Deborah Kirkham: Mind the technology gap—how can the NHS bridge it?

deborah_kirkhamI find the exhibition halls at conferences fascinating. They provide an interface between private and public sector which many clinicians are not exposed to in their day to day work. There’s the private companies with their baristas and artisan coffee beans; a stand that’s bigger than the square footage of an average UK home, and so many lights, screens, and colours, that one can only stand and gaze in wonder. At others, more modest organisations, or perhaps more modest public sector budgets, stretch to a branded tablecloth, a pop-up banner, and a free pen.

I can remember having a particularly visceral reaction to seeing the pharma stands at a clinical conference I attended. One particular drug was new and no expense had been spared. It was clear that the set-up alone cost tens of thousands of pounds; the visual merchandising was akin to walking through the duty-free section of Dubai airport. All that was missing was the celebrity endorsement. There was a marked juxtaposition with the leaking portakabin in which I worked in the NHS.

Most recently I was at the ninth Patient Safety Congress at Manchester Central. I was struck by the number of companies offering technological solutions. They had screens with showy videos demonstrating how you could view real time data on patients’ observations, and blood results with alerts to let you know when an individual was at risk of deteriorating. It all looked wonderful and I was excited at the prospect of new and exciting ways of keeping patients safe. Then I thought about my own experiences in healthcare. This world seemed at odds with my experience on the ground as an NHS worker.

After graduating I started as a Foundation Doctor at Salford Royal hospital, a mecca for healthcare technophiles. Patient notes are computerised, together with their blood results, imaging, prescriptions and observations. When I moved around six other secondary care organisations during my postgraduate training, none had electronic inpatient notes. This is an era where I can transfer money in seconds across the world at the click of a button, or, more simply book my hairdresser or gym class online. However, as a patient I still have to call the hospital to change an appointment sent to me through the post, and as a doctor would often spend time searching for patients’ physical notes.

There are clear advantages of incorporating technology into our clinical practice, but it seems like pie in the sky. The all-singing all-dancing technology offered by the private sector is undoubtedly beneficial but I am concerned it is currently unsuitable for an organisation that relies on fax machines and letters. The NHS does not have a good track record with managing technology solutions, earlier this month it was announced that, its data sharing programme, has been scrapped. A few years ago, the NHS National Programme for IT was also cancelled. Both of these national programmes have cost millions and achieved very little. Locally the story doesn’t seem to be too different with many hospitals using multiple separate systems, or still relying on pen and paper. The lack of integration of information results in duplication of efforts and daily staff frustrations.

There is a chasm between what the private sector are offering and where the NHS is with two potential solutions. First that these technology companies meet the NHS where it is, not where it could be. However, this runs the risk of patients and staff missing out on the best, most innovative solutions. Second, that the NHS advances to the point it reaches a level of technological compatibility to the rest of the business world. This is likely to be difficult without the influence of outside agencies bringing the NHS into the 21st century. In reality, both are necessary. The involvement of organisations outside the NHS can bring new perspectives and push managers’ and clinicians’ technological aspirations. But there are also fantastic examples within the NHS which we can learn from. Some organisations have been doing technology well for over a decade—what’s your excuse?

Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none

Deborah Kirkham is an ST5 trainee in Genitourinary and HIV Medicine currently on secondment as a National Medical Director’s Clinical Fellow.