A Consultant's Eye View (3 Nov 2006)

From Nhs It Info

I am a Consultant Physician with considerable expertise in clinical systems. I also am an experienced clinical user. I am writing to explain why I have been so disappointed and concerned after my training sessions on an NPFIT Clinical Records Software system (CRS) featuring a Patient Administration System (PAS) and Orders and Communications. My fear is that should we "go live" with this system, our hospital might close down within hours.

As soon as the contract for NPFIT was awarded in our cluster, I contacted the supplier, inviting systems analysts to come and spend time with me in the clinical setting, so that they could learn how clinicians work. I know that to make a good system the supplier must understand the processes and end users. I also know that clinicians are poor at explaining their activities and how these vary by individual, speciality and hospital.

In response to my invitation, I was invited at short notice to numerous meetings in distant places. In the 18 months of the project, only one supplier employee came on one ward round for one morning. A few months ago, I had my first glimpse of the system and asked how it would work in outpatients. The supplier's consultant asked "What is outpatients?" It worried me that the supplier did not seem to know about something so fundamentally common to all UK hospitals.

Two months ago, I was involved in a training pilot of the CRS. I found that the system could not produce a list of all the patients' under my care in the hospital. In a more recent training session, I was taught how to write a query to list all my patients on screen, but I am not allowed to print the list out; the list on screen does not show what the diagnoses are. The situation appears far worse for nurses.

In the new system, routine processes, such as logging into the system, discharges, room booking and follow-up appointments are complex, sometimes incomplete and laborious. By laborious, I mean that processes that currently take seconds take minutes on this new system. A specific example is routine ordering of blood and urine tests. It was unclear who would receive the results or even if the samples were ever taken. I ordered a standard set of bloods and a urine test and had to enter 23 mandatory fields to complete the order.

I was dismayed as were several other senior clinicians and expert IT users around the hospital. I see a system with no evidence that anyone in the supplier's team has observed UK clinicians at work, or probed to understand what we do. There appears no understanding that confidentiality in medicine is to do with not disclosing information under an ethical and legal code, rather than not knowing the information. I believe that I saw an unusable system, which would have slowed every process in the hospital to the point where we could not handle the daily clinical emergencies and routine care. Their plan was to switch our PAS off for six days and revert to manual mode while the new system was installed!

What would I suggest as a starting point for a nationwide CRS? I suggest a single web page for every NHS number holder, on which are their demographic details, current significant medical health problems and an alphabetical list of drugs, doses and frequencies, and significant allergies, with one free text comments field. This tiny quantity of data, updateable on one page, would transmit so much useful medical data to make patient care more safe - ask any doctor or nurse! If these data could be linked to clinic letters, discharge summaries, etc, its usefulness would be enormous. If we understand each other and work imaginatively we can crack this apparently insoluble problem!

Dr Gordon Caldwell FRCP

[A copy of this note has, at the author's request, been forwarded to the PAC]

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