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Forget Clinical Involvement

pacs.jpgAt a conference last week in London, UK “Successful Implementation of NPfIT 2006” engaging clinicians in the National Programme for IT was brought up time and again by speakers: let's engage them, let's involve them, let's get them on board—phrases that to me are meaningless shibboleths. I do not want to involve them at all.

I wrote an article last year for Hospital Doctor “Switching on to IT Benefits” in which I suggested—despite the assertion of some professional medical bodies—clinicians are not turned on by technology or the security of patient records or their transfer from existing systems. They are interested in what an Electronic Patient Record can do for them and their patients.

I give examples in the article of successful clinically-driven IT projects. One was the implementation of a PACS at the Royal Berkshire Hospital in Reading. A Radiologist who played a leading role in the project presented at the conference: not only had the PACS provided clinical benefit, and enabled new working processes—it had also paid for itself through savings. I can assure you that clinicians did not need to be pushed to use the PACS—indeed a recent survey reveals they find it of huge benefit.

Recently I also wrote about telemedicine projects which clinicians also enthusiastically endorsed.

All healthcare IT should aspire to the condition of PACS and Telemedicine, because I do not want clinicians to be involved, I want them to be inspired.

Image of PACS: GE Healthcare


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I am a strong supporter for inspiring clinicians, which also involves leading them gently towards an electronic future, and setting up systems that they vie to use, and are vocal to improve.

But the NPfIT engagement is still very patchy, and seems to be involving mostly senior doctors, and extremely rarely the medical secretaries, clerks, scientists, AHPs, or junior doctors and nurses who will do the brunt of the data entry.

And it is only once using in anger that clinicians will start to demand what they want. I believe that the scale and inflexibility of the NPfIT approach will make responding to that very difficult.

Nothing in my experience is more engaging than clinical staff seeing and thereby believing that their comments and concerns are acted swiftly upon.

I have no idea how we will sensibly achieve that in CfH land.

I think maybe this is a chicken and egg situation.

In my experience, if clinicians are shown a vision of the possible we will need to step aside rather than lead them gently.

I agree that NHS CFH is offering basic systems at the moment; for example patient administration. These are unlikely to inspire clinicians.

Choose and Book is innovative but is suffering from poor reliability and design and the reaction of GPs to changes in well-established practice.

Despite a few PACS implementations, there seems little to turn on clinicians. Most of the radical and innovative stuff is outside of NPfIT's scope.

Maybe we will see a change soon. After all, NPfIT systems were specified in 2001/2, so by the time they are implemented they risk being obsolescent.

I work on user engagement for the Common User Interface program at Microsoft and while we are not selling a clinical application to the NHS, we are investigating and developing guidance on the design of clinical software - to be given to those of you that are making such products. (www.connectingforhealth.nhs.uk/crdb/nags/common_user_interface.ppt)

We run interviews, observation studies and design reviews with practicing doctors and nurses in both primary and secondary care, and are very keen to hear from anyone who would like to participate. Or knows anyone who might like to participate. We have some design reviews coming up but run engagement continuously - please get in touch via: v-jamfo@microsoft.com

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