18 October 2008

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.


BenefitScroungingScum said...

I've noticed this problem at every appointment I've been to recently, at what seems a much greater level than even 6 months ago.
In an outpatients appt the poor locum consultant just could not work the computer system. Eventually with the help of nursing staff, medical student and myself we all figured out how to get various tests ordered and details entered, but it took longer than the actual consultation time to do.
Even with my regular consultant who does not have the disadvantage of being older than the NHS it still took a ridiculous amount of time to work the computer systems.
In GP land I'm not sure it's much better-at an appointment with the practice nurse it turned into a computer tutorial because she was so stressed about being unable to work the shiny new system. It did seem ridiculous as for flu jabs (with the same batch number etc) there was no way to cut and paste, each set of numbers had to be inputted for each patient. Time consuming and more likely to cause mistakes I should think.

I wonder if one of the reasons this situation has continued is that despite the hopes of politicians and the media, your average person has such a high degree of trust for doctors and nurses they probably won't question these issues.
Bendy Girl

Dr Grumble said...

It's great to have these observations confirmed from the patient's point of view. Dr G is embarrassed at how he has to struggle with the computer systems in front of patients who must assume that because of his great age he is computer illiterate. He stifles his curses in front of the patients but lets forth at the receptionist who tells him that he is not the only one to be held back by the technology.

Patients may think consultants have the power to rectify these problems. They don't. We need patients to complain for us.

Improvements could start by having a single log in which does not time out between patients. To be fair the Grumble hospital is working on this.

Anonymous said...

As a long-time IT geek, I just had to wonder who made that decision. Is there someone in the upper echelon of the NHS with an interest in a smartcard vendor? Vendors of same seem to be the primary beneficiaries of large smartcard implementations. Single sign-on (SSO - one user name and password logs a person on to the systems s/he is permitted to use) has been around since IBM mainframes. Unfortunately, SSO is not often implemented for new(er) and/or small(er) systems. I suspect that the perceived increase in IT administrative overhead and the multiplicity of various (and possibly incompatible) systems that would interface with an SSO system could be to blame. Why not use biometrics (e.g. fingerprint readers, scanners that read blood vessel patterns in the palm, retinal scanners)? Are biometrics too invasive of privacy, as the biometric data must be stored somewhere? Biometrics would help with the locum, phantom employee, and vanishing cards issues. In any case, it would still be necessary to have some criterion for password re-entry after x minutes of idle time - you really don't want somebody messing around with your patient's data. Eiminating the time out could lead to unintended results for both you and your patients.

Anonymous said...

"Single Sign-On / SSO" (as our Anonymous IT person puts it) is how the University systems I have used all work.

Our local equivalent of the "8 separate **!!dy passwords" problem is loads of keypad locks on lab and office doors, all of which need a different code. We have in the past sometimes been reduced to dismantling them after most people (esp. building admin) have gone home and re-setting them all to the same number.

Anonymous said...

slightly off-topic, but this case demonstrates how staff aren't even writing notes in some cases - it's the most recent entry to which I refer.


Dr Michael Anderson said...

It's an utter joke I thought I had it bad, but 8 passwords is just stupid.

Like you say, they've been "sorting it out" since I was in medical school and the system is a worse mess than ever.

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