Swans in the sunset
Long ago, when I was an undergraduate, I was for a time a member of the
(strictly non-dancing) University Ballet Club. Amongst the events organised
by the Club was the showing of a film by a fellow undergraduate. He had set
out in the previous long vacation to film the whole of Swan Lake, in
technicolor, 3D and stereophonic sound. In the process of so doing, some
small difficulties arose, and the film we eventually saw was of one scene of
the ballet (I forget which, except that the scenery was obviously held up by
string) in black and white, 2D and mono.
Why this sad cautionary tale of bounding ambition coming hard up against
brute reality? Are there perhaps parallels to be drawn, lessons to be
learnt, in a rather different field, that of healthcare computing? In
September 2002, the Journal interviewed Sir John Pattison(1),
at the time responsible for implementing Delivering 21st century IT support
for the NHS. In that interview he laid out quite clearly the national aims
in the field of prescribing: “This pillar of work is on the electronic
transmission of prescriptions between GPs, community pharmacies, and the
Prescription Pricing Authority (PPA). We now have three pilots to test the
issues ...” In our March 2004 issue, Martin Strange, who had played a major
role in the evaluation of those pilots, set out some of the problems that
needed to be overcome, the progress that had been achieved, and the
considerable benefits that could be expected — for patient care and
convenience, for the role of community pharmacists, and, in particular, for
the PPA.(2)
He noted, too, that at that time the target was for half of all England’s
prescriptions to flow electronically by the end of 2005, and for all
prescriptions to flow in this way by 2008. Slightly less than two years on,
the target for 2005 has been waived. The objective now is that by the end of
2007, every general-practice surgery, every community pharmacy, and many
appliance contractors will have access to the Electronic Prescription
Service (EPS). At present, it is not clear what proportion of total
prescriptions will be processed through the Service, nor quite how the
astounding workload of the PPA is to be expedited.
In our first article, Tim Donohoe, Director of the Electronic
Prescription Service, gives an overview about the method now to be adopted
to ensure a smooth transition from the existing paper-based system to an
electronic system. As his article shows — and indeed as the evaluation of
the pilot schemes showed — the task is one of considerable complexity with a
number of barriers to be overcome. Much progress has been made by patient
negotiation with all those concerned. At one stage, difficulties were
anticipated with the necessity to employ electronic signatures — a step
which will come into use with the second stage of the system’s rollout as
now conceived.
Our second article is by Stephen Mason, a barrister, General Editor of the
e-Signature Law Journal and Director of the Digital Evidence Research
Programme of the British Institute of International and Comparative Law. In
it, he explains the various forms an electronic signature can take and
indicates the weaknesses, illustrating that no form of esignature is totally
secure. There are lessons here for the NHS, not only in prescribing, as more
and more use is made of the information systems upon which the Service will
increasingly depend.
Despite the evident progress overall, particularly in overcoming problems
that earlier had seemed intractable, there has to remain some concern. Like
so many big projects, the electronic transmission of prescriptions programme
is behind the original timetable. Like so many big projects, some of the
original objectives seem quietly to have slipped out of sight, at least for
the time being. Anyone with experience of the impact of politics on sound
management will appreciate that, on occasions, targets have to be ‘unreal’;
but politicians have still to realise the totally dispiriting impact on
workers in the field as the unreality becomes evident. Many ministers would
benefit from taking the advice, drummed into young infantry officers, that
time spent in reconnaissance is seldom wasted.
As a ballet, Swan Lake is unusual: there are at least four different
endings. In one, the bad guy wins — an ending rejected by Soviet censors on
the grounds that “the working class deserves an uplifting, not a depressing
end to the story”. In another version, the good guy gets the girl and goes
off into the sunset. We must all hope that ETP not only finally fulfils all
its original aims, but does so in the golden glow of the sunset.
Michael Fairey
References
1. Interview with Sir John Pattison. Br J Healthcare
Comput Info Manage 2002; 19(7): 2–4.
2. Strange M. Why should the National Programme for IT
include the electronic transmission of prescriptions? Br J Healthcare Comput
Info Manage 2004; 21(2): 30–2.
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