Computer chaos

Have you ever had your broadband connection fail? These days if that happens you feel really deprived. Dr Grumble got his connection on the very first day his local exchange was enabled. It seems ages ago but it was only a few years back. Now, if his connection fails he cannot blog, he cannot email, he cannot read the newspapers, he cannot bank, he cannot do his shopping and so on. We have become very dependent on computers. If you call in at the petrol station and the computers are down there is no way you can pay. If you are in a hurry and offer to leave them some cash they threaten to have you arrested. They can't even work out the change without the electronic till. In a very short time we really have become extremely computer dependent.

When it comes to computers the NHS is behind. In hospitals anyway. GPs, being empowered, have been ahead of the game. Primary care in the UK is heavily computerised compared with, say, the US. (UK 89% v US 28%). Why are hospitals so behind? There are various reasons but one problem is that they haven't been able to get on with the job because of all the national initiatives going on around them. When it comes to computing government has a bad record. Sadly there are no signs of improvement.

Some of the recent problems that have been encountered seem familiar to Dr Grumble. They arise from a failure to engage clinicians. Take the issue of smartcard sharing. Dr Grumble thinks this is unforgivable but he believes this sort of behaviour in the NHS to be rife. Only last week Dr Grumble was tentatively asked to give his login details to somebody else. He declined. People about to leave the hospital may agree and that is how they can be found to be logging in long after they have emigrated to work in the antipodes. These things happen all the time. And if you are a clinician it is easy to see why. It's even easy to see that it is inevitable.

What happens is this. A locum doctor arrives at 11pm on, say, a Sunday. Locum doctors tend to plug gaps out of hours so there is less than a 24% chance of the doctor arriving during normal working hours. He arrives without being sure of where he has to go or what he has to do. He takes over from a departing doctor who is keen to get to bed and he asks how to get into the computers in order to access the information he needs to manage the patients. Getting a smartcard is either not possible out-of-hours or nobody actually knows how it should be done. Just at this moment there is a cardiac arrest. The inevitable then happens. The smartcard along with the PIN is quickly passed to the locum who will leave it in a drawer for the morning. That's how it happens. There is no other way.

In reality it is much worse than this. In some hospitals multiple programmes are needed for patient care and there are multiple log-ins and passwords. They time out rapidly. Doctors in outpatients will look at a radiograph, then blood tests, then, say, the appointments system or a recent discharge summary, then there are a few tests to order. Each requires another programme with another set of log ins. By the time the next patient is in all these programmes have timed out. Logging in takes an eternity. If you tell people about this problem nobody listens or they don't want to listen because they will be responsible if computers are left idle and unauthorised people can get in. It is worse than this because you have to keep changing your passwords and they cannot be synchronised. Dr Grumble cannot even work out for sure how many hospital passwords he has on the go but it is at least eight and they keep changing.

Computing in the NHS is a dog's dinner. It needs sorting. One thing it doesn't need is any more money spent on it. What is needed is real clinical engagement.