Our first batch of readers’ comments on the National Programme for IT in the NHS brought some interesting replies.

The discussion started after IT tsar Richard Granger asked, in the course of his speech at HC2003, whether there were any alternatives to the direction of travel set by the National Programme.

Our first correspondent took up E-Health Insider’s challenge for some female readers to join the conversation.

“I can not resist any challenge to urge females to have their say! I think the national programme will be good for the NHS, as it will at long last ensure we are truly supporting the patient journey across the care continuum.

“I agree with a previous reader that the success of the delivery of the Integrated Care Record Service (ICRS) will depend on the ability to manage change locally. I too am concerned about the modernisation programme being distanced from the ICRS programme, as we cannot hope to achieve the aims of the NHS Plan if the two are in isolation.

“My issue, though, is more around the expectations/demand from local modernisation groups and the inability to have the technology to support what they want in the timeframe they need. With the phasing of the ICRS, I have some difficulty seeing how the two are aligned and it just seems to say, ‘Levels of an EPR’ again. I sincerely hope that there will be some flexibility to allow sites, if they have the capability and capacity, to do the phases in a more rapid timeframe, or even pull out things from a future phase.

“If modernisation [groups] are looking at ‘new ways of working’ shouldn’t that be said for IT and health informatics professionals as well? It would seem to suggest the time is here to have innovative ways of delivering IT solutions. Let’s have ‘fast track’ implementation; it is being done elsewhere, so why not in the NHS?”

A “frustrated LIS co-ordinator” replied to complaints about lack of consultation…

”I would take issue with the alleged lack of consultation over the National
Programme. The draft ICRS and procurement strategy were widely distributed
last year and comments invited, I wonder how many of the people complaining about the lack of consultation actually responded? I coordinated responses in my LIS area and about 85% of IT managers were too busy to respond.

”We have two alternatives, we can debate and procrastinate till the cows come home and agree in principle that "something should be done" – or we can get on with it!

”As a LIS Coordinator, I lost count of the number of meetings and conferences attended at local, regional and national level over the past few years where everyone has agreed that something must be done, only to find that the promised resources have withered away with little or no central guidance and direction so far as implementation is concerned. There have been obvious exceptions – the Pathology Messaging Implementation Project springs to mind – where a strong national lead has been given, resources allocated and results delivered.

”Yes we do need to engage clinicians, but they are very busy people who are as fed up as everyone with empty promises and will only be interested in
engaging in debate when we have concrete proposals to discuss.”

Right on cue, a clinician wrote…

”I have just come from a ward where I left three nurses whose time had been diverted from patient care to try and process a laboratory form for an MSU (a urine specimen). It was not one of the relatively frequent periods when everything is down, but they all bemoaned the fact that it took 10 times longer than it used to take to fill in a paper form.

”The quality of the current IT product is so poor, with myriads of unnecessary key strokes, that it is a constant source of frustration. Everybody adapts to using it but it is not necessarily better nor does it justify the massive outlay and ongoing maintenance rip-offs that follow.

”The potential dumbing down to a national specification is frightening unless there is the facility for an individual Trust to "add on" their needs easily to help clinicians rather than the current obstacle course we have to run.

”There needs to be an ergonomic evaluation of every proposal with front-line clinicians of all grades using the system to reduce unnecessary key strokes and find out how to help them and the patient, rather than the imposing of bad systems.

”There also needs to be a real evaluation of what exactly we are aiming for, i.e. paper-less or utilising the advantages of paper where it is best…
The majority of clinicians find it easier to read and handle paper documents.

“The good paper record with colour-coded edged paper for different specialties and the essential letters filed separately in chronological order gives an instant analogue awareness of the other disciplines involved with the care of that patient.

”Flicking through the letters is much quicker than trying to find the right screen and not being aware of what else is hidden in the computer. At the same time laboratory-generated results are ideal to be stored in the spine for information when needed.

”The analogy which some of you may have experienced is trying to book the next game after a game of squash. The person with a paper diary is at least 5 times as fast and more flexible in checking through available times, and quicker to enter the new data than the opponent trying to find the right screens in his electronic diary.

”Doing a ward round and moving from bed to bed needs the fastest access to information, and the facility to enter rapidly the new information obtained at the bedside. Tablets do not appear to give this flexibility and we need to study with genuine clinicians the optimum interface with paper and the computer. One cannot have enough memory to look at a computer away from the bedside and retain enough information in one’s memory safely. The paper-less statement of intent does not seem to be the best for patient or clinician.”

Any comments on these contributions or further thoughts? Send a note to: comment@e-health-media.com
Comments may be edited before publication.