Monthly Archives: November 2011

A group of Junior Doctors fight to improve IT in their hospital

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Below is a anonymised post based on a real-life situation:-

I am a junior doctor. I am trying to improve the working conditions in my hospital with a group of junior doctors, in order to provide better care in a more efficient manner so that we can spend more time with patients on their medical problems.

We feel that IT problems wasted a ridiculous amount of our time at work. A large part of our time is spent trying to log on to one of the many computers on each ward. Here it goes: Each member of staff has a username and password for Windows. Once you’re logged-in to Windows, anyone can access programmes for blood results, X-Rays and patient letters (through different programs which you need to log on again with different usernames and passwords) and the internet. Continue reading →

EHI Live 2011 and OpenEyes – A turning point in NHS IT?

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Carl (@drcjar) and I (@wai2k) have just returned from EHI Live 2011 and we have seen and met some amazing people doing amazing things. The lasting impression is that of an abundance of clinically-driven initiatives and the recognition by all that IT is a tool for improving patient outcomes and not an end in itself. Transparency was also high on the agenda with a drive to giving patients access to their electronic patient record. Dr Amir Hannan at Haughton Thornley Medical Centre has been tirelessly pushing this agenda and his message is getting heard at the highest level.

Open source software solutions also featured highly with a whole section and several sessions dedicated to it. I personally believe that the values of the open source movement aligns perfectly with the ethos of the medical profession; sharing best practice and welcoming criticism for the shared goal of continuous improvement. I recommend Carl’s publication for a detailed analysis of open source software in medicine.

There was also an opensource skunkworks were one of the challenges that was posted on the Openhealthcare UK google group was attempted by team at ScrapperWiki. This was to gather all the WHO Global alerts and response to outbreaks of disease world-wide. You can have a play with the data gathered here: https://scraperwiki.com/scrapers/who_outbreaks/

The EHI CCIO campaign is now truly in full swing with an announcement of the first 3 clinicians into this role and a personal endorsement from Andrew Lansley, Secretary of State for Health.

There is going to be a lot more on EHI Live 2011 here over the next few days and weeks but I would like to finish by highlighting the OpenEyes Project.

OpenEyes

OpenEyes is a collaborative, open source, project led by Moorfields Eye Hospital. Carl and I had the pleasure of meeting Mr Bill Aylward, Consultant Ophthalmologist and creator of OpenEyes who personally demonstrated the system to us. Our jaws dropped countless times as he showed us the capabilities of the system and how it truly enriched the doctors workflow and personalised the consent and shared decision making process with patients. I hope to be able to do a whole feature on this system with some personal insights from Mr Aylward.

Imagine this:-

  1. Patient attends with a lesion around his eye.
  2. A photograph is taken with an iphone.
  3. The photograph is immediately transferred to the patient’s electronic patient record. (Yes. Really!)
  4. The doctors annotates the picture on the computer screen.
  5. The history and examination is recorded logically and electronically.
  6. A diagnosis and management plan is entered.
  7. A GP letter is ‘magically’ generated from all the above information and immediately emailed/ faxed.

This system is going live in a few weeks time at Moorfields and 13 satellite clinics.

You can read more about OpenEyes in this recent Guardian article. Oh yes, you can even collaborate on this project now and improve it as the source code is free for all to see.

Thank you EHI for a great event and thank you OpenEyes for showing what’s possible when great people work together to achieve great things. And this is just the beginning…..

 

I need a brain scan.

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The failure of the NHS IT programme to deliver on it’s promises originally set out in 2002 has been well publicised and I would not re-iterate them. Instead I want to share one of the many experiences that I have using NHS IT everyday as part of my work in an acute NHS hospital.

My hospital has electronic ordering system for scans. Below is a representative process of ordering a CT Head Scan.

  1. Find a free computer to log-on to.
  2. Find the application icon for ordering.
  3. Log-on again into that system.
  4. Put in the patient hospital number.
  5. Find the correct scan to pick.
  6. Specify the consultant.
  7. Specify my identity.
  8. Specify my contact number.
  9. Insert clinical reasoning behind the request for the scan.
  10. Specify the urgency of the scan.
  11. Find a printer and hope it works and has paper.
  12. Print the completed form generated by the computer.
  13. Walk out of the ward to find a radiology doctor to authorise the form.
  14. Line-up whilst the radiologist deals with other requests.
  15. Discuss the request with the radiologist who approves it by scribbling it on the printed form.
  16. Take this form to the CT Scanning room.
  17. Try to convince the staff in the CT Scanning room to prioritise scan.
  18. Staff in the CT scanning room has to re-enter data into the radiology system.
  19. Return to the patient on the ward to explain that we hope that the scan can be done urgently but we cannot say exactly when.
  20. Frequently check on the patient throughout the day to see if the scan has been done.
  21. Log-on frequently to check if report of the scan is ready.
  22. Let the patient know the scan results and decide on what to do next.

If you are a non-health professional, I hope that this real-life example shocks you.

If you are a doctor, I hope this shocks you but my concern is that this scenario is so common throughout the country that it no longer has that effect.

My personal opinions are that this system:-

  1. Takes away valuable time that I would like to spend with my patients to help them make sense of what is going on in an uncertain time of their lives.
  2. Increases the anxiety of patients by introducing uncertainly about when they scan is going to be done and how long they have to wait for the results.
  3. Exhausts unnecessary energy that could be better spent thinking about solving clinical problems and treating patients.
  4. Does not realise the potential power of an electronic system.

This is just not good enough; not good enough for the doctors, not good enough for the patients and not good enough for the general public.

Something has to be done.