# Everything Is Awesome! in Health IT
**Category:** [blog](https://bawmedical.co.uk/c/blog/9)
**Created:** 2016-11-04 00:00 UTC
**Views:** 875
**Replies:** 0
**URL:** https://bawmedical.co.uk/t/everything-is-awesome-in-health-it/83
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## Post #1 by @marcusbaw
> !['Everything Is Awesome' (from The Lego Movie)] (upload://p2A188TZPxjXut8hp3qR8r7Kp7h.jpeg)
> [**TL;DR:**](https://en.wikipedia.org/wiki/Wikipedia:Too_long;_didn%27t_read) Everything is not Awesome.
If you were at the recent [EHI Live digital health conference/trade-show](http://ehilive.co.uk/), 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* ](http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_086127.pdf) *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.
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## Smart Cards
> 
### 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](http://systems.digital.nhs.uk/rasmartcards) (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.
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## A Paperless NHS
>
> Some **reality** - crappy thumbnails of scanned documents in a GP clinical system
### 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** record keeping — 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](https://en.wikipedia.org/wiki/Document_management_system) systems. **This is the ‘dark’ clinical record. Like ‘dark’ matter and ‘dark’ energy - you know it’s there, but you can’t find it.**
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## 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.
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**Canonical:** https://bawmedical.co.uk/t/everything-is-awesome-in-health-it/83
**Original content:** https://bawmedical.co.uk/t/everything-is-awesome-in-health-it/83