Resilience from the consulting room

This article first appeared on Microsoft’s NHS Resource Centre on 14 April 2009 (site now defunct; ).

GPs can’t work without IT any more. So why do they have to put up with poor infrastructure, crashing systems and applications, and a lack of data on what is going on, asks Neil Paul.

I sit in a lot of meetings with IT people. Our local IT management team has always been very helpful and supportive - which I’m sure can’t be said of IT bodies all over the country.

(I should add that all the members are attractive, kind, intelligent and generous and that my practice would be happy to find a home for any spare, colour laser jets they may have lying about).

“If the computer goes down we might as well close up and tell everyone to come back tomorrow.”

No computer, no work

One of the things clinicians often raise in these meetings is systems reliability and how difficult it is to work without a computer these days. Not just difficult; impossible.

If the computer goes down, we don’t know who is in the waiting room and whom they are waiting to see, what their past history is, what medication they are on, what their results are and so on. We can’t take notes, do dictation, answer queries, write prescriptions, order tests.

I heard a senior partner say the other day that “if the computer goes down we might as well close up and tell everyone to come back tomorrow”; and I agree with him.

Now, this column isn’t about disaster recovery - although it could be - it is about putting more investment into infrastructure and resilience. It’s also about making sure we have the data to back up that investment.

Patient’s won’t wait

Our local director of IT introduced me to the idea that business IT now being led by home users. Well, general practice is now being led by the Tesco ‘one in front’ policy.

Patients going to hospital clinics still tell me that they wait for hours to be seen. Managers tell me that appointment times are just placeholders to stager patients’ arrival. In my surgery, that isn’t the case.

If we are running more than 10 minutes late, we are so full that the receptionists start playing calming music and apologising repeatedly. “Good” you might say.

I could get into a long argument about how I think general practice needs to move to 15-20 minute appointments, but instead I will explain why some people now hate clunky IT and applications like Choose and Book so much.

Time is frustration

Essentially, it’s the time thing. My printer jams - I run late. An application crashes - I run late. Having to reboot a machine is like going on a 15-minute walkabout.

“I’d like to see the data on my IT system compared to national and PCT averages. What worries me is that it would probably come out as one of the best.”

Yet last week (at the end of the financial year when, no doubt, all the Quality and Outcomes Framework reporting was running in the background) our system went down twice once at the beginning of afternoon surgery.

We have also had two major power-outs in the last couple of years and numerous other glitches. Our IT department tells me that a lot of the assumptions made for national systems are based on old data, that it is underfunded to deliver improved resilience, and that it is doing the best it can.

Although I’m not sure of the details, I’ve been told the links from the N3 national broadband network going into practices are bandwidth restricted because they are based on activity data that is up to ten years old. In other words, on information from the days when we only just had heard of email and the internet was a few thousand pages.

I’ve recently tried an iPlate at home. This is a £9 box that fits into your master BT socket and, for most people, speeds up your broadband. I live in a remote rural area and my speed went from 3Mbs to 5.2Mbs.

I checked this using a couple of online speed testers one from BT. I don’t know how accurate they are and I’m sure they have problems; but why can’t we have something similar for NHS IT?

In my practice, it feels as if the network is running slow in an afternoon and we get lots of disconnects to our Exchange server. But we have no easy way of testing that.

Why can’t NHS IT set some standards and have tools to measure them? Why can’t we measure ping time to servers as a measure of network speed, keep logs of up-times and real world application speeds like time to print a prescription or to call Choose and Book?

IT performance matters

In general practice, we increasingly have all sorts of metrics and data about us used as a means of performance managing what we are doing, so why can’t we do this to IT?

Our primary care trust recently produced a hundred-page document filled with spine plots detailing every practice’s score on a range of QOF and public health targets, all weighted for size and deprivation. None of them were weighted for IT performance; yet that’s how all the data was collected.

I’d like to see the data on my IT system compared to national and PCT averages. What worries me is that my practice would probably come out as one of the best - and I feel sorry for those that would come out the worst.

About the author: Dr Neil Paul is a full time GP working at the Ashfields primary care centre in Sandbach. He sits on his primary care trust’s professional executive committee and has a lead role for IM&T and Payment by Results.

Tags: GP, Healthcare, Infrastructure, IT, NHS