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I am a Consultant Physician with considerable expertise in clinical
systems. I also am an experienced clinical user. I am writing to
explain why I have been so disappointed and concerned after my
training sessions on an NPFIT Clinical Records Software system (CRS)
featuring a Patient Administration System (PAS) and Orders and
Communications. My fear is that should we "go live" with this system,
our hospital might close down within hours.

As soon as the contract for NPFIT was awarded in our cluster, I
contacted the supplier, inviting systems analysts to come and spend
time with me in the clinical setting, so that they could learn how
clinicians work. I know that to make a good system the supplier must
understand the processes and end users. I also know that clinicians
are poor at explaining their activities and how these vary by
individual, speciality and hospital.

In response to my invitation, I was invited at short notice to
numerous meetings in distant places. In the 18 months of the project,
only one supplier employee came on one ward round for one morning. A
few months ago, I had my first glimpse of the system and asked how it
would work in outpatients. The supplier's consultant asked "What is
outpatients?" It worried me that the supplier did not seem to know
about something so fundamentally common to all UK hospitals.

Two months ago, I was involved in a training pilot of the CRS. I found
that the system could not produce a list of all the patients' under my
care in the hospital. In a more recent training session, I was taught
how to write a query to list all my patients on screen, but I am not
allowed to print the list out; the list on screen does not show what
the diagnoses are. The situation appears far worse for nurses.

In the new system, routine processes, such as logging into the system,
discharges, room booking and follow-up appointments are complex,
sometimes incomplete and laborious. By laborious, I mean that
processes that currently take seconds take minutes on this new system.
A specific example is routine ordering of blood and urine tests. It
was unclear who would receive the results or even if the samples were
ever taken. I ordered a standard set of bloods and a urine test and
had to enter 23 mandatory fields to complete the order.

I was dismayed as were several other senior clinicians and expert IT
users around the hospital. I see a system with no evidence that anyone
in the supplier's team has observed UK clinicians at work, or probed
to understand what we do. There appears no understanding that
confidentiality in medicine is to do with not disclosing information
under an ethical and legal code, rather than not knowing the
information. I believe that I saw an unusable system, which would have
slowed every process in the hospital to the point where we could not
handle the daily clinical emergencies and routine care. Their plan was
to switch our PAS off for six days and revert to manual mode while the
new system was installed!

What would I suggest as a starting point for a nationwide CRS? I
suggest a single web page for every NHS number holder, on which are
their demographic details, current significant medical health problems
and an alphabetical list of drugs, doses and frequencies, and
significant allergies, with one free text comments field. This tiny
quantity of data, updateable on one page, would transmit so much
useful medical data to make patient care more safe - ask any doctor or
nurse! If these data could be linked to clinic letters, discharge
summaries, etc, its usefulness would be enormous. If we understand
each other and work imaginatively we can crack this apparently
insoluble problem!

Dr Gordon Caldwell FRCP

[A copy of this note has, at the author's request, been forwarded to the PAC]

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