Improving the use of IT in the NHS

I used a cash machine in Ecuador a couple of years ago and managed to withdraw $3 from a cash machine when I meant to withdraw $300. The next attempt delivered the $300 I wanted. Five minutes later my mobile phone rang. It was from someone at Natwest Bank, calling to ask me whether I was in Ecuador and whether I had withdrawn $303 dollars in the past 10 minutes. That distant transaction had automatically emailed a fraud investigation officer somewhere in a UK call centre.

A combination of things are required for such a response, but it made me think that rather than just being about the big technical things, such as shared global banking networks, it was also because of the little things, like the fact that my mobile phone number was up to date and that someone had the vision to use what is probably a relatively simple algorithm and alert system to save what, I imagine, has been millions of pounds of defrauded money.

Either way, as a customer I was very impressed with the way in which my bank used information technology to make me feel really valued as an individual customer.

As someone who works with the NHS, but also as an occasional user, I am less impressed with the way in which computer technology makes me feel valued as a patient. It might be expected that as a man in my 40s my medical history should be scattered across many hospital and primary care computer databases and paper records. But my 5 month old son, who was born in one hospital and then admitted to another a few weeks later and has had a couple of visits to our GP, is almost certainly in the same situation.

Despite many years of increased spending driven by Connecting for Health, the Department of Health’s directorate for computer services, IT in the NHS remains a patchwork quilt of poorly functioning, disparate, and unconnected systems. Many hospital systems are so old that they are held together by workarounds, faxes, and parallel paper systems. They are desperately in need of replacement, but publicised failures of new system developments provided by the NHS’s national programme for IT have created a well founded fear of introducing change.

A great emphasis is placed on the failure of the new systems themselves—that is, poorly functioning software and hardware. However, while there is no question that the suppliers have made mistakes and that some of the criticism is justified, a broader set of problems have combined to make success very difficult to achieve. I believe that even without technical problems with hardware or software, the national programme would remain substantially unimplemented.

A number of things can happen to improve the situation. Firstly, organisations can improve dramatically their response to the national programme. Too many NHS leaders have said something along the lines of “my strategy is the national programme for IT.” I can think of no other industry where managers would be so content to hand over the control of implementing the core operational computer systems of their business to a third party.

The assumption that suppliers and recipients of new systems have a shared interest is not quite true. Suppliers want to implement systems as quickly as possible and move on; recipients would like suppliers to stay around longer to ensure that systems work correctly. NHS organisations need to ensure that they possess strong, experienced local implementation teams that represent the interests of that business, hold suppliers to account, and keep them honest. Some obvious examples can be cited of a lack of organisational effort up front resulting in huge costs later, as hospitals spend a small fortune on management consultants to run clean-up programmes, lose revenue because activity was not captured, risk the safety of patients, and absorb huge amounts of management effort.

Secondly, the quality of IT investment, planning, and strategy in NHS organisations must be improved. Only when organisations take more effort to understand the role that IT has in supporting their business strategies will they force suppliers to adopt a more pragmatic, tailored approach to deployments. There is certainly a debate to be had about whether IT directors should always sit on the executive management teams of NHS organisations. Given the monumental importance of good information to effective medicine and efficient health care, I am surprised that more are not.

Thirdly, the quality of local risk management needs to be strengthened. I am certain that other forms of investment in the NHS (such as construction projects funded by private finance initiatives) are subject to much more rigorous levels of risk management. Evidence of local assessment of the effects of IT failure on trusts, their staff, and, most importantly, their patients is scant. A little more effort in this area would help NHS managers predict and prevent some of the problems.

Finally, the clinical engagement model must be changed. Clinical engagement has become a byword, something that translates roughly as “talking to doctors and hoping they tolerate these computers that we anxiously hope will work properly.” This is not the fault of Connecting for Health; doctors themselves should step forward as leaders of innovation and exploitation of the national programme for IT. Too few have been prepared to see the initiative as a real opportunity for their organisations and their patients. Many have, at best, been passive or indifferent or, at worst, have gleefully displayed their schadenfreude as failures have arisen. This reaction has been compounded by the stance of the professional bodies, often negative and unhelpful, when being positive and supportive might have made the difference.

This is important now, because the NHS faces a new set of efficiency challenges. Past years have brought painful reforms, but the changes have been well funded. The next few years require a continuing drive to provide improved access and enhanced quality with less new money.

The NHS needs more investment in IT, not less. Efficiently used, money for computers can save the NHS a fortune by reducing staffing levels and supporting the efficient use of assets. It can also help provide a service that patients find impressive rather than depressing. An opportunity exists for managers and doctors who work in frontline NHS organisations to get a better grip of their requirements and to invest adequately in local resources and processes, particularly proper risk management.

Once they start to do this, I am convinced that there is a real chance of some really successful implementations, which in turn will create a renewed confidence in computer technology in the NHS.