            Re: NPfIT

            That would account for the data being somewhat out of date - they do like to keep tinkering with the structure - still, keeps a roof over the management consultants, and ex-health ministers in gainful employment after Westminster

          2. Anonymous Coward
            Anonymous Coward

            Re: NPfIT

            There are still over 200 Local Trusts.

            In my area - 50 mile radius if Birmingham) there are about 2 dozen overlapping from University Hospital’s for emergency, adjacent . Non-University Trusts also for emergency , through several Primary Care trust’s for less sexy medicine, through Mental Health Trusts plus ovetlling Ambulance Trust/.

            All with CEO’s, finance teams, payroll teams, IT Teams, property teams, training teams and local Mandatory Training.- all layered on top of national systems with extra stuff.

            Working for 2 adjacent trusts needed to do 2 sets of mandatory training.. all by and large the same, but with a local set of policies grafted onZ

            Same nonsense as school education trusts.

  4. Anonymous Coward
    Anonymous Coward

    From personal experience with dealing with some Drs and their IT complaints - I expect that things like printer jams and loose mains/network cables mean that IT in their minds are crap and reliable. It wasn't IT's big feet that kicked the mains lead out of the block!

    We have a laptop in A&E that is used exclusively by the ambulance team - complaints were made were made a board level about lack of access to their data. Even when I watched one of them mis-type the password to get into the system, even though it was printed on a label...*

    * yeah I know, but it was for their use to communicate with their offsite system, so it was isolated from the main network and just a direct link out. T'was setup that way because, oh you get the idea

    1. Anonymous Coward
      Anonymous Coward

      It wasn't IT's big feet that kicked the mains lead out of the block!

      But it was IT that didn't arrange for sufficient mains sockets on the wall, or maybe that was facilities or somesuch. Anyway PPPPPPP.

      1. Anonymous Coward
        Anonymous Coward

        Re: It wasn't IT's big feet that kicked the mains lead out of the block!

        Err no...IT probably had nothing to do with electrical sockets and if they did, it was probably very early on before any quotes were raised. The number of sockets was probably reduced by a bean counter when the quote came in. Probably similar for network sockets.

        How many of us here have heard "we probably only need two sockets per user, the phone has a passthrough socket on it, so technically that's 3 sockets".

        The weird thing is, the actual cost of running ethernet is quite cheap in the grand scheme of things, it's the huge markup for labour that makes it pricey. You're usually charged per "end" or "termination" which depending on where you are in the country can be as high as £60-£70. Even higher in London.

        So if you have a building that requires 100 sockets, you're at £6,000 already before you've even bought the switches to cover that many sockets, and the rack, and the routers, the wifi APs etc.

        By the time an IT guy arrives, there will have been £10k-£20k spent at least...so their fee has to take into account budget that has already been spent.

        What's even crazier is that the NHS is absolutely loaded with IT guys...they have large teams of people...but they contract out a lot of work.

        I used to work for a London based NHS trust quite a few years ago now and I was blown away the first day I turned up to do some maintenance...there were 20-30 IT guys occupying a massive space all sat round playing Quake 3. While I spent the day checking databases, DNS servers, directory servers, disk arrays, switches, routers etc etc...literally everything.

        I spoke to a few of them and they told me that most of these "IT guys" had been hired through graduate programs and had very little training or experience and thus had no idea what to do.

        There wasn't a senior techie anywhere to be seen to train them, help them, guide them etc.

        I calculated at the time that the total salary bill for this massive NHS funded Quake 3 clan would have been around £1m-£1.5m a year. There were 30-40 of them on an average £30k a year...which was almost twice as much as I was earning at the time. They had all started in different years in batches of roughly 10 with another 10 planned for later that year.

  5. AndrueC Silver badge
    Joke

    If interoperability is a problem I think someone needs to have a FIHR lit under them.

    But more seriously we do now have better APIs available that cost nothing and cover most of the key providers. Just a matter of joining the NHS Developer Hub. Now..if only we had the time to incorporate them into existing products...

    1. NeilPost

      … or junk that communist nonsense and get Palantir to do the work.

    2. Anonymous Coward
      Anonymous Coward

      FHIR is a framework not a standard

      As soon as you try and implement FHIR, you realise it's fine for bloods/pressure observations but it's not really standard for anything more complex, which the majority of healthcare is.

  6. myhandler

    I was with an NHS eye specialist recently, she moves from one hospital to another. She wanted to write a prescription for me and forward it on my GP for repeats. She had to call a colleague to help - who was rude and said "you should know this by now". So I looked over and the arcane set of clicks and buttons would confuse anyone not using it regularly.

    It looked like it had stepped out of the 1980s. I was in at the dawn of the web and interface design and it looks like the NHS are still there. It doesn't need to be 'Appified' it just needs UX people to be involved.

    1. ColinPa

      Noooo!

      You get the UX people involved second... it is the end users first.

      Ive had experience where the new UX interface which wasted so much space on the screen - you have to scroll many more times to see all of the data - it used to be 90% of what you wanted was on the front page. The new interface was "modern" and won prizes (by people who did not have to use it).

      My sister was a nurse on the wards and she said a prototype "new interface" was terrible. The UX people worked with the people who had spare time - the back office - and so the GUI's were aimed at the back office. For example for a patient it displayed their home address ( of interest to the back office). As a nurse she was more interested in have the test results come back - and been looked at yet, so had to scroll down every time to get to the data of interest. When UX came to visit and get feedback - they quickly found that nurses would need much bigger screens (and smaller fonts) to be able to display all of the key data on one screen, unless they redesigned their interface again. The UX team were never seen again.

      1. david bates

        Re: Noooo!

        Ah the new government framework or whatever its called that HMRC, Companies house etc use.

        One question per screen

        On a standard laptop a scroll required to find the Next button

        Every.Single.Time.

        Brilliant.

      2. Alan Brown Silver badge

        Re: Noooo!

        Get the UX people involved, with a bunch of endusers prepared to hit them - HARD - around the head and shoulders if they make it difficult to use

        "I'll just add this whizzy bit here.... Ow! ow! stop! ok, I won't"

      3. Alan Brown Silver badge

        Re: Noooo!

        "The UX people worked with the people who had spare time"

        mistake #1 in a lot of orgs.

        Those who turn up "in their spare time" for such consultation sessions are the LAST people you want to be involved

        Find those "who don't have spare time" and schedule breaks in their workload so they CAN attend

    2. J.G.Harston Silver badge

      Is that the one named after a village in Yorkshire? I get confused by that, and all I'm doing is trying to find the configuration dialogue to do a test print after doing an installation. I much prefer the one with the 8.3 DOS name.

    3. Anonymous Coward
      Anonymous Coward

      This isn't unique to the NHS. Where I work (in a tech company) we have a ticket tracking system where the link to create a new ticket is in 7pt light grey text on a white background, and it opens a textarea that is 40 columns wide an 4 lines high. Most of the screen is taken up by things that managers are interested in but which mean nothing in the real world.

      1. Alan Brown Silver badge

        The worst part is that this stuff is tunable.

        I'm guilty of having done this - enabling everything that's there to see what people actually want/don't want

        Once you have feedback you can remove the uncesseary items for various groups - manglement-interest stuff not showing up on the coalface forms unless people go into advanced mode, etc

    4. daflibble

      Hhahahahah bad UX is subjective.

      I remember working on the spine project back in the 2000s. rolling out smartcard readers to Primary care, the poor UX emis system (showing it's dumb terminal design heritage) was only going to be taken from the cold dead hands of it's users. They were so efficient using it's arcane series of shortcut keys. Whereas the newer windows based GUI system (name escapes me) but it took so many clicks to do anything emis users hated it.

      Back then the big problem was lack of centralised management of IT across multiple organisations like Acute and Primary care trusts. They were all separate organisations, some with full fledged central IT and SMS management of end clients, other with a dental nurse co-ordinating the IT roll out replacing PC's based on someone tell her the date that shows up when you power on a computer (BIOS Copyright notice) would tell you how old a computer was. You can guess which trust had to send dozens of expensive engineers back revisiting site multiple times to update software and which just pushed updates with 3 guys from a central office.

      I doubt things have improved much since then.

      1. LybsterRoy Silver badge

        Wow that does sound familiar. My definition of user friendly is

        "I've been using it for years and I know where everything is"

        It has little to do with using the "right" colours or box shapes or having/not having borders.

        Think of your "shopping experience" at Tesco - where have they moved the (product of choice) to now - it was here for the last five years.

        1. JohnMurray

          Well..

          Like the time they switched location of crisps and cereal around......and sales of both increased.

          Or when they put own-brand products on the bottom shelves and famous-name products on eye-level shelves, and famous-name products increase sales?

          Big-name stores employ companies to plan those changes, not to make your life easier but to increase sales.

          Or maybe you though big-names had higher prices because they are better, or maybe because they pay to have their products placed better?

      2. Alan Brown Silver badge

        "They were so efficient using it's arcane series of shortcut keys. Whereas the newer windows based GUI system (name escapes me) but it took so many clicks to do anything emis users hated it."

        There's nothing preventing both modes to be provided.

        Being GUI-only is the kind of mistake that can be cured by introducing the dev's face to the desk in front of him - at speed

  7. Anonymous Coward
    Anonymous Coward

    Can only speak as I find

    AC for reasons that should be obvious...

    My daughter has had an absolute nightmare moving from CAMHS to Adult MHS

    Records missing (whole 6 month periods where we know she was seen by people just aren't recorded), disparity between separate systems, one set of data held by GP's, which doesn't match with CAMHS, referrals to hepatologists and urologists and gynaecologists all on different systems with no joining up of records. Specialist A says she needs to see B, no referral followed up, blood test taken and results only found years later.

    She's pushing 19 now and only now starting to get a full picture of the stuff she's been treated and investigated for since she was 13, and that's only because she has went down the route of demanding a second competant adult accompany her to meetings, often with the specialists pulling faces at the very thought.

  8. Anonymous Coward
    Anonymous Coward

    I work in healthcare. All you get from clinical staff is "I don't know how to do IT" or some variation on that theme. When knowing about IT is absolutely bugger all to do with knowing how to use a tool to do your job. Do you drive a car? You don't need to be a mechanic to do that strangely enough.

    They make up problems, they don't listen, they don't read communications about changes. They don't bother attending meetings about changes crucial to their departments then complain afterwards that things have changed. Best of all they don't report problems in the first place and go whinge at a director that they have problems. Trust me when I say that clinical staff and their attitudes are most of the problem. But saying that is of course very unpopular.

    1. T 7

      I'm going to have to call out some of this.

      I report computers all the time. The rpeorting system is based on the idea that I use a single computer. As an anaesthetist I report computers on Ward A not working. I leave ward A's phone number. IT support call back 2 hours later and as they cannot speak to me on Ward A, the ticket is closed. I am now in the operating theatre giving anaesthetics. I have also had IT support come to the anaesthetic department to fix computers on Ward Z. Because I am an anaesthetist, the ticket must relate to the computers in my office.

      I use >5 computers a day. Every day. The reason people do not report is because when they do the problem does not get fixed, and I have to chase up all the 'closed' tickets

      We are on the same side but I think we probably do not appreciate how each other works

      1. Dacarlo

        That is a fundamental process failure and one which should have been identified and fixed by the seemingly endless supply of middle management types in the NHS. It's literally their job to make everyone elses jobs easier.

        1. LybsterRoy Silver badge

          Nah. Its their job to employ more middle managers so they can be promoted to senior management to manage all the newly recruited middle managers.

      2. LybsterRoy Silver badge

        What you are complaining about is not IT its incompetent organisation, or just plain incompetence.

    2. AndrueC Silver badge
      Meh

      Yup Drs can be the worst. They have no interest in anything other than their work. We've had cases where they delegated account creation to one of their minions and got arsy when our support staff advised that MFA should only be set up by the actual user. One even moaned about having to actually log in to use our software. There's been others that just refuse to adapt to new software because it's different. In some cases they kept on using tape-based voice recorders and leaving the tapes on their secretary's desk instead of using a digital recorder and plugging it into the hub to charge/download at the end of the day.

      Thankfully most of them are no worse than a typical user but a few of them really seem to be living in their own ivory tower.

      1. The Oncoming Scorn Silver badge
        Coat

        "As an anaesthetist I report computers on Ward A not working. I leave ward A's phone number. IT support call back 2 hours later and as they cannot speak to me on Ward A,"

        There is your problem, while I commend you for reporting the issue, the call ticket needs to opened by or created on behalf of the name of the ward manager\doctor\matron, not someone passing through as the initial point of contact..

        Icon - Doctor White Coat.

        1. J.G.Harston Silver badge

          I don't want to down-vote you as you make a good point, but all too often the IT Support *REFUSE* to book a ticket to anybody other than the one sole human being at the other end of the telephone. I've had it myself as IT engineer. "I need to book this DOA equipment for collection." "Are you available on Thursday?" "No, it's my last day here on Tuesday". "Sorry, we have to book it in for collection from you." etc.

          "Ok, my name is..." Bangrah! Are you in on Thursday? "... Bangrah. Yes, I don't sound Indian, yes my accent is very clear...."

        2. T 7

          The ward managers do not work every day. Long days means they work 3 days a week. The matrons cover several wards. The ward doctors are a team. We are not 9-5 teams. Operating theatres have different staff in then every day.

          The solutions should fit our working patterns and normal practices.

          1. Anonymous Coward
            Anonymous Coward

            IT isn't 9-5 either. We also don't get to take the rest of the week off if we work 3 long days. In fact we usually have to work around people because we can't reboot, update or patch anything while it's in use.

            Hours in IT can be extremely brutal. Especially for younger IT guys. In my younger years, I'd regularly do a straight 48 hours with only quick naps on an office chair or office sofa to keep me going. I'd then take a half day off to catch up with sleep and jump back in. There was a period of two years where I felt permanently knackered.

            There was a point I reached when I was in a customers offices during the Oxford Street riots trying to catch a nap on a sofa that I decided "fuck this", got up, told the customer they're on their own, walked through the riots and went home. I got an angry phone call from my boss the next day and I told him to fuck off, I quit and went freelance.

          2. LybsterRoy Silver badge

            Out of interest, if IT support can't contact you - how does anyone else?

            1. T 7

              By calling my mobile, or emailing me. Mainly emailing as mobiles do not work in the operating theatres (reception rather than any concerns about interferance)

              Or coming to see me in any one of the 20 operating theatres I might be in after looking at the rota. They do not assume I am sat in the office, or in the place I was in for 10 minutes, 3.5 weeks ago.

        3. Dan 55 Silver badge
          Stop

          the call ticket needs to opened by or created on behalf of the name of the ward manager\doctor\matron

          Who knows nothing about the ticket opened by someone else so cannot give more information, and the ticket is closed?

      2. Anonymous Coward
        Anonymous Coward

        I've had similar issues with file sharing platforms at a client of mine in the past.

        They had a creaky old FTP server for donkies years that my predecessor installed, and I fucking hated it. You had to use a very specific version of an FTP client to access it because of old protocols and I wasn't allowed to upgrade it because nobody using the FTP was willing to use a newer client.

        When the fucking thing finally died, I refused to rebuild it as it was and I rebuilt it to make it fit for purpose and to have some semblance of security on it. I explained that I have already conceded to have an FTP server when really we shouldn't because they are a security nightmare. After about 2 weeks of people raging and stomping around, they gave in and went with the upgrade.

        I went as far as completely replacing the hardware. Bought a new box for it, decent disks and so on...I didn't ask for a damned thing, I just whacked it on the company Dell account.

        Sometimes you have to be tough. I know I was a bit brutal about the whole thing, but ensuring security and stability is my job, I can't just cave in because some fuckwit users are "used to the way it works".

        These people now know that if something needs to be done, it'll be done right and on my terms.

      3. kwlf

        I can program in PIC assembly language but had to call IT for help when asked to set up MFA for my phone. It may be easy when you have to talk the whole hospital through the process, but in our hospital the process wasn't well explained. After I'd finally worked it out, I ended up setting up MFA for half the department.

        Logging in is a huge problem because it takes a long time and doctors often don't use computers in the same way that most other people do. We wander the whole hospital and use the nearest computer whenever we need to check something or print a form out. Logging in and loading the program that we need to use, can easily take 5-10 minutes. It would be much faster if computers were left with a generic account always open; the programs that we need always open, and we used a password to access data and functions rather than having to log in and out all the time.

        1. Alan Brown Silver badge

          "We wander the whole hospital and use the nearest computer whenever we need to check something or print a form out"

          Which is arguably entirely the wrong approach in the first place. You should have a tablet you can carry and the ablity to simply throw printing at the nearest device

    3. FatGerman

      If those are the kind of problems you're seeing, then the systems being provided to end users are not fit for purpose. People shouldn't have to keep going to meetings about changes to how their tools work. When did anybody last redesign the spanner? Design them around the end user's needs and then STOP CHANGING THEM. Busy people shouldn't have to re-learn how their tools work every few months. Your comparison with mechanics is nonsense. I know how to drive a car because the design *of the controls* has not changed since I was taught it.

      1. Anonymous Coward
        Anonymous Coward

        "STOP CHANGING THEM"

        I'm the AC you replied to.

        Quite often the changes are as a result of their whinging. Then they get the opportunity to be consulted on the changes to make their lives easier and they don't engage, then whinge again when things are changed.

        To use the car analogy again, the biggest change to my particular set of clinical staff is having MFA and Office 365, we are talking about the locks being upgraded on the car to improve security. The "I don't do IT" bullshit comments come from changes like that.

        1. Anonymous Coward
          Anonymous Coward

          Yeah but office 365 sucks. Older Excel versions behaved much better.

      2. LybsterRoy Silver badge

        First let me say I 100% agree with you and support your concept.

        Second - how do you stop even a bit of the IT industry changing stuff and fucking it up yet again.

        When you figure that out please apply to Microsoft, Apple etc

  9. Kubla Cant

    Why a specifically NHS problem?

    Healthcare isn't exactly a local concern. Most countries in the world have a healthcare system of some kind. The NHS is only unique in its funding model and in its monolithic structure. The requirements should be much the same everywhere, and the data sharing problems should be, if anything, greater in less closely-integrated systems.

    Most of the other requirements of healthcare seem to be filled globally. The NHS doesn't design and manufacture its own equipment, and its staff is notoriously drawn from all over the world. So why doesn't it use IT systems that are in use elsewhere?

    It's not that many years since the last attempt to address all the NHS IT requirements in one gigantic project. The only output from that seems to have been a gigantic bill.

    1. AndrueC Silver badge
      Meh

      Re: Why a specifically NHS problem?

      It's not specifically the NHS. It's a common problem all over the world. Efforts have been made to break down the barriers. HL7 and as I jokingly referred to in an earlier reply the latest incarnation FIHR. But of course other standards exist because why would you ever need just one?

      But this takes time (has taken decades and is still a work in progress).

      A lot of it stems from the large sums of money that private companies can get from governments for health care related systems. That makes them reluctant to allow interoperability. Adapting standards like HL7 isn't easy either. Even if you're willing to do it as we were it's a big resource commitment both to implement and then to support. There's enough wiggle room in the standard to mean you're almost forever having to deal with edge cases. That's a lot less common with FHIR since it uses RESTful but HL7 could be a pig and a half when setting up communication between different systems for the first time.

      1. Alan Brown Silver badge

        Re: Why a specifically NHS problem?

        "That makes them reluctant to allow interoperability. "

        Which is why you make it a legal requirement and then use legal paths to remove beancounters/manglers who refuse to toe the line

    2. graeme leggett Silver badge

      Re: Why a specifically NHS problem?

      The NHS is not monolithic. It's an assembly of many small organisations working to the same principles (deliver healthcare free at point of use) under a common brand. Or three brands of you consider NHS Wales, NHS Scotland and NHS England are separate and the first two operated under devolved governement. (Northern Ireland has a national system but its brand is "Health and Social Care NI"

      It might be compared to McDonalds (other burgers are available) franchises - but without the rigourously standardised practices and workflows. Those individual organisations and groups of organisations have separate purchasing, separate IT, make their own decisions about which medicines to use (though informed by NICE) and so on. This is how you get different care and different problems in different parts of the system - to return to my metaphor - one area of the country has good burgers but half the time the tomato is missing, another part always has tomato but the burgers are overcooked.

      The software they do use for patient management may come from one or more providers such as EMIS (https://www.emishealth.com/)

      This helps give some oversight to structure

      https://medicalschoolexpert.co.uk/the-structure-of-the-nhs/

      1. NeilPost

        Re: Why a specifically NHS problem?

        Oh there are standards of care, IT, systems, national protocols etc underneath.. then you layer 250+ local trusts on top, local management teams and it becomes a nightmare.

  10. Anonymous Coward
    Anonymous Coward

    What about missing patients?

    I heard today from my doctor that the local hospital had "gone electronic" during the year and it is only now that it is becoming apparent that they have lost trace of a number of patients.

    In June I was referred after a scan showed nodules on my lung, the first appointment was canceled by the hospital and subsequent attempts to get seen have been ignored. Now, six months later my GP finds that I am not recorded on the hospital system and that is why I haven't been seen on the urgent (14 day) pathway.

    I blame the software, the firm that installed the crap system, and the anonymous coward who was happy to leave all trace of us in the ether.

    Paper is better.

    1. JohnMurray

      Re: What about missing patients?

      Rest assured, paper records are still used.

      They follow you around the country like a bad smell..

      1. Norman Nescio Silver badge

        Re: What about missing patients?

        And paper records get lost. Absolutely none for the first 21 years of my life. I moved GP 4 times in that period, and the last one claims I was never registered with them as a patient. After much paper-chasing with no results, I've given up. My current GP does not regard this as unusual.

        I know some people are not competant to look after their own records, so having a system where one was the only custodian of ones own medical records would not work, but I (currently) trust my own ability not to lose stuff as better than some public bureaucracies.

    2. An_Old_Dog Silver badge

      The Blame List

      I blame the software, the firm that installed the crap system, and the anonymous coward who was happy to leave all trace of us in the ether.

      Your blame-list should include the hospital executives which selected and approved the crap software.

      1. Will Godfrey Silver badge
        Unhappy

        Re: The Blame List

        I've yet to find any kind of executive who has the remotest idea about software, or system design.

    3. Korev Silver badge
      Thumb Down

      Re: What about missing patients?

      > Paper is better.

      In ancient history I was a temp in a hospital (paper) records library.

      There were shelves and shelves of bits of letters, test results etc which hadn't been labeled, but we couldn't chuck out.

      I spent a week with another member of staff searching microfilms for someone's lost records.

      I can recall a few people's notes who were so big they needed a trolley to themselves - good luck searching that!

      1. F. Frederick Skitty Silver badge

        Re: What about missing patients?

        Going off topic, but this reminds me of the abandoned NHS mental health hospital that friends and I used to wander around back as teenagers. One room was absolutely full of records from the late 1940s up until the hospital closed at the start of the 1980s.

        The hospital had been sold to a developer, who then did nothing with it in the hope it would decay to the point it had to be torn down, so it wasn't as though the NHS were just storing the records there temporarily. The building was historically significant, and you've probably seen it in a number of music videos or films - notably Bonnie Tyler's "Total Eclipse of the Heart".

      2. kwlf

        Re: What about missing patients?

        I sorta agree, but paper isn't always as bad as you make out. There's some texture to the notes. One portion is for written notes. Another for obs charts. Another for drug charts. You can normally find what you are looking for reasonably quickly. The user interfaces for electronic notes tend to be so abysmal that in practice it can be harder and slower to find your way around them. Not to mention that for paper notes you can only lose one set at a time, but a whole computer system can go down at once.

      3. Alan Brown Silver badge

        Re: What about missing patients?

        This kind of thing is a long-solved issue - lawyers did it in the 1990s when data warehousing due to the extreme costs of real estate in places like New York City

        reinventing the wheel inventing a new conversion and records system for every single local trust is beyond stupid

  11. T 7

    I am an NHS Consultant Anaesthetist.

    We do not have tap and go at work. So as I see patients prior to the operating list, who are spread far and wide, I have to log on seperately at each computer.

    Approx 20% of COWS (computers on wheels) are in graveyards on each ward.

    I do not understand it but if too many people log onto a computer, the profiles build up and the computer slows down. So they need a wipe (hard drive, not clinell) every now and then. WTF are we wheeling round unwieldy machines with terrible battery life when the rest of the world has moved to fondleslabs.

    Mice are attached by the shortest possible usb leads and have large weights along the lead that makes them very difficult to use.

    Wifi is patchy at best.

    We use cerner. The UX comments above are bang on the money. There have to be better ways streamlining common workflows rather than a one size fits no-one approach

    And it's not like getting data out for operational improvement is much easier.

    There is a wholesale lack of ambition and funding.

    Most of what we do is the same. Nurses in pre-op admit pateints to pre-op and do pre-op checks. They then discharge patients. A lightweight web based API driven website, with decent UX that tied into the cerner backend would be a game changer for them.

    Healthcare seems to have got caught up in an 'AI' (let's not expand on that one!) driven 'big data' drive and completely forgotten the basics of trying to run a high turnover business. The NHS is easyjet, not BA first class, and we need the technology to drive that level of required efficiency. At the moment it drags us down.

    1. dharmOS

      Re: another closed system with no upgrade path

      I think part of the problem is that the ancient software (Cerner in your case, EMIS for mine) was designed in an era when everyone had to use a ethernet-attached |Windows OS desktop with a horrid native exe designed to Win 95 era GUI/UX. Any NHS smartcard-based logins meant that for that one session, you had the machine to yourself and could tolerate a 5-7min from login screen to working desktop as it was a once-only occurrence.

      So designed by someone who does not have a clue how health care workers actually work! Computer-on-wheels connected via Wi-Fi are an update too far for the software. Having the chance to look at the backend, the database (Oracle, MS SQL, GTM Mumps) where the data is recorded could be driven by an HTML5 web app run on a wi-fi connected tablet. But the big companies making the software (Cerner, EPIC, EMIS, TPP) do not seem interested enough to do this.

      1. T 7

        Re: another closed system with no upgrade path

        Exactly this.

        Like what openbanking has done for bank back end / front end separation, let’s see the same for healthcare.

        1. Martin Gregorie

          Re: another closed system with no upgrade path

          The message I'm getting from this thread is that a major reason for NHS IT systems being unfit for purpose is that apparently THERE ARE NO QUALIFIED MEDICAL STAFF IN THE DESIGN TEAM.

          There is no excuse for this: but incompetent project management is an entirely reasonable explanation of why it happens.

          One of the most complex (and successful) projects I've been associated with was the BBC's Radio 3 Music Planning system. There are two reasons why it was successful:

          1) The initial design team included a newly retired member of the Music Planning Team, a decent project Manager and two IT specialists, of which I was one

          2) It was obvious from the outset that the data model would be complex, since it had to deal with musicians and orchestras, composers and their works, broadcast schedules and, last but not least, musicians fees, both for the initial recordings, but also the additional payments made if a concert or parts thereof were re-broadcast.

          So, the first thing we did was to teach the ex-planner and the project manger to read data structure diagrams and then we all stood in front of a large whiteboard for around a month until we'd developed a DSD that everybody agreed with and that nobody could find problems in.

          We didn't do ANY technical design until this point was reached.

          At this point we considered the users, who covered everybody from the music planners, who would use the system all day, every day to the program producers, would use it only every month or two when they were planning a new concert and needed to check that the performers and music they intended to use weren't already scheduled to be broadcast around the target date. This, and the terminals (24x80 green screen block mode devices) determined both the command syntax (7 single character commands, any data shown on screen could be shortened using personal abbreviations, command+abbreviation could be concatenated to run a set of related commands in sequence). We also introduced a permission system: any user could look at anything in the catalogs, or run clash checks on programs, but updating and/or data entry needed appropriate permissions.

          Then, last but not least, we used a modular software design and, and delivered subsections, e.g the music and performer catalog creation and search tools the the music planners, ASAP, since maintaining this data was part of their job and concerts couldn't be planned without them. We also showed them how to use the fault logging system and encouraged them to use it as well as to call us if they hit problems. We delivered modules incrementally but in a sequence that allowed to planners to input music and performer detains, and then to enter broadcast details. The consequence of all this was that the way the system worked suited what the music planners needed and we got prompt feedback from them on anything that needed fixing or re-implementation.

          The system was originally intended for around 6 - 10 users, but it turned out to be useful for rather more people that its original sponsors expected: last time I heard, it had nearer 40 users.

          The main message to take away from this palaver is that, if you're designing an IT system that must support experts in any profession which is outside the development team's personal expertise, then YOU MUST INCLUDE AT LEAST ONE MEMBER OF THAT PROFESSION IN THE DESIGN TEAM for your project to be something that its users will find both easy and (hopefully) enjoyable to use.

          1. Herring`

            Re: another closed system with no upgrade path

            if you're designing an IT system that must support experts in any profession which is outside the development team's personal expertise, then YOU MUST INCLUDE AT LEAST ONE MEMBER OF THAT PROFESSION IN THE DESIGN TEAM

            I'm with you on this. The best projects I have worked on, we have had the time of expert users to work with the dev team. By "best" I mean delivering something good and useful on time.

            Other projects, well all the experts are far too busy/overloaded to spend time with IT. The budget constraints happen and features are cut and an MVP has been delivered - with "viable" being defined by the PMO. And then you end up with the holes being plugged by shadow IT/ "Dave's Spreadsheet".

          2. Alan Brown Silver badge

            Re: another closed system with no upgrade path

            "The message I'm getting from this thread is that a major reason for NHS IT systems being unfit for purpose ..."

            And yet, most of these software companies are headed by groups of doctors

      2. Korev Silver badge

        Re: another closed system with no upgrade path

        I think part of the problem is that the ancient software (Cerner in your case, EMIS for mine) was designed in an era when everyone had to use a ethernet-attached |Windows OS desktop with a horrid native exe designed to Win 95 era GUI/UX. Any NHS smartcard-based logins meant that for that one session, you had the machine to yourself and could tolerate a 5-7min from login screen to working desktop as it was a once-only occurrence.

        My local hospital implemented a remote desktop system not long ago which would solve a number of these problems. Performance was good enough that the physiotherapists and medics could look at my MRIs etc. They used to log on with their smartcards too.

        1. babydave

          Re: another closed system with no upgrade path

          My sentiment regards RDS exactly. Have been recommending / installing this to clients for years - even a 3 user dog kennel. Staff can skip between any pc, laptop or phone and just carry on from where they left off. Even a power cut leaves them at the curser where they were typing until power restored. End user devices can be considered "dumb" and throwaway if need be - so any old cheap device will work. Backup is a cinch too.

        2. kwlf

          Re: another closed system with no upgrade path

          We use CITRIX, but it is not very reliable - I think many of the problems are due to people being logged into more than one computer.

    2. AndrueC Silver badge
      Meh

      Better software can be written (and has been) by young 'upstart' companies but there are a lot of hoops to jump though to get approval to supply into secondary care. Officially the hoops are there to ensure quality but some of them require that you get a referral from an existing approved supplier..

      1. BenDwire Silver badge
        Holmes

        And according to people in the know, those hoops require brown paper envelopes stuffed with pictures of the Queen

    3. The Oncoming Scorn Silver badge
      Holmes

      "I do not understand it but if too many people log onto a computer, the profiles build up and the computer slows down. So they need a wipe (hard drive, not clinell) every now and then"

      I'm gonna simply tackle this one very simply,

      Computers swap "pages of data' back & forth between memory & hard drives continually.

      Computers slow down when cached files of these are not purged by a reboot or shutdown (I'm not going to touch on Microsoft Fastboot issues).

      Sharing computers doesn't typically impact performance (Unless users stay logged in), however in some instances of my experience, when we migrated to Lotus Notes at GSK, a shared computer across 4 shifts in a production area was perfectly happy under Outlook/Exchange, but very quickly ran out of HDD space after 15 people out of 45 logged in & Lotus Notes gobbled up the space with it's databases for each user signing in, leaving the remainder (& those previously signed in) unable to sign in due to lack of space\resources.

      We also have a number of COW's at my current place of work, they are moved to various locations, plugged into power & network. The main difference is that the users sign into a shop floor account & then into a Citrix session for their actual work rather than fill up the PC's with profile data.

      1. kwlf

        _Sharing computers doesn't typically impact performance (Unless users stay logged in),_

        Our emergency department has 70 employees and there are probably several dozen people from other departments who pass through. Everybody in the department has a contractual obligation to check their Emails at least once weekly, and there are only a few computers that are convenient for this. The computers are always on (i.e. the department never shuts, so there is no natural 'computers off lights out' time). How else are they going to be used?

        Imagine I have to send an urgent Email to get urgent advice about a sick patient from a bigger hospital... last week there was only one computer that didn't hang when I tried to log in with my own username rather than the generic one. The one that did work, the last one I tried, took 10 minutes to log in - then remained painfully slow. This week I had a similar problem and I just traipsed 5 minutes up to the ward as I knew it would be faster to use a computer that was exposed to fewer users. Not ideal as I couldn't take the patients notes with me.

        And Citrix... Perhaps it works in some circumstances but it does not work well for us. Programs are forever hanging (then are reluctant to be terminated) and it seems to fill with empty orphan sessions. In the midst of doing some work, the program you are using vanishes from in front of your eyes... Or perhaps you are immersed in typing an Email and all of a sudden an X-ray that somebody else was looking at pops up in front of your eyes, unbidden. So much for confidentiality.

        NHS environments are too chaotic for the software that we are using.

    4. J.G.Harston Silver badge

      "We use Cerner. The UX comments above are bang on the money."

      God, there's another one? I've only encountered three, EPIC, EMIS and SystmOne. Thanks for the warning if I ever come across it. :)

    5. Anonymous Coward
      Anonymous Coward

      Not the same

      I've seen working groups of clinicians across specialties fight over the "right way" to deal with patient referals. Even to try and pin it down to 5/6 common methods. Then along comes oncology, rolls up it's sleeves and laughs as they explain their 500 ways to refer a patient - and they don't often don't discharge because they head to end of life care. Then you ask two orthopaedics consultants at hospitals 50 miles away what their hip replacement pathway looks like and they argue for about 3 hours and you end up with nothing.

      I think it's complex because the domain isn't standardised. It is from your point of view but how often do you truly sit in a room and talk process with lots of other specialties?

      1. Alan Brown Silver badge

        Re: Not the same

        This comes back to the issue of medical egos. Everyone has their own best system and the aviation model of standardising _everything_ to minimise risk/mistakes plays second fiddle to massaging those egos

        Once upon a time (not so long ago), pilots were much the same too. Things can be changed.

  12. JohnMurray

    it...

    makes you wonder how, with such garbage IT, they can still give the data away to Palantir et-al...

    1. dharmOS

      Re: it...

      Because the NHS Clinicians have had to curate it into an accurate data set as part of their clinical job to record medical, nursing notes for patients, i.e. we give them high quality human-curated supervised data sets without any of the reward.

      Palantir have to clean it up a bit, but not as much as they would have to do otherwise.

  13. J.G.Harston Silver badge

    Hold on, General Practices are private contractors, their IT systems are their responsibility, not the NHS's. In the GP practice IT support organisations I've worked in, the clinical software suppliers have done very well in getting their data interoperable with each other's software - market forces, a GP practice just would not buy a package if it couldn't import data from a practise using other software. Like the pre-Post Office Telephones days of your telephone only being able to connect to the suppliers other customers.

    1. Anonymous Coward
      Anonymous Coward

      > Hold on, General Practices are private contractors, their IT systems are their responsibility, not the NHS's.

      I'm only familiar with HSC NI (aka NHS Northern Ireland) - the GP Practices can *only* use approved patient records systems of which there are 3 in NI - EMIS, Vision/INPS, and Merlok.

      Likewise I believe in England the main (only?) approved GP records systems are EMIS and SystemOne.

      So whilst Practices may be responsible (i.e. as Data Controllers) for their records system they are not allowed to select vendors other than those mentioned above.

      [Side note, I'm still fighting with the ICO for failing to take action against a GP Practice, as Data Controller for their patients records system, acknowledging to the ICO that they are not actually in control of their record system's sharing with other external systems.]

  14. Dante Alighieri
    Windows

    Radiologist

    We just "did" Cerner.

    I invested a lot of time in the interface to our dept. My manager nuked it from orbit.

    I had 200 (ish) codes for requests, we now have 6000, many not previously available (for good reason)

    I am more geek than our chief information officer.

    UI is awful. so many issues...

    I dip in and out as I use a radiology system. But messaging is broken

    Just had notices sent out [at my instigation] that & ^ " all break messages/referrals so 'usually fit & well, new bleed & breathlessness' comes to us as 'usually fit'

    I've had to update reports re inappropriate details (grrrr)

    3 screens, working on the right - pop ups on the one on the left.. Can't set date ranges easily.. can't "favourite" our local label printer, can't reprint labels.. microbilogy requisitions don't print... you get the idea (I stab people for a living before you ask, and samples need to be identified apparently)

    Icon for current activity

  15. Anonymous Coward
    Anonymous Coward

    Not just the NHS...

    I see your medical IT software system and raise you one HMCTS Common Platform!

  16. Anonymous Coward
    Anonymous Coward

    Twas ever thus...

    Very early in my IT career, I did a Desktop\Exchange rollout for an NHS hospital. Before automated builds were really a thing, I was expected to go around the building installing Windows\Office manually. When I asked for the source media, I was pointed to *two pallets* of Windows\Office retail boxes in a store room. As inexperienced as I was, even I spotted that was a massive waste of cash....which sadly my taxes were payinjg for :(

    1. Alan Brown Silver badge

      Re: Twas ever thus...

      "When I asked for the source media, I was pointed to *two pallets* of Windows\Office retail boxes in a store room"

      At one point in the early 1990s I worked for a government radio station for a while and discovered that they had installed "multiple unlicensed copies of Windows 3.1" (yes, it was that long ago)

      It was actually 30% CHEAPER to buy retail boxes than a volume license, for.... "reasons" (mostly down to the disties gouging heavily, because they could)

  17. a pressbutton

    Most of these hospital based systems were written for US - based hospitals - or ones that charge, where _every_thing_is_chargeable_ and so needs to be recorded.

    ... and by the way hold patient records.

    these systems are installed by consultants of varying abilities in hospitals of varying purpose and age and IT infrastructure.

    Sometimes successfully, sometimes otherwise. This can lead to utter failure ( google cerner bristol failure )

    There are a number of key reqs that do not really happen anywhere else in the world

    - every hospital is different and so is often managed differently

    - hospitals do different things (some are overgrown GP practices, some specialise in war injuries, some in eyes)

    - your data is supposed to be available to all of them, very quickly

    - it is supposed to be updated in a way that makes sense to all

    and

    - it is the NHS - the prime need is to record what happened to the patients, not how much to bill them.

    (disclaimer - things may have changed in the last 10 y or so, but it does not sound like it)

  18. Anonymous Coward
    Anonymous Coward

    NHS Systems

    Designed by managers to show KPI’s

    Used by practitioners to drive themselves mad

    Pushed on patients to help them to die quicker

  19. Paul 87

    It's not hard

    Standardise the structure of health records, and fund a migration plan involving a few thousand staff to update records into the new format

    1. hup hup hoo

      Errm

      2004 called, we tried that back then.

    2. T 7

      You are right. It's not hard. PC / HPC / PMH / Meds / Allergies / Social History.

      Any number of diagrams that have come to be used as medical shorthand

      Risks / Benefits types of blood tests, specific diagnoses etc etc etc

      Remind me how many SNOMED categories there are?

  20. Anonymous Coward
    Anonymous Coward

    Multiple applications needed

    As a slightly tech savvy doctor in an acute nhs hospital trust the lack of systems needed to do my job is ridiculous.

    In outpatients 10-15min a patient.

    Use a “paper light” electronic patient records to access pre-existing notes and letters and write my clinic notes. It does not have radiology or recent investigations.

    A dictation system to dictate patient letters for the gp and patient

    A patient administration system to record what procedures I did when I saw the patient and what follow up they need

    A pacs system to review imaging

    A in-house developed results system

    An ordering system for imaging and investigations

    A system to access cancer MDT outcomes and treatment plans

    Let alone teams, outlook(web based to save money)

    I still have to write prescriptions, write tci cards(listing people for operations) and other requests.

    You can see where the wasted time goes

  21. Anonymous Coward
    Anonymous Coward

    I retired after 20+ years in the NHS, where I worked in a number of non-clinical roles. The NHS, Scotand in my case, is full of hard working people who want to give the best service, hamstrung by governments getting hard-ons for yet another top down re-organisation, senior management decisions, crap software, scalping suppliers, lack of money, lack of investment in staff training, leaking buildings and the occasional time-served irritant who wants to slow everything down by not allowing change to take place.

  22. bernmeister
    IT Angle

    Remember pen and paper?

    So, they are losing 13.5 million hours a year rue to inadequate IT. Remember the days of pen and paper medical records? How many hours are present IT systems saving compared to pen an paper records? Records had to be posted around the contry by Royal Snail!

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