From the consulting room: Making information free to be useful

This article first appeared on Microsoft’s NHS Resource Centre on 01 June 2011 (site now defunct; ).

GP Neil Paul sets out his vision for a home visit IT kit, and wonders why healthcare IT companies are so unwilling to let third parties provide attractive add-ons for their products.

I’m awaiting feedback from my talk at the Primary Health Info conference with interest. I probably put too much in - I usually do.

I fielded a few questions at the end about a comment I made during my presentation. I had mentioned that it’s dreadful that there isn’t a great IT solution for home visits. I met one questioner after the talk and told them that I have tried numerous solutions from different companies, and that none of them truly satisfy me. Offline access isn’t good enough, and online access is so dependent on signal quality that it’s a pain.

I once tried a laptop which at each visit required me to boot up and log into Windows; then run the 3G software and log onto the 3G network; then connect via a Cisco VPN, then log onto Citrix, then log into EMIS, then find the patient. All before I could do anything.

At this point, the signal would disappear or the laptop would fall off the bed or the power would go.

Although my enquirer argued that the 4G signal due next year should make this a lot better, he conceded the point about usability.

The black IT bag

My vision would be a tablet-based application with instant-on. A PIN to access the tablet, then a code from a dongle on running the app would give you access to custom software with built in encryption and remote-wipe facility.

It would have both online and offline access. Plenty of apps do this and it works well; they keep an offline copy but constantly sync it when online. No signal loss is experienced by the user.

Enterprise features would mean that any visits assigned to you were pushed to your device ready for your visits. New visits and messages from Reception could also be pushed out. Similarly, you could message back to base or other practitioners if appropriate.

Most tablets have GPS and access to maps, so you could plan your route. And I envision the user interface (UI) not being so much a replication of the desktop experience, but a custom UI for visits that allows for easy data entry and viewing of relevant information.

It might even keep a mileage log and have links to the British National Formulary, local patient care pathways and contacts. I think this sort of thing would be amazing.

Opening up APIs

The talk after mine was given by NHS Chief Information Officer, Christine Connelly. Her headline message seemed to be that NHS IT is looking at how it can open up the client side of electronic records by separating the data from the interface.

I guess this could be achieved in numerous ways. Putting all the data into some massive data farm and preventing companies providing both server and client sides might be one.

However, making every existing company have a proper API might be another. I’m very attracted to this idea.

My surgery uses Frontdesk for its appointments system. We outgrew EMIS appointments more than five years ago, but the linkage with EMIS has never been amazing and while this approach has gained us some features we have lost others.

EMIS Web looks to have caught up and we will probably switch back. But five years is a long time for a business to be at the mercy of a poor piece of software, as we would have been, if we hadn’t had the ability to use something else.

Similarly, we use Docman for documents; and the same applies. EMIS, to its credit, announced an API partner programme several years ago; it said it couldn’t deliver everything and wanted to work with others.

However, there’s a lot of complaining that the API has not been great. People I’ve spoken to say its slow, limited in functionality, and more about passing data forwards and backwards than what some feel is a true API – something that allows even the look and feel of an application to be changed with deep hooks into the application itself.

I’m not picking on EMIS. As I’ve said before, it’s just the company I know most about. I guess it’s similar with others.

Back in the real world

Am I being naïve? Are big companies going to allow small start-ups to deliver small, feature-rich add-ons to their main product?

Well, this happens in the real world, and there are plenty of examples. All the main mobile companies (Microsoft, Apple, Google etc.) have App Marketplaces. Facebook’s meteoric growth was predicated in part on an open API which allows third parties to build apps. These are billion-dollar companies, and they seem to think it’s a good idea…

Further information:

Dr Neil Paul is a regular columnist on the EHI Primary Care website where this piece originally appeared.

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