Columnist Dr David Turner on the computerisation of the NHS
Now, I would say I don’t trust computers further than I can throw them, but that wouldn’t be true. There are days I reckon I could win a gold medal at PC-lobbing, if the Olympic games ever introduce such a category.
Computerisation may be the best thing since sliced bread in some areas of human endeavour. But in the NHS, in my experience, IT is at best a necessary evil and at worst a malignancy. I don’t use these words lightly; I mean by this that computerisation is allowing the powers-that-be to snoop ever more intrusively into our work in primary care.
There seems to be an assumption that any task that can be done electronically should be done that way, and that the computerisation of things is always better. This is where the naked emperor comes in; both of those assumptions are nearly always wrong in the NHS.
Don’t take my word for it. A quick flick through recent news stories should be enough to make us very worried about entrusting ever-increasing amounts of healthcare data to electronic circuitry. Patient data being leaked by cyber attacks, IT failures causing patient death, and cover ups just to name a few.
These are the big picture problems with IT. The smaller stuff is the everyday irritations that grind us all down. The 10 minute wait to log on in the morning. The frequent computer crashes during the working day. The electronic referral forms, which seem to be designed as a test of GPs’ patience and persistence – the reward being that your patient may get put on a several month-long waiting list to see a specialist, who will invariably bounce the patient back to the GP with A&G, and a list of jobs for the family doctor to do unfunded. I often daydream about when I used to dictate referral letters. When I would address a specialist by name and – yeah, this is the weird part – tell them what was wrong with the patient and why they needed to be seen. Halcyon days indeed.
Computerisation was sold to us as a means of making healthcare easier to deliver. And at the most basic level (legible notes and repeat prescribing) this might just be true. It is everything that has happened in the IT development of our systems since this point that seems to have been designed to data harvest and spy on us and at the most sinister level, ready us to be hoovered up by the private sector.
If you need evidence for my paranoia, you need look no further than the recent events concerning the emergency action to warn practices to urgently switch off the GP Connect Update Record function on their IT systems. We were advised that NHSE were about to disable this switch-off option. Potentially this could lead to third parties entering data into our GP records, which we (as data controllers )would have responsibility for and ironically no control over.
It would be hard to imagine a better example of an Orwellian/Kafkaesque hybrid scenario playing out in front of us.
Or maybe I just can’t recognise a nice new outfit of clothes?
Dr David Turner is a GP in Hertfordshire
David – sad to say you already are fully responsible for the patient’s record and have no control over it. It is hosted at a remote server, over which you have no control, and you are only allowed temporary and dhort-term partial access to it. You no longer have any say over it at all, other than temporary permission to edit some parts of it. Do you even know where Mrs Thomas’ electronic records are stored?
indeed it was so much better in my day, why did we ever get rid of faxes, signing FP10 and printing out referral forms, phoning patients to tell them of results or even better writing a letter. Everything was better in past….
I don’t think Dr Turner fully acknowledges the fact that without computerisation modern primary care would be impossible. There is no way paper-based systems could handle the volume of prescribing and monitoring that happens daily, nor the complexity of maintaining a modern medical record. Imagine trying to navigate records if the patient’s “problem list” was still a card at the front of a folder of papers.
Now some might argue that a return to minimal investigation, minimal documentation and minimal intervention might be a good thing. But I think it would be difficult to make a persuasive case to that effect.
There’s some binary thinking going on in the comments section but, hey ho, binary thinking is a thing Drs are prone to. Nobody is suggesting a return to a fax machines and paper records. The idea put forward in the article is computerisation is increasingly used to expand third party control and monitoring, and isnt all fantastic, thats all. Anyone who used to use EMIS LV will know that that was an IT system. It was ugly, it was (apparently) difficult to extract data from, it was pretty inflexible but it almost NEVER crashed, took 30 seconds to log in, could run fast on a computer with less grunt than a modern £10 mobile phone and you could record an entire consultation in less than 20 seconds. That was “IT” too..and from a basic data entry, GP consultation user interface perspective it was 300% more efficient than the centralised, monitoring obese sloth that is the “upgraded” windows variety. Not all IT is good IT. Mission creep, third party interference and loss of control is what much if modern IT is. If you didn’t know that you don’t know that. Think on
What I do clinically as a GP hasn’t changed. I still take a history and examine the same way. I don’t need computers for this, but they have given easier access to a continuous patient record and ease of repeat/prescribing (over paper records). EMIS LV was sufficient.
An IT system that does anything more is not for GPs but for the researchers, the auditors, the managers, and data collection for IT, Big Pharma and soon AI corporates. Our power as data controllers is a fantasy. We’ve been hoodwinked into accepting bloated IT systems (SystmOne in my case)
Computerisation has also enabled remote working, so we are now never off duty. Patients and the media complain bitterly about remote working but also expect their GP to action all their requests immediately. Add onto that the constant IT problems we experience and you have almost continuous low level torture. AI & fit for purpose IT is undoubtably the way forward but with accountability to IT providers & reimbursement for any time spent by practices sorting out problems – otherwise there won’t be any GPs – only AI
This weeks BMJ rapid responses have CEO from a company that provides software for third parties to write in GP notes complaining that GPs are trying to block his product and this will harm care……
Introduction of computers mey have been presented as a means to improve care for patients, but in reality the main role has been to monitor and hence control the practitioners.
https://www.bbc.co.uk/news/live/cnk4jdwp49et
No working computers today. Not able to help our patients as no notes!
Q.E.D.
Very prescient David. It’s much easier. See the patient, say hello, smile, write the script , open the door for them and say goodbye . No answerphone messages , no text messages, no consultations. Workload crisis solved and patients much happier 😁
*was supposed to say no e-consultations*