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MedEconomics: IT frustration in a GP's practice

Simple changes and more thought about how GPs work could improve practice IT, says Dr Richard Lawson.

For better or worse, computers play a vital role in modern general practice.

Since the demands on modern GPs are increasing all the time, it is important that the computer systems that we use are designed to assist and not to hinder our work.

However, they do not always meet this aim. In the system I use, if I am looking at incoming pathology results, and I wish to open a patient's notes, I click on the patient's name and a dialogue box asks me: 'Do you wish to open Consultation Manager?'

I click 'yes' with a little flash of irritation, because this is an option to which I have never clicked 'no'. I have no need for that dialogue box.


Nor do I have need for the dialogue box that asks me if I am sure I want to re-authorise a repeat prescription.

These are only two tiny niggles, but they interrupt the flow of work.

It would take a few moments for a programmer to add a control that says: 'Do not show this in future'.

Another helpful, but sadly lacking improvement, would be placing range lines on the axes of graphs - for instance, to show the therapeutic range for INRs or the target ranges for BPs.

I have of course put in a change request to my software supplier, but no change occurs, despite the huge maintenance fees.

I must say that our system is excellent, with the potential to be the very best, if only it would be more flexible and responsive to the requests of its users.

Moving up the scale of computerised incompetence, a more serious unmet need in my system is that of determining the rate of consumption of medicines.

Sometimes, if we suspect that a patient is taking too much medication, we have to go back over the past few months, count the number of tablets ordered in that time, work out the number of days, and divide tablets by days to arrive at a daily rate.

Time wasted

Five minutes of our day wasted for want of a simple formula function that could be written into the program in four minutes flat. Two key clicks should give us exact knowledge of any patient's compliance.

But this function is not available on a major GP system.

In no way am I an IT Luddite. Our practice was computerised from an early date, and computerisation has brought us immense benefits in access to data.

The ability quickly to check drug side-effects is a boon. Computers are brilliant for searching patients' records.

But it is another source of grief that my system cannot search its own Read codes for a term within a patient's notes.

This unforgivable absence causes my diastolic reading to rise by an estimated 5mmHg each time I am forced to scroll back through the history records, searching for when my patient first presented with a particular symptom.

Worse still is the doleful inability of different GP computing systems to talk to each other, more than a decade after they were introduced.

IT versus paper

Each time a patient moves between practices, all the valuable electronic data is printed out on to paper in a non-standard format, often on worn out ribbon so that the words are barely legible, and posted to the next practice where they might be given a quick scan by the new GP before they are stuffed into paper notes.

This is not rational, nor is it safe. Important information such as drug allergies might not find its way on to the screen.

Again, it is not beyond the wit of man to create a common code for clinical data, so that it can pass intelligibly and reliably from system to system.

We might never see the day when patients' notes are transmitted by email, yet they could be downloaded to floppy disc or CD-ROM and carried from practice to practice with the same degree of security as paper note transfers.

All these deficiencies should give pause for thought with regard to the DoH's IT plans for the NHS.

If the NHS computers are too ill-designed and inflexible to respond to our present needs, what confidence does that give us that the huge projected centralisation of NHS computers will be able to offer a bug-free service?

Will the £36 billion that the DoH has put up for it be money well spent, or will it be seen as another of the bottomless financial pits that have drained money away from sound medical and nursing care?

Our patients and the NHS deserve better than the service that is currently on offer.

- Dr Lawson is a GP in Congresbury, Somerset.

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