Digital Frustrations

By Dr Hannah Laidley

There are plenty of articles complaining about how awful IT is not just in the NHS but in healthcare around the world. I recently read one by Atul Gawande who invoked research suggesting one of the strongest predictors of burnout is how much time an individual spends doing computer documentation. Some organisations found it so awful that they videoed their consultations and sent it to doctors in other countries to type up.

I would love to spend more time with patients, but my job is to sit at the computer or to be on the phone sorting things out for people.

It’s an important job and someone’s got to do it. There are a lot of differences between IT systems in separate hospitals. For example, where I used to work you would fax your referrals but here you can do a lot of them on the computer. That’s great because I’m not very handy with a fax machine. However, when my login doesn’t work, or my computer freezes, or some wires get crossed down the line and the systems stop talking to each other my day grounds to a halt and I literally cannot do anything. Why can’t we have systems that just work?

As a doctor with these digital frustrations I would love the NHS to spend more of its budget on good IT infrastructure. Replace the old slow computers, and pay more IT staff to make sure when the systems break they are fixed quickly and my productivity will soar. Multiply that by all the staff across all the hospitals around the country and we would see record improvements in waiting times, ease of discharge, and patient satisfaction. Sadly, patients don’t agree.

A recent headline from HSJ states ‘Public want new NHS money to go on cancer and staff, not digital’. Is this a case of the public just not understanding how useless digital services currently are, or do they really not care if we go back to pen and paper? Maybe they are worried about who will have access to their data, or what will happen if there is another breach of cyber-security. Will the Secretary of State’s digital agenda be pushed through the despite the public’s wariness of the promise of something shiny and new?

What little I have learned about leadership so far, I know for sure that a top-down approach cannot work on its own. Of course, it is necessary for people at the top to develop strategies that will benefit the maximum number of people over time and to make the unpopular decisions. But that is impossible to do without staff and service user buy-in. It is absolutely imperative to involve all stakeholders in the agenda setting, especially patients.

I think this is about more than getting the public to fill in a survey choosing between cancer services or new software – the answer to that question is obvious. What needs to be captured here is the detailed stories you get when a patient shares their experiences. Then we need to ask ourselves how that experience could be improved. If the money that would be spent on one more staff member to reduce waiting times for one cancer clinic could be spent on software that would reduce waiting times for every clinic, the decision would be simple. The problem is that both digital and analogue systems are never simple, and a lot of thought needs to go into how they are designed and implemented. The future is coming, and when we start to reap the benefits of good interoperable digital systems we will wonder why we waited so long.

Finally, what can we do as junior doctors to further the digital agenda? Sometimes we just need to speak up. When a system failure compromises patient care, fill in an incident report. When a patient is delayed you can tell them to raise the issue with PALS or their local healthwatch. Do an audit for the IT department. Write a blog about your experiences. If we want to work to change the system we work in we need to be vocal on the issues we care about.