PATIENT RECORDS
has not. Health care generates a huge amount of information but the value of the information decreases rapidly. It is important now to know how a patient slept last night or their current haemoglobin. In six months’ time this information will be worthless.
Electronic health records require a huge investment in data capture and this is taxing for frontline staff. They are expensive to keep secure and accurate and for the most part contain largely useless information.
and effective that health informaticians confidently promised? Thomas Edison allegedly said: “I have not failed 700 times. I have not failed once. I have succeeded in proving that those 700 ways will not work. When I have eliminated the ways that will not work, I will find the way that will work.”
While it is also possible to find areas that could be improved, NPfIT did many things right. Management was reasonable. There was substantial political backing and sufficient financial resource, procurement was honest and robust and contractors in the main diligent. One failing that has been identified is lack of clinical consultation.
Clinicians as a group are not shy and inarticulate and the views of clinicians are well known. Clinicians do not storm into hospital managers’ offices to complain about antiquated paper-based information systems and to angrily demand more IT investment.
When summary care records Sep/Oct 10
were being uploaded, the BMA was concerned about issues of patient consent and recommended the upload of records be suspended. They did not urge that outstanding issues be resolved rapidly because lives would be at risk if summary care records were not available. US clinicians use pen-and-paper because high quality electronic patient records are not that important for clinical care.
It’s not that health
informaticians do not consult clinicians. Clinicians’ views are ignored because they are not what informaticians like to hear.
The truth is that clinicians are not punters. They do not study a patient’s ‘form’ in order to determine how a condition will progress. Clinicians are more like airline pilots, dealing with the the here-and-now. It is important to know the aircraft’s current height and airspeed. Its height this time last week is of little interest.
There may be good economic reasons why retail banking has computerised and health care
When this is taken into account the overall value of electronic health records may well be negative and putting in more IT investment may actually decrease the efficiency and flexibility of the health care system.
Is the focus of health care IT investment simply wrong? Instead of investing in collecting and storing old information, perhaps IT investment should be directed at getting current information to the person who needs it quickly.
How would such a system look?
Twitter demonstrate the value of information to the recipient depends not on the profound nature of the information but on its provenance and timeliness. While profound information retains value and trivial information perishes rapidly, Twitter suggests that the value of trivial information may be very high initially. For example, knowing if a patient passed urine last night may be very valuable to their doctor now.
Knowing that a hospitalized child asked for (and got) ice- cream for breakfast would be very valuable to their parents on that morning.
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There is no need to store this information indefinitely.
Social network sites like Facebook and LinkedIn show the importance of describing social networks - having a map of how people connect, so they can send messages along these relationships to each other.
No one would seriously suggest that sensitive health information is put on Twitter or Facebook. Secure networks and trusted identities are an absolute requirement.
This infrastructure is exactly what NPfIT has developed. N3, NHSMail, Healthspace, ePrescribing, Choose and Book and Summary Care Records provide exactly the building blocks that are required if a general purpose NHS wide social network were to be developed to allow messages - whether concerned with appointments, prescriptions, investigations, dietary preferences or other matters - to reach the people who need the information rapidly.
Forget health records. The new NPfIT 2.0 should concentrate on the here-and-now.
The NHS can be made fit for the 21st
century. Once the false starts and badly allocated resources are forgotten, NPfIT may be remembered as the programme that made this possible.
Dr Derek Meyer is lecturer in biomedical informatics at St George’s, University of London.
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