TL;DR: Everything is not Awesome.
If you were at the recent EHI Live digital health conference/trade-show, you’d be forgiven for thinking that we are poised at an unique point in medical history — within a few years every single disease and affliction will be eradicated by the simple application of the proprietary technology they’re selling, and we as a human race will ascend to the stars on a pillar of unicorn-flavoured glitter.
You look around — every enormous glowing stand exhibits great tech that just works .
There are keynote talks about the brightness of the future, earnest admission of (but crucially not accountability for ) the past mistakes of NHS IT, and all-round blind optimism.
There is much lauding of #blockchain and #bigdata , even though we haven’t really worked out how (if at all) they will be intelligently, safely and ethically applied to medicine and the NHS.
The tech is in fact so Awesome, and so perfected, that many stands just have gimmicks (games, massage chairs, freebies) instead of showing the tech — so much so that if you ask to see and test-drive any of the software, many stand-holders are frankly agape.
As an aside, every one of those stands costs tens of thousands of pounds, by the way, and — eventually — pretty much all of that cost comes back to the NHS — in the form of higher prices on systems.
(actually, I noticed there was little or no real innovation to be seen, only mashups and remixes of the Clinical 5 being sold at the same or higher price than 10 years ago — but that’s another story for another blog post )
There’s a gaping chasm between this glitzy, high budget world of tech and the dystopian reality of working with tech in a real NHS setting. It also seems there aren’t many people in Health IT talking about this gap.
The ‘Everything Is Awesome’ version
The ‘Everything Is Awesome’ version: All NHS staff have an NHS Smart Card and the problem of staff identity and roles is solved.
The Reality: Access to smart cards can take weeks, and workarounds are used that could make ID’ing the staff member responsible for a particular action difficult or impossible.
Woefully inadequate funding of front-line IT support, and a frankly unbelievable disconnect between HR and IT teams, means that NHS Smart Cards (which are required to access critical NHS services, and without which it’s pretty hard to do anything in some settings) can take weeks to be provided to new or itinerant staff, and in the meantime you’re still expected to be clinically effective .
Patient care is our priority, so people find workarounds : they do all those things we are explicitly told we must not do — sharing smart cards, leaving cards in computers for the whole team to use, all sorts of ugly shenanigans that we know we shouldn’t do but we sometimes have to do in order to carry on carrying on.
As a locum doctor, although I have my own NHS Smart Card, I am often asked to use one of a stack of ‘Locum Smart Cards’, because these are already set up to have access at that care organisation. There is sometimes a cursory attempt to record my name and the times I was using that card for. But we all know the likelihood of being able to work out who was using a particular card at a particular time is pretty thin. It doesn’t feel exactly robust, and it ain’t Awesome.
The ‘Everything Is Awesome’ version: Paperless by 2020 (or is it 2023 now?) obviously makes everything better.
The Reality: In many places this will probably be achieved by just scanning paper records, creating an impenetrable, unsearchable ‘dark’ clinical record. Obviously everything is worse.
I know of at least one trust where the community nurses have utterly broken recordkeeping — they have a full GP clinical system at their disposal, installed at the trust at considerable expense and allowing the trust to claim they are #’digital’, but the community nurses in some areas are only allowed to use it for collecting managerial data , and then have to duplicate everything into the paper records they actually use for clinical care.
At some point the trust will run out of time to be #paperless and so, in a panic, someone will get all the clinical records digitally scanned. Awesome! Except the problem is that these records are now locked in clunky, unbrowseable, unsearchable EDMS systems. This is the ‘dark’ clinical record. Like ‘dark’ matter and ‘dark’ energy you know it’s there, but you can’t find it.
If we don’t talk about it, we can’t fix it
This isn’t a rant about EHI Live itself. There are a dozen other similar events across the year, all the same. The same glib Everything Is Awesome atmosphere, the same hollow emptiness I feel when I think about the reality.
There’s so many more examples I could give, but you get the picture. Let’s start talking about it.