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October 16, 2011

What's After the NHS IT Programme?

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My second patient record procurement gained the attention of those setting up what would become the NHS National Programme for IT. I remember suggesting there were essentially three options for a national health IT system: replace everything with one system, seek to integrate exisiting or disparate systems, or something in between. I said the integration option was the one most likely to be successful.

Of course, I speak with the advantage of 20:20 hindsight, but maybe we are about to find out if I was right. In a recent interview Katie Davis, managing director of NHS informatics, says the new watchword will be connect all rather than replace all.

The NHS IT Programme squeezed out many of the smaller, and more innovative, suppliers from the health IT market, something Katie Davis accepts. Thankfully, some determined suppliers have managed to hold on and are now ready to re-enter the market applying their long experience of the NHS. Also, though my cartoon pokes fun at them, IT departments have been itching to deliver local solutions that add real value for 9 long years.

The energy of NHS IT staff and suppliers and the need for more efficient services may be enough to carry us through this very difficult phase in the evolution of healthcare IT. Let's hope so.

October 11, 2011

Do Doctors Dream of Electronic Records?

A former Apple CEO says healthcare missed the PC and Internet revolutions. He loads the blame squarely on the shoulders of reluctant doctors.

When I first came to healthcare fresh from completing my MBA, my head was full of ideas of quality management. In leading my first electronic patient record programme in a London teaching hospital, I found doctors warmish at the prospect of having transactional information, like diagnostic test results and visit information, but distinctly cool at the prospect of recording outcome information.

Evidence-based healthcare should encourage the analysis of the relationship between process and outcome, but much clinical practice still seems to have no evidence base. Could this be the reason for slow uptake of electronic records?

In an insightful article in Information Week one chief medical officer supports this view, pointing out that most doctors still prefer medicine as an art rather than a science. That being the case, electronic records would represent a cultural mismatch.

In the UK all GPs now use computers to automate their practice and information from them them is used to manage the Quality and Outcomes Framework (QoF). For me QoF has some way to go before it manages quality rather than process. Nonetheless, GPs regard themselves as being at the forefront of medical computing.

GP systems have automated GP practice and eliminated some routine tasks, but this is hardly a revolution in care delivery. My former GP was one of the last to computerise his practice and the main benefit for me was that I was handed a typewritten prescription--though I did have to go back among the sick in the waiting room to an erratic printer to collect it. It is difficult to identify the direct patient benefits of GP automation. Given it began in the 1990s, this is very disappointing.

It is unfair for doctors to shoulder all of the blame for the slow uptake of IT, but they must shoulder some of it.