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.
- Find a free computer to log-on to.
- Find the application icon for ordering.
- Log-on again into that system.
- Put in the patient hospital number.
- Find the correct scan to pick.
- Specify the consultant.
- Specify my identity.
- Specify my contact number.
- Insert clinical reasoning behind the request for the scan.
- Specify the urgency of the scan.
- Find a printer and hope it works and has paper.
- Print the completed form generated by the computer.
- Walk out of the ward to find a radiology doctor to authorise the form.
- Line-up whilst the radiologist deals with other requests.
- Discuss the request with the radiologist who approves it by scribbling it on the printed form.
- Take this form to the CT Scanning room.
- Try to convince the staff in the CT Scanning room to prioritise scan.
- Staff in the CT scanning room has to re-enter data into the radiology system.
- 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.
- Frequently check on the patient throughout the day to see if the scan has been done.
- Log-on frequently to check if report of the scan is ready.
- 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:-
- 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.
- 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.
- Exhausts unnecessary energy that could be better spent thinking about solving clinical problems and treating patients.
- 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.
Excellent post! Succinct, precise and drives home a vital point really well. This is precisely why clinicians in general, and doctors in particular, need training in process improvement and lean – because they are in the best position to experience the problems on the frontline and drive both culture and process change to make systems more efficient and effective. Non-value adding steps in the process simply need to be eliminated after taking into account their interlinks with other processes in the system.
@drsuparnadas
If doctors did not password share and the systems logged off after user walks away e.g. NHS SmartCard or similar Single Sign-On… then you’d be able to prepopulate the form with the users’ credentials, push it to the Radiologists’ shared RIS inbox for authorisation, prioritisation and push to CT.
To those non-medics, there are ingrained practices from the days of hard copy xray films, such as pulling up the image for the Ward round, and walking away with the machine and application logged in, the image up for when the Consultant is ready to see it 10 minutes later.
These practices are why the system is configured not to automatically pull in the current userID.
Dear Wai
Great blog post. It’s amazes me when you actually write down all the steps. Alot are unnecessary but checks and balances do allow for the safety checks and appropriate use of CT. I staggered that the online systems in place in lots of hospitals still require printing of the request. Not only does it waste time but the NHS wastes so much energy. As one of the largest organisations in the world I dread to think what it’s carbon footprint is!
It’s interesting to read your thoughts on how IT slows down the basic medical role. Full “order comms” for electronically requesting radiology specifically shouldn’t involve the printing of anything for a consultant radiologist to sign. If the IT solution is properly researched and implemented, the user information could be automatically populated and the permissions set to allow junior doctors to request (subject to any local radiology protocols).
Thank you for the interesting article. It seems that there is plenty of opportunity to improve the process workflow here…
Steps 11-18 strike me as an incredibly inefficient use of resources and resolving these would require investment from all the parties involved (domain experts such as doctors from both requester and requestee user roles) as well as the systems integrator responsible for the upkeep and maintenance of the existing software.
Step 20 could probably be completed as a simple feature request by the current systems integrator (send an email or a text message to the requester’s contact number/address upon status change of the original request).
The earlier steps 1-8 could be streamlined via the use of barcodes, RFID or simplified as VJ suggests above with single-sign-on.
All the best,
Mike Wilson