Why is health care in the 21st Century still so… analogue?

Rachel Harries, tells us more about the ways technology can improve NHS services and our report Informatics Systems in NHS Wales says it can do better

The white heat of modern technology has transformed the way we live in many ways, including advances in medical care, but if we consider how that care is delivered, the nuts and bolts of record keeping and logistics… it’s been more of a slow burn.

In some places across Wales, you can book GP appointments or repeat prescriptions on line, and doctors will access the information they need through their PC or tablet. Elsewhere, big chunks of the NHS still rely on physically moving hard copies of reports and x-rays around, by post or in some cases by fax. It’s hardly cutting edge.

To find out more, we had a look at Informatics in the NHS (which is more interesting than it sounds, honestly).

Informatics is “the science of processing data for storage and retrieval; information science.”  In the context of our report, it means all the software being used across the NHS in Wales to book appointments, record medical tests and results, store scans and x-rays, as well as the infrastructure that allows this massive amount of information to move around the system and be available to the people who need it, when they need it.

In Wales, there is an ambitious vision to join all this up so that all the separate parts of the NHS become, from the point of view of the medical professionals or patients, seamless. There won’t actually be one single record for each patient, but the various parts of the system should work together as if there was. So if your GP refers you to the hospital for a test, your GP will be able to see the results of that test from their surgery. If you have an x-ray done in one hospital, a doctor in another hospital will be able to see that x-ray, even if the first hospital is in a different health board. As a patient, you won’t have to give the same information to lots of different people, because the information will be recorded the first time in a way that allows other people to access it. When you come out of hospital, the pharmacist will know that you will need all your regular prescriptions again, and will know if any of your prescriptions need to change as a result of your hospital stay.

It’s obvious that this is a very sensible idea, but like many things that sound obvious and sensible, it’s a bit more complicated than that. Linking up all these different systems is actually really difficult, it’s taking a long time to deliver and clinicians are becoming increasingly frustrated with the whole thing. They told us about existing systems that were time consuming to manage, missed deadlines for improving or replacing systems, and new systems that, when they arrived, didn’t do what they were hoping they would. All of which meant that clinicians were spending time wrestling with IT when they wanted to be treating patients instead.

There’s frustration on the other side of the fence too, that clinicians can’t or won’t find the time to get involved in developing systems, so developers won’t always know what clinicians really need. Meanwhile, health boards historically haven’t given informatics and IT as much priority as they deserve, so developers are trying to install new systems on ancient infrastructure that can’t cope, or health boards don’t prepare properly or train their staff to use new systems. The bottom line is that everyone has a part to play to help move things forward.

So what can be done to make things better? Our report found that the NHS in Wales is clear about what it wants to achieve, and has put some key elements in place, but there have been significant delays too. There have been some important developments while we were completing our work but there are still some key weaknesses in terms of the governance, support and oversight arrangements. It’s not really clear how much we’ve already spent on this (but based on the information we’ve got – probably not enough), how much it will cost to deliver and whether that’s affordable – or whether we can afford not to do it. Nor is it clear who’s responsible for making sure that once a system has been designed, clinicians are able and willing to use it – doctors are busy, and if it’s quicker and easier for them to use pen and paper, that’s what they’re likely to do.

It can improve – you could argue that it must if the NHS is going to use its finite resources efficiently. But in order to get there quickly enough, the NHS will have to have some difficult conversations about where the money is going to come from to help move things forward, more honesty about what hasn’t worked so well and why, and more clarity about who is responsible for what. If the NHS can get that right, our experiences of health care should start to get less analogue and more space age.

About the author
Rachel Harries is a Performance Auditor in the National Studies team and has worked for the WAO for three years.

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