Change management

Engaging clinicians in IT: one step forward, two back

February 2006

By kind permission of the British Medical Journal, we reprint the experiences of an anonymous hospital consultant.

I am a consultant in a busy hospital department known for its teamwork and for being an innovator in IT. We do more than the average number of clinics per week, and we have a commitment to communication, audit, and other things you need IT for. So why have I recently been reported to my trust’s lead clinician for IT as being “intemperate”? Maybe because I know how the technology ought to work and am expressing my frustration.

In the late 1990s my colleague then as new and enthusiastic as I had been until recently developed, together with computing science students, a database for recording letters to outpatients and for discharge summaries. This system worked, and it proved its worth when minocycline and then rofecoxib became issues: we were one of the few departments that could identify which patients had been treated. The system has also been invaluable for audit and for identifying patients for audit or research.

Our first scare came with the millennium bug: after several days work (unpaid and unrecognised) my colleague made the system secure. By this time the system had proved its worth but also had out­grown the storage space allocated. My colleague searched for alternatives, and by early 2001 we had identified another database that would serve our needs better.

We constructed a business case. We presented this to the IT depart­ment and at our annual clinical governance report meetings with the trust. My colleague tried to arrange a meeting with the head of IT; despite 15 telephone calls and 27 email messages no meeting was arranged. We began to feel bruises on our foreheads.

In September this year a contractor arrived, while I was in clinic, to fit a new keyboard to my computer to serve the needs of the NHS's new Choose and Book system. I had been notified of this but not that they would delete my hard drive, replacing only Windows files, and that therefore I would lose all my database files. Worse still, they did the same to my secretary's computer. The new keyboard didn't work with her ancient computer, which was upgraded by one of the anonymous figures from the IT department.

he upgrade was from Windows 98 to XP but no one thought to check that the database system would work. There were instant results. The database system would not work properly: some­times it would combine different records, seemingly at random, and sometimes it simply wouldn't respond.

IT technicians came and went, and finally after a number of weeks one technician came and said that he'd fixed it ... except that it could no longer print. Printing, as my secretary pointed out, once she had regained her composure, is an essential function in the delivery of letters to GPs at least until we have a system that can email letters securely. This seemed to be news to the IT people, who took another week to come and uninstall the system from her computer, with no indication of what would take its place.

She tried typing the letters in Word, but her dictators (another consultant and I, and a specialist registrar) were used to the old system and failed to mention the diagnoses, past medical histories, and treatments, as previously these would have been rolled forward by the system. Doing a letter in Word took about five times longer than on the database system.

We were told that the database wouldn't work on Windows XP, that it was a legacy system, that we shouldn't be so precious, and that earlier systems couldn't be reinstalled as this would be a backward step, and the thrust of developments in IT in the NHS was to move forwards, not back.

We tried to impress on IT the need for urgency in restoring my secretary's computer system. Our almost daily phone calls and emails produced no result, until the day my head of service (the same con­sultant who authored the system) called me into his office to say that he had been called by the trusts clinical lead for IT to have a word with me about my intemperate email.

I circulated this email to my colleagues: all saw it not as in­temperate but justified. Six weeks had passed since my secretary had a functioning computer system; a further two weeks would pass before it worked. The IT lead listened to my account of her problems, and then somewhere in the background something happened and an IT person came and restored my secretary's computer to a functional entity: working on Windows 2000 slowly, but working.

At a rate of seven clinics of typing a week my secretary is still behind. The positive result of all this is that she knows we are behind her and that we value her work. The negative ones are that I now know its a fight to get some­thing sensible done and that clinicians are regarded as being out for themselves, rather than protecting a functioning system and the welfare of their staff and patients. Am I helping or hindering the NHS's IT development? It depends who you ask. n
The author of this article wishes to remain anonymous.

Reprinted from the British Medical Journal 2006 (14 Jan); 332: 127. © BMJ Publishing Group