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Replies to There IT goes again

1 October, 2011 (20:59) | Computers are Magic, EPR, Government policy, Initiatives, IT fallacies, National Programmes, Nightmares!, Paper Records | By: Helga Perry

This is our response to

Information Technology: There IT goes again

Michael Cross

BMJ 2011;343:doi:10.1136/bmj.d5317 (Published 2 September 2011)

published as a Rapid Response in the BMJ:

NHS IT requires the wisdom of the crowd not the marketplace

Susan Bewley, Obstetrician, Helga Perry, Rupert Fawdry, Grant Cumming. Kings Health Partners, SE1 7EH

In his recent upbeat article on IT in the NHS Michel Cross reverses some of the recent press nihilism e.g. the “NHS IT nightmare” described in a Lancet editorial[1]. But why then did the recent Department of Health DH Information Revolution consultation only garner individual responses from seven clinicians and 21 health professionals?[2]  Are they disillusioned because of past failures to engage and involve frontline clinical staff? Arguably, those failures to consult and harness their expertise might explain the NHS England IT fiasco.Cross gives evidence for optimism and draws attention to an agile iterative approach and the need for a mature debate about what constitutes success and failure. We favour a Hippocratic revolution in medicine[3] involving clinical wisdom, participation and collaboration in keeping with Greenhalgh and colleagues[4] and disagree that more leadership, oversight and accountability are required[1].

Creating a one-size-fits-all national electronic patient record was always an illusory, “magic” solution. Sydney Dekker recently wrote, “Converting to electronic databases that are accessible independent from the physical location of a patient record makes a whole host of assumptions about what makes human work and interaction easier,” therefore “reading a patient record or adding something to it is never going to be a simple conversion from paper to computer screen.”[5] The possibilities may be great but so are the opportunities for failure.

An entirely different approach to design considers paper-electronic hybrids, and focuses on input, interconnectivity and the keystroke burden of data collection by asking the right questions in a logical, flow- patterned sequence. In our specialty of maternity care, a wiki approach to encourage global interaction and interconnectivity in organising the input questions has recently been launched.[6] This may be a blueprint for other shared-care specialties that, like the current DH “Maps and Apps” initiative[7], taps into the wisdom of the crowd rather than the marketplace.

[1] Anon. The NHS IT nightmare. The Lancet, 2011 Aug 13; 3789791: 542. doi:10.1016/S0140-67361161275-0

[2] Department of Health. Liberating the NHS: an information revolution. A summary of consultation responses. Page 9. 580.pdf accessed 26 September 2011

[3] Cumming GP, Fowlie A, McKendrick D, Hogg J, Brooks E, McClusky C, French T, Eckl C. H=P4 +Cn and Health Web Science: A Hippocratic Revolution in Medicine. Discussion paper for Wecsci11 workshop

[4] Greenhalgh T, Stramer K, Bratan T, Byrne E, Russel J, Hinder S, et al. The devils in the detail: final report of the independent evaluation of the summary care record and HealthSpce programmes. University College London, 2010

[5] Dekker S. Patient safety: a human factors approach. Boca Raton: CRC Press, 2011: 84[6] accessed 26 September 2011

[7] accessed 26 September 2011


Competing interests: RF has served on virtually all UK national maternity notes and IT projects in the last 30 years. From 1990-2001 he was reimbursed by Protos now iSoft Evolution for the use of his expert medical knowledge. He has had no commercial connection with them, or any other company, since 2001 and has entirely self-funded the open EEPD website. The authors declare no other interests.

Published 27 September 2011

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