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IT uses and abuses

June 18, 2015

By Basket Press

A recent news item in the Nursing Times in which a trust partially justifies cuts to certain services by saying that the loss of nurses would not really matter “largely due to efficiency savings it believed it could make through introducing more mobile technology for district nursing teams” got me thinking about the role of IT systems in clinical practice (HR etc is something else).

Firstly, let me be clear that I do not follow King Ludd: I like technology when it is properly implemented and makes life easier or enables me to do things I previously couldn’t; but I do not believe that technology, especially IT, is automatically A Good Thing. I mean, I am old enough to remember the days before PCs and laptops when computers were the size of a living room and you fed them cards with holes in.

Electronic records are, I believe, A Good Thing. Gone are illegible consultant scrawls and the concomitant confusion; pretty much everything you need to know about your patient is in effect in one place and can be found straight away. Lost notes became a historical oddity. Results of tests and scans can be available instantly. If, as I did, you work in a community team with a huge patch, electronic records made it easier to keep up with colleagues’ work with shared patients. Note audits were far simpler to conduct; assessments were far easier to record; much time could be saved.

Unless, of course, there were problems with access. Sometimes it could take an hour or more to log on to the system, assuming there was a computer available. If one was away from base for a day or two, which happens in the sort of patch I had, completing notes in trust specified times was impossible. System crashes are frequent. Different pieces of software are incompatible, causing computers to throw hissy fits, sulk and not talk to each other.

Oh, and when the records software was written, the views of clinicians were not sought. Because only managers were consulted, the resulting set-up lacked obvious bits of functionality, like copy and paste facilities – stuff we needed for writing clinic letters, for example. Additionally, different systems used in different organisations were not compatible. Still an improvement on paper notes, but with unnecessary built-in time wasting difficulties.

To get round some of those difficulties and make us “more efficient”, some bright spark then came up with the idea of laptops with mobile access. First off, the cost was vast – the devices selected were over £1000 a throw. Then they forgot that this is a county with huge holes in mobile network coverage (no network covers more than around two thirds of the county; my house is in a black spot for the one chosen), so a lot of the time there was no access to the work systems unless one returned to base, defeating the object of mobile devices.

I repeat: about £100 000 spent on devices and system changes which did not and could not do what they were bought for. Are you listening University Hospital of South Manchester? Where is the cost effectiveness in that?

Passwords: they make your system secure, don’t they? Except when everyone is forced to change them every month, then told you cannot repeat more than three characters in any six months. Upshot: everyone writes their passwords down on Post-its stuck on their monitors as it is impossible to remember the rubbish we all come up with.

Then we have electronic diaries…Now, because of the poor coverage mentioned above, we still used paper diaries; the records system had a “diary” in it which we were required to use to record appointments and their outcomes. So, of necessity, we filled in two separate diaries before we started. Next we were told to also use Outlook diaries, (i.e. fill in a THIRD diary). Not only that but also open it up to certain people to put appointments in and change existing appointments…Bear in mind this is a community service with no clinical staff below Band 6, y’know, autonomous practitioners. To my mind that made it impossible to do anything, as I had restricted access to my own electronic diaries so I never knew if someone was changing my work patterns – which they tried to. I took matters into my own hands and stopped using Outlook, which went down like the proverbial lead balloon.

Also there were “electronic nanny” filters bolted on to the work browsers. I had a sideline in working with bairns with gender identity issues (no-one else felt comfortable doing this so I cornered the local market) and often needed to research related stuff. At other times I had to research risk of sexual offending, as child protection issues cropped up regularly in my line…Except I couldn’t do any of that at work because I was blocked by the “e-nanny”. I had to do it at home on my own computer then e-mail myself documents…I was even blocked from some sites related to eating disorders or self harm: this is Children and Adolescent Mental Health Services, what do you think we do? Apparently there was no way round the nanny. “Computer says no!”

Theoretically, increased use of IT should make our lives easier – and often it does. However, if the available money is not spent effectively, if little or no thought is given to how systems work and are to be used in real life, if the realities of who uses IT and where they use it are ignored, if systems are set up to function as a means of policing staff, of controlling them, of limiting or interfering with what they can do and when they can do it, then one must wonder if our resources are actually being used in the most efficient or effective way; and if not, then why not? For whose benefit are these systems? And do they deliver the savings in time, money and staffing so frequently claimed?

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