As a hospital doctor, I have been treating NHS patients up and down the country for the past seven years.
Along the way, I have been exposed to a variety of IT systems. These systems often leave me and my colleagues with a feeling of frustration. Frustration with their poor reliability, poor user-interfaces and – most of all – with the lack of consideration about the way we actually work in the process of treating patients
I wanted to understand why this was the case. After reading many articles, blog posts and books and holding many conversations, I realised that one factor was consistently identified as a pitfall: the lack of clinical engagement.
When I talked to them, clinicians used engagement to mean the involvement of healthcare professionals in the development of software and in the feedback process after deployment. Hospital managers tended to see engagement as getting the input of clinicians in IT procurement and strategic decisions.
In my opinion, engagement goes much deeper than this. Engagement should mean clinicians and IT professionals working together towards a common goal of improving the value and quality of patient care.
But before this can happen, an open and honest conversation is required. We need to recognise that there is lack of confidence and cynicism towards IT vendors amongst clinicians.
This stems from the well publicised failures of the multi-billion pound National Programme for IT in the NHS, and from that daily experience of using IT systems that fall far short of their potential.
Let’s start engaging
In my first act of engagement, and as part of my call for an open and honest conversation between clinicians and the health IT industry, I will begin by laying out a few of my own observations and thoughts.
1. IT vendors are heavily focused on winning contracts based on a promise of delivering specifications instead of on delivering quality software.
This stems from my observation that a lot of systems promise a lot but their execution can leave a lot to be desired. For example, I have come across a blood result reporting system that had a 30 minute delay between the results being authorised on the laboratory system and their appearing on the reporting system.
I have also heard of an electronic prescribing system that cannot safely handle insulin or warfarin prescription; leaving clinicians to work with a hybrid of paper and electronic prescriptions, with all the resultant risks to patient safety that implies.
2. There is no robust framework for assessing the quality and value of healthcare IT systems.
Business cases for IT systems are often based on arguments about how they will facilitate safer and more effective patient care and potential cost savings. However, there is no recognised governance framework for actually measuring and monitoring whether they do this. As long as this continues, there is no way of holding IT vendors to account for the quality of their software.
3. Not enough priority is given towards enabling easy interoperability and data exchange.
It is not in the interest of some incumbent vendors to make it easy or affordable for other software to interoperate or exchange data with them. This increases the barrier to entry for other developers, which can develop innovative IT solutions to fill gaps in the functionality.
4. Most health IT software is not responsive or flexible enough to serve the ever changing and varying needs of healthcare professionals.
Healthcare delivery is an ecosystem that continuously changes as it adapts to the changing needs of the population and improvements in care delivery. They are not designed to be readily adaptable for the future but are instead focused on the needs of the present. Furthermore, the vendor may choose not to develop a particular change request if it did not align with their business objectives.
We must be clinical leaders
As a member of the clinical community, I feel that we are equally responsible for the situation that we find ourselves in today.
With a few exceptions, we have not actively participated in IT related decisions, either within our hospitals or nationally as a united voice.
Neither have we equipped ourselves with the knowledge or skillset to do this effectively. We must recognise that as the process of healthcare delivery become increasingly digitised, technology will both enhance and constrain the way we deliver healthcare.
A call to action
To my fellow clinicians, it is time to become participants and not just commentators in this process. A good start will be to take part in the NHS Hack Day.
To our employers, it is time to recognise that IT will increasingly influence the way we deliver healthcare. A good start will be to invest in the employment of a chief clinical information officer.
To CCIOs, it is time to come together and influence the national health IT agenda to ensure that it prioritises the quality and affordability of patient care above other interests.
To health IT vendors, the points I make above are wholly my own; but all strong relationships begin with honesty and openness. Then, we can start exploring how you can help us become better healthcare professionals and me, a better doctor.
About the author: Dr Wai Keong Wong is a physician specialising in haematology and a national leadership and management fellow. He is on secondment to Bupa as part of the NHS Medical Director Leadership and Management Scheme.
In addition to this, he is chair of the project board of the joint BCS, The Chartered Institute for IT and DHID project to create user guidance for safe keeping of their electronic health and social care records. He sits on the CCIO Leaders Network advisory board as the representative for doctors in training.
He blogs at blog.openhealthcare.org.uk and he tweets as @wai2k