Reflections
If one happens to have (or perhaps, more sensibly, to make) an idle
moment, the progress of medical computing over the last 40 years would not
be a bad candidate for reflection. It is a very wide field: indeed, it is
sufficiently wide for the British Computer Society to propose the
publication early next year of a sizeable tome on the topic. It has been a
considerable journey from the days when computing was viewed solely as a
calculating and storage device for radiation dosages perhaps, for
biochemical results, possibly and — more prosaically — for wages and other
dull topics that were the province of administrators and people in offices.
Of course, even then there were starry-eyed dreamers who could foresee
that one day the technology would advance, and with that advance would come
previously undreamed of potential, a patient record possibly, one that might
perhaps transcend the dull (and frequently inaccurate) record of hospital
activity analysis. They were right: the technology did advance, and with
that advance so too did the dreams. The Department of Health’s bold and
enlightened Experimental Computer Programme showed that there was much that
could be achieved with the technological advances of the time. Sadly,
however, in many cases the dreams had travelled further and faster than the
technology: the heroic failure of the attempt at King’s College Hospital to
computerise the patient record showed the pitfalls that awaited those whose
dreams were bigger than the technology.
Today, to continue the process of reflection, it could well be argued
that the process has been reversed. Technological capability — properly
harnessed — now far outstrips not necessarily our dreams but, far more
importantly, our capacity to adapt our methods to the potential that
technology can offer. Information systems now play some part, sometimes a
major part, wherever you look in healthcare. Leave aside for the moment the
major national initiatives such as England’s national database of summary
medical records, its Choose and Book and electronic transmission of
prescriptions programmes. Who, 30 years ago, would have thought that
decision-support systems would be driving NHS Direct, a major advance in
services offered to patients? Who would have supposed that engineering
software would optimise performance in outpatient clinics and inform the
design of new facilities? Who — except perhaps for the most starry-eyed of
dreamers — would have imagined that telecommunications would be able to
ensure that the elderly could live safely at home, rather than be confined
to a care home or hospital? And who would have dared to think that
telemedicine was able to effect major changes in diagnosis and treatment in,
say, dermatology, or the care of oral cancers?
From these brief glimpses of some aspects of today’s healthcare computing
stem both questions and an observation. Firstly, the questions. Why is it
that, with all the beneficial results that have demonstrably been achieved
in so many different fields, those applications are not in universal use
across the Health Service? What prevents the uptake of demonstrable good
practice, with proven benefits for patients? Is the Service to be able only
to achieve slow laborious growth in its use of information technology,
painfully acquired over years, rather than, like the early dreamers, to aim
high and move fast?
These are not idle, rhetorical, questions: answers for them have to be
found if the benefits technology can offer the Health Service are not to be
lost.
The observation is more encouraging. Information technology has now
demonstrated that it has a role to play throughout healthcare. It is
available as an adjunct, increasingly an indispensable adjunct, for the
myriad activities that make up healthcare. Even the dreamers of the 1960s
would be surprised at its ubiquity.
Our three articles — diverse though they are — show how progress can be
made. Whether in co-operation between users and providers or in engaging
users (mainly clinicians) in the design of their new systems, teamwork and
interoperability are essential. That is the common thread that links these
three articles in this issue.
In his article, William Payne, a freelance writer with a particular
interest in new technology, discusses the potential of open-source software
for healthcare developments and the possibility that it may come to play a
greater part in realising the dreams of England’s National Programme than
had previously been supposed.
Jeff Jacklin, until recently the IT lead for the Milton Keynes General
NHS Trust, highlights the ongoing and long-term need for many existing
systems, and stresses the importance of an overall strategy for integration
between those systems and the (slowly) materialising national systems.
Our third article encapsulates a debate held at HC2006 that illustrates,
point by point, the close interdependency of clinicians and healthcare
informaticians in determining and implementing successful ICT-enabled
improvements in healthcare delivery. Clinician engagement is a factor that
more and more observers are stressing to be of paramount importance in
taking forward Connecting for Health’s ambitious programme.
There seems to be little doubt from the experience of the last 40 years
that ICT and healthcare are increasingly and inextricably intertwined. We
have still to discover whether the undoubted potential ahead can be realised
only by a massive central effort or only by slow organic growth at local
levels. Both the evidence and the demands of today point to united effort as
the way forward.
Michael Fairey |
