Opinion

It's time for the hospital doctor to embrace IT

Dr Paul Shannon

As a consultant anaesthetist, most of my medical career has been spent working in hospitals. On the whole, I wouldn’t have it any other way and I think we do a great job. But in one respect, I look with envy at my colleagues in general practice and, dare I say it, wish that secondary care would take a leaf out of their book.

GPs are fabulous at information technology (IT) and I wish that hospitals were too. In primary care, practices are, to a lesser or greater extent, seeing tremendous benefits from electronic appointment systems, information-sharing and other processes, saving them time and money and improving the patient journey. General practice has made tremendous progress in the last 10-15 years.

Hospitals, however, are another story. Why should this be? Is it that my GP colleagues are intrinsically more innovative and accepting of change than those of us in hospital medicine? Or is it more to do with the conditions under which we work?

I lean more towards the latter view. As independent practitioners, GPs are essentially running small businesses. And, as small businessmen and women, they can actually see the positive impact that information technology has on their bottom line. That’s not just the financial bottom line, by the way, although that’s definitely involved (of which more later). Practices also see the benefits of IT in terms of improving patient experience and outcomes, and making the working lives of the GPs and staff much easier.

Doctors want best outcome for patients

Money does, of course, come into it: the information entered into GP systems has a direct effect on how practices are remunerated and, ultimately, is reflected in the profit realised for each GP partner — something which possibly helps to concentrate the mind?

But — and I don’t think I’m being naive here — personal financial rewards are rarely uppermost in clinicians’ minds. What my colleagues want — be they in hospital or primary care — is the best outcome for their patients. And I truly believe good IT, properly implemented, can be vital to achieving that.

IT, in my view, can help in three key ways. These are:

• Overcoming the current fragmentation of care delivery;
• Hard-wiring quality into healthcare; and
• Managing costs, particularly as budgets tighten.

For the first of these, we could use a good computing term — ‘defragmentation’. Few would attempt to deny that current care is very fragmented. There’s not enough sharing of information about the patient and this is detrimental both to the care the patient receives and to the efficiency of the way we work.

IT can help to cut duplication and make the journey smoother for staff and patient alike. For example, it’s important that anyone prescribing or dispensing drugs to a patient knows whether or not they are allergic to anything. So it’s reasonable that this should be one of the first questions put to each patient.

But I read recently that, on average, a patient is asked that question some 15 times by the end of a given hospital episode — that’s a lot of duplication, which wastes the clinician’s time and must make the frustrated patient wonder if the right hand knows what the left is doing.

‘Latest and greatest’ information

As an anaesthetist, I’m aware poor information sharing can lead to cancelled operations or worse. Yesterday, I heard of a safety incident, where the wrong patient was brought to theatre because the theatre list information had been changed, but not all the printed-out copies were the latest ones. In other words, the surgeon was working off an old theatre list, but the anaesthetist and theatre staff were using an updated one.

This is a classic example of how information must be ‘latest and greatest’. An electronic system would remove this risk, as whenever a change is made it automatically becomes the most recent one. Moreover, there would be an audit trail of when changes were made and by whom. Whenever multiple paper copies are used there is the risk of a mix-up of out-of-date information.

Hard-wiring quality and safety

Getting doctors on board is another issue. Unlike many GPs, there are those in the consultant body who may be reluctant to learn new ways of working — they don’t, quite frankly, see what’s in it for them, their patients or their organisation. Some even feel a bit threatened by it.

For example, some hospitals are using decision-support systems that really tap into the patient safety agenda — something which is uppermost in all our minds at the moment. Such technology means that we cannot, for example, prescribe something inappropriately (say, at the wrong dose, or when a patient is already taking a drug which would interact badly). If we try to do it, the programme will remind us that what we’re doing isn’t correct so won’t let us move on to the next stage.

Some people might think this impinges on clinical freedom, but I don’t believe that it does. Do we want to be free to make inadvertent mistakes? The programme still allows us to use our clinical judgment and go ahead and prescribe as we wish, but we will have to justify it; to have a good reason for departing from the pathway. And, unlike paper records, the electronic system can’t be ignored. And, as its ensuring quality and patient safety are built in at every step, why on earth would we want to ignore it?

What’s more, in these days where everything we do is subject to audit – sometimes even our funding can depend on it – then it’s great to have an objective electronic means of helping to prove we’re doing a good job.

Tightening budgets

And again, we come back to costs. As Liberal Democrat leader Nick Clegg said just a short time ago (January 11), the ‘politics of plenty’ are over. We all know that health service budgets — relatively generous in recent years — are anticipating a major squeeze.

If we want to carry on providing excellent care — and making improvements too – we have to find ways of saving money. Technology is a great enabler. It helps avoid duplication — tests don’t have to be repeated unnecessarily if all the information is to hand in an electronic record — and better information sharing helps make sure that theatre time or outpatient appointment slots aren’t wasted.

Of course it isn’t all about money — although that’s important; it’s also about the way we do things. Technology helps us work smarter, it helps us work better and it helps us use every minute more effectively. Surely that’s as important in hospital medicine as it is in general practice?

It has been almost a quarter of a century since I qualified, and, in my experience, the use of information technology in secondary care hasn’t changed much in that time. Could 2010 be the year that changes? I do hope so.

Dr Paul Shannon FRCA MBA, Consultant Anaesthetist, Doncaster and Bassetlaw Hospitals NHS Foundation Trust and Medical Director, CSC UK Healthcare

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