Dr Kit Latham sets out the case for hospital medics to halt the technology train and jump on
The less than glorious history of NHS IT and computer systems has created an epic and battle-scarred landscape, claiming the heads of commissioners, beggars and knaves alike (or external consultants and contractors, as the latter two are better known), writes Richard Bagley.
It feels like not a week goes by without a fresh call from the Secretary of State urging the NHS to enter the 21st century, get “app-ified” – or at least to use emails rather than faxes.
The scale and depth of the problem was underlined when news of the latest apparent white elephant hit the headlines in April, the Care Quality Commission pulling out of a project to link 12,000 computers across five organisations. It launched a stinging broadside at a host of failures as it left.
But if the national bodies can’t manage to pull their systems together, let alone Trusts and the myriad NHS organisations locally, where does that leave the foot soldiers – the front-line clinical staff.
To Dr Kit Latham, a junior doctor whose experience of dire NHS IT systems has created an obsession with making things better for medics, it’s not just important for hospital doctors to take back control, it’s essential. And we should be demanding it.
“Around 43 per cent of all clinical time is spent on what’s called non-productive data entry – something that ‘doesn’t move the story forward’ for the patient but is either the inputting of data or the copying of it from one place to another,” he says.
“This also includes the time spent logging in, and the time spent waiting for a computer. This is a shocking statistic.”
Doctors across the land will be familiar with having to use multiple disconnected systems to carry out their clinical work. But Dr Latham explains the facts which underline why a new system is no silver bullet.
“A fairly robust finding, from both here and America, is that when implemented electronic patient records typically, but also prescribing systems, will slow doctors down. And not by a small amount, by about 30 per cent typically,” he says.
“It’s known as the productivity paradox of digital health – this is increasingly recognised as a very important issue.”
Dr Latham believes doctors themselves are key to winning the battle against poorly designed technology, which is part of the reason he co-founded the Doctors’ Digital Collective with likeminded colleagues across the UK. He is also CEO of DrFocused, a software company which aims to bring the experiences and views of front-line medics to the fore in technical developments. And he is scathing about the tone of some of the companies pitching to build clinical systems.
“When people talk about health technology in the media, this is a common refrain: ‘All of the problems in the health system can be solved if we just… if we just…’. That healthcare can be solved if only we can get rid of those pesky clinicians and replace them with this technological utopia.”
He cites one such advocate of health tech, who suggested “A lot of money is wasted on manpower.”
Dr Latham says: “Now to me, money that is spent on manpower in the health system is the opposite of waste, particularly when it’s spent on clinical care.”
The challenge is to devise technology that removes barriers to care. And, according to US research, failure to do so doesn’t just slow medics down, it makes them ill.
Dr Latham cites the work of Robert Wachter, who conducted a 2011 UK government review into technology in the healthcare system.
Wachter has written “about the increased levels of doctor burnout that are seen in the US that are directly attributed to the electronic patient records that doctors have to use,” Dr Latham says.
Wachter refers to a scenario familiar to many doctors: “Windows 95-style screens, drop-down menus, data input by typing, and navigation by point and click.
“These antiquated user interfaces are astonishingly difficult to navigate, clinical information vital for care decisions is sometimes entombed dozens of clicks beneath user-facing pages of the patient’s chart.”
Dr Latham says: “It’s completely obscene all that time that is wasted in a massively resource-strapped healthcare system. We can get that back if we improve the user experience for doctors.
“Too much has happened to us and not with us as clinicians. If we want to be more in control of the tools that we use, we should demand that we are more in control of the tools that we use.”
So how can doctors follow through on his call to “take back control”?
“My advice to doctors would be that the person who is the Chief Clinical Information Officer in your Trust needs to be you, or you need to be encouraging them to look at the massive benefits that can be had by freeing up all that wasted clinical time,” he says.
But it doesn’t stop there. The use of technology “that increasingly determine the way that we practise as doctors” must also be confronted head on, Dr Latham argues. “Things like how our rotas are administered, which determine how much annual leave we have or how frequently we can take it. Things like how our jobs are apportioned.
“There are off-the-shelf packages that can be used for rostering. The problem is, not many of them can accommodate the complexities of the various contracts with hard and soft constraints in them.
“Rostering is something we need to get right, and something that unions need to have a really big hand in.”