Gallimaufry
As regular readers of this column will know, an issue of the Journal not
with a single theme, but covering a variety of topics from within the broad
spectrum now embraced by medical informatics, is one which brings a sparkle
to the eye of this writer. An opportunity presents gently to reflect upon
the burning issues of the day, to ruminate on past lessons, to prognosticate
about the future, or to point out how — if only the world had been square
rather than spherical — things would have gone so much better. That of
course is the privilege of the armchair critic, or the man in the saloon bar
who, armed only with conjecture and the tabloid press, feels entirely
competent to offer definitive judgement on any topic you like, but
particularly about computers and progress. Over the years, however, the
Journal has positively set out to avoid that approach, and instead to offer
informed and balanced comment based on a wide range of genuine involvement
in medical informatics and to present authors with real achievement to
report. The gradually increasing role of computing in healthcare and
socialcare shows the constructive value of such an approach when everyone
involved in the field can benefit from shared experience. At the far end
of Douglas Promenade in the Isle of Man, there stands — or stood — a
comfortable hotel, good for a family holiday, or a Saga tour. Its
proprietress, Mrs Drain, had the agreeable habit of mingling with the
residents in the bar after closing time and the departure of the
non-resident customers. Then, like so many licensed victuallers, she would
offer to an admiring audience her views on life. Not for her the passive
acceptance that “Life is like that”. Her approach was much bolder. “Life”,
she would say, “is like a football at your feet. All you have to do to score
a goal is kick it”. That is the approach that animates the Journal’s
approach, and which the articles in this issue yet again demonstrate. That
the National Programme for IT has many potential benefits to offer, there
can be no doubt. Until those systems come into operation nationally,
however, there are a number of difficulties in the interim — not the least
of which is the uncertainty about just how long the interim will be. Those
who work in organisations providing patient care know, however, that to wait
and do nothing indefinitely until a national solution arrives is
impractical. Legacy systems wear out. Clinicians quite properly need a
service that helps them to meet the increasing pressures on them from the
NHS ‘reforms’.
In her article, Diane Nixon, IT Programme Manager at Addenbrooke’s
Hospital describes how, working with clinicians and small commercial
solution providers, a patient-centred electronic medical-record system has
been developed. With over 3,000 registered users from more than 70
departments, over 2.5m documents together with an archive of medical records
and diagnostic results are available from any of the Trust’s 4,500 PCs. This
overall achievement shows how much can be done at grass-roots level now,
well in advance of the National Programme’s solution. In his article,
Marce Colucci, Marketing Manager for Clinical Solutions, describes the
introduction of paperless record systems in Liverpool’s four walk-in primary
care clinics, dealing with over 200 patients a day. Amalgamation of the
City’s PCT structure brought all four clinics under single direction and
brought the opportunity to harmonise their record-keeping systems. The
result has been in effect to create a virtual single clinic, to any part of
which patients may return knowing that their records will be immediately
available: the benefits for patient treatment are obvious. In her article,
Kate Lawrence, a senior Analyst from the Courtyard Group, sets out a recent
experience in implementing in Canada systems that in their objectives are
very similar to those of NPfIT, but where the process is markedly different.
Those differences can only partly be ascribed to the Canadian Provincial
healthcare system or to the considerable differences in geography. The
greatest difference lies in setting national objectives, and — by
appropriate financial incentives — stimulating those on the ground to
proceed towards those objectives in the way most suited to their existing
environment and circumstances. Current developments in England suggest that
the Canadian approach may have something to offer. In our last article,
Pam Hughes, Policy and Customer Manager at the Information Centre for health
and social care, and Secretary of the ASSIST National Council, reports on
her study on the emergence of healthcare informatics as a profession. In
particular, the study shows a considerable consensus on the way forward, and
the measures necessary to make that aim achievable. Overall, this month’s
articles show just how much can be done, and learnt, until the products of
NPfIT come to maturity, and into general use. Mrs Drain was right: life —
certainly in healthcare informatics — is indeed like a football. All you
have to do to score a goal is kick it. Michael Fairey |
