lockley john

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Originally I bought it for the driver’s seat (no kidding—I have a bad back and a good seat is a blessing). But with the car came a whole load of technical frills that initially I wasn’t interested in, until I discovered how useful they could be.

The door key is contactless: I just leave it in my pocket—great for when I’ve got my hands full carrying things. As the engine starts, the steering wheel automatically moves out towards me, into my preferred position. When I select reverse, the wing mirrors dip down to point at the rear wheels: wonderful for parking. There is also a rear-facing camera and proximity sensors at all four corners to help me park without having to turn my head (great for my neck).

In other words, my car is programmed to think for me as much as it possibly can, removing unnecessary stress, and allowing me to concentrate on driving well instead.

I can’t help but think that this is how it should be when we practise medicine. In the unbelievably complex world of medicine the technology should take the strain. It can do it, and it should do it. And the fact that this isn’t happening thoroughly, consistently, and across the entire NHS is a major indictment of that organisation.

As it happens, a large part of my working week is involved with the development of truly user-friendly medical computing— working towards IT that is simple to use, neatly integrates all its programs, has clear instructions, and is efficient in whatever task it is performing. Inconsistency and uncertainty are the enemy, but crucially, so is ambiguity. For example, when an on-screen button says ‘Finish’, does that indicate that the user has come to the end of the process (such as booking an appointment)? Or alternatively, do they need to click on the button in order to finish the task?

User-friendliness isn’t limited to on-screen activity, either. The ‘IT eco-system’ (everything around, or relating to, the computer) is just as important—the people, the paperwork, and the protocols. To work smoothly and effectively these must all dovetail together: the IT has to fit in snugly with the clinical procedures.

Good tuition is also a vital part of easy, integrated IT use. All too often, official communications and instructions can sound like a brain dump from the managers or techies writing them, with little attention paid to how sensitively the text communicates what the reader actually needs to know.

Then there is ease of access to information. How quickly can the user acquire the patient information they need, whether this was created in primary, secondary, or community care, locally or 200 miles away? How easily can the clinician discover whether the patient is on the right pathway, and if they are not, what should be done next? Finally, can the computer automatically guide the clinician through the jungle of over-complex, ever-changing NHS rules and regulations?

Sadly, present-day healthcare workers often find themselves impeded rather than enabled by their medical IT, thus utilising only a small percentage of the power, information, and convenience that really should be available. In comparison with my car, NHS Informatics are still in the Edwardian era, when each vehicle needed either an enthusiastic amateur or a dedicated chauffeur just to keep it running.

Yet it doesn’t have to be like this. Techniques are already available to weld medical IT into a seamless, supportive, stress-free whole— it’s just that no-one has yet done it, and that makes me both frustrated and sad. I want my NHS colleagues to be able to use the technology without undue stress; have all background processes automated; communicate efficiently; access relevant parts of the medical record without fuss and without legal hindrance; and use the power of IT to find relevant and reliable medical guidance quickly. Doing it like this would take the strain off front-line staff and leave them maximally empowered to tackle the human part of medicine—diagnosing and managing the patients.

Medical IT could and should be much more supportive than it is at present, and I want to help bring this about.