Volume 1. Discussion Documents

Volume Editor:  Rupert Fawdry

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Discussion Links: Pending

 

"Too Medical for IT journals; too IT for Medical journals"

 

Summary

A series of Discussion Documents concerning various aspects of Medical IT, with priority being given to using Information Technology for Individual Patient Care (especially by Individual Patient Encounter Assistance - “i.P.E.A.”) i.e. “Primary Data” rather than putting the main emphasis on the collection of “Secondary Data” for later analysis.

 

The current priority in the development of Acute Hospital Electronic Patient Records too often seems to be to collect more and more data for managers to analyse regardless of the extra workload for front line staff (“Paralysis by Analysis”).  As a result too often I find midwives doing voluntary overtime just to enter data into the “black hole” of a computer system, and the most frequent complaint about computers concerns the time that it takes to enter duplicate data.

 

Rather as if Airline pilots were very little direct electronic help with flying the plane but were personally expected to enter data onto the airline company’s laptop mainly so that the management could later tell them how poorly they have flown the plane - as illustrated in   

                          Jumbo,    TowerA,     TowerB

Instead the primary aim of IT (both through electronic and paper records of high quality) should to reduce human errors both in communications and in individual patient management.  If used in this way IT has the potential to provide welcome help to doctors, nurses, midwives and other health care workers by reducing rather than increasing their workload, their stress and their fear of litigation, while, without any extra workload or cost, far more data of better quality and quantity can potentially still be collected invisibly for managerial purposes. 

(Updated 9 Aug 2010)

Introduction 

Ever since, in Edinburgh in 1979, it was suggested to me as a research registrar by my then consultant John Scrimgeour and by Denis Rutovitz of the Medical Research Council that computers might have the potential to reduce human errors in maternity care, I have taken a consuming interest in how this might be practically achieved.

It has turned out to be far more difficult that I had imagined in my worst nightmares.

Over and over again, as I have repeatedly seen, from the many maternity IT initiatives in which I have been involved,

(as may be seen in Berlin Wall (Click here) and http://fawdry.info/index.php?&id=46  there has been a massive chasm of thinking between the complexities of medicine and the need for the clear-cut precision which is unavoidable in computer databases as also illustrated by Chasm between Medicine and IT

From my long experience  I gradually wrote these discussion documents but unfortunately they seemed too “IT” to be suitable for publication in medical journals and too “Medical” to be suitable for publication in Health IT journals, which then, and since, have tended to be dominated in the U.K. by Primary Care IT.

The complexity of the situation also often demanded much more space than is reasonable in a journal.

In 2001, in the hope of stimulating some realistic discussion regarding the use of IT in hospital medicine I offered to distribute some of my earlier discussion documents on a regular monthly basis to any obstetric colleagues who had from time to time expressed an interest in my long endeavour to tame computers to help us in the care of our individual patients.

Sadly then, (and sadly too often still), the medical profession seemed to be under the impression

a) that medical computer systems would be created almost entirely by IT specialists, with health professionals playing only a minor role on short term “advisory committees”

b) that computers were “magic”

c) that they were, in any case, quite understandably, already overwhelmed by other clinical and managerial responsibilities.

As as result I had no response whatsoever; and even now any attempt to initiate a serious discussion on how acute hospital IT computer systems might be created almost invariably stops any conversation dead! (“I work with computers” is reputed to the the worst chat-up line known!)

But hospital computing systems are only fully welcomed by those in acute hospital medicine when it helps doctors, nurses and midwives in their care of individual patients, especially when that care involves both hospital and community care; using both electronic records and where appropriate paper case-notes, paper proformas and computer printouts.

And computers will only achieve this in a cost effective way, as I hope the content of the EEPD demonstrates, after hundreds of hours of work and decision-making by dedicated individual doctors, not by a continuing series of independent short term expert committees.

So far both IT specialists, hospital doctors and epidemiologists still seem to be under the impression that Acute Hospital Medicine IT will be eventually be created by IT specialists, with intermittent free part time expert advice from hospital doctors in their “spare” time, or at most with one or two sessions per week for a year or so.

From my experience over the past 30 years, this seems to me to be rather like Victorian printers being confident that they can write great novels themselves, with only intermittent advice from expert committees attended from Charles Dickens and other actual writers.

I now hope that, by making these discussion documents openly available on the EEPD website, I may at last stimulate the kind of realistic discussion that is long overdue, using the internet (e-mail to editor@www.eepd.info  or by phone (UK.  +4477 678 23 827) between IT specialists, midwives and hospital doctors,

I have been encouraged several times to make use of the material for an M.D. or Ph.D. but my priority has always been to create and then distribute useful material via the internet.

Do feel free to photocopy any of these articles and pass them on if you think that a colleague would be interested.  

Rupert Fawdry (Updated 9 August 2010)