“Have you tried turning it off and on again?” The challenges of NHS IT

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There are a lot of challenges that come with transitioning from medical student to doctor—from passing required exams to coping with your new responsibilities. One such challenge that every new doctor faces is navigating the temperamental labyrinth of NHS technology. 

Whether you struggle with Microsoft Office, or are coding your own apps, anyone who trains as a doctor in the UK will have to get to grips with the unique challenge posed by NHS IT. “If I don’t laugh, I’ll scream,” remarked Chidera on our latest episode of Sharp Scratch, recalling her experience of the technology in her first years working as a junior doctor. It seems likely that we will all have similar moments as we come up against a firewall of complicated systems, interwoven and tacked together over years of IT upgrades, resulting in a frustrating experience. 

From day one of medical school, students are educated about the importance of communication. Whether we are communicating with patients or colleagues, in routine scenarios or in emergencies, often having one system of communicating provides a safe and streamlined method of working. However, this unified method of communication does not seem to translate to the technology we all use every day. “Some hospitals will do this really fun thing where you have four or five different apps or programmes that you have to use and different logins for all of them . . . there’s no one way of doing it, regardless of where you work, it’s never intuitive because everyone has designed them slightly differently and they never work with each other,” said Chidera. “We have a national (health) service. We do not have a national IT service”.

So how did we get here? Nikki spoke to Stephen Armstrong, a freelance journalist who has written for The BMJ and Wired. In the interview, Stephen outlined the immensely complex series of events that have occurred over a number of years to culminate in the technological mess we now find ourselves in. He describes exactly how technology works in the NHS as “a setup that almost nobody understands,” with “so many different cock-ups along the way.” He explained that at its inception the NHS was, and remains to this day, a “pioneering, progressive tech organisation” when it comes to the equipment that is patient facing. So the technology required to conduct surgery or imaging, for example, is “cutting edge tech.” Where it falls down, he says, is that second layer of technology that doesn’t necessarily deal directly with patients, but is required to keep track of data, records, and information.

Stephen remarked on some discussion in the replies to Nikki’s tweet about NHS IT bugbears, which raised the much derided continued use of the bleep and fax machine in the NHS. To summarise: as shortness of breath is symptomatic of a failing heart, the fax machine is a symptom of the complexity (and often inability) to transfer documents between software programmes in the NHS. It is easier for staff to deal with an archaic, unwieldy piece of technology than rely on, or navigate, the multiple programmes that would be required to complete the task electronically. 

We also heard from clinical fellows at the Faculty of Medical Leadership and Management (FMLM), Sarah El-Sheikha and Sarah Blackstock, who spoke about some apps that they have found useful, before highlighting that “it is the behaviour change and the pathway change around that technology that can really improve for your working lives.” They brought up one of Chidera’s favourite apps, Induction, which is a directory for hospitals across the UK. A large part of the app is user driven, so if the doctors’ room for a ward has been moved, those who use the app can mark it as incorrect and keep it up to date. 

They also talked about WhatsApp, and the pros and cons of using it as part of your clinical work. Some of the interesting points raised were about it being an app that most of us use in our personal lives, and that blending work and social messages in the same app might provide a source of error and potential data breach. From a wellbeing standpoint, it also prevents us from “switching off” after shifts if our phones continue to notify us of what is happening at work. They discussed the possibility of a shift to Microsoft Teams as an alternative. Another interesting aspect of their discussion was the mention of “communication silos.” It is all very well using the best app with the most secure methods, but if the seniors that you need to contact or colleagues in different departments all use different communication apps then it all becomes very fragmented and disjointed.      

Stephen indicated that successive bad procurement decisions over the years, driven by financial restrictions and the lack of a unified approach to technology, have led us to where we are today. Yet while we may have to be patient and cope with the challenges IT poses at work, we don’t have to accept them. I think it is up to us as the new generation of doctors to innovate and develop software that works for us all in the way that we need it to. Whether you can code, design, communicate, or lead, I think there is scope to improve the technological environment that we work in. 

It is definitely a gargantuan task, but one we must rise to—because there are only so many times you can turn something on and off again. 

Andrew MacFarlane is a third year medical student, Scottish Graduate Entry Medicine (ScotGEM) course.

Listen to the episode on Spotify or Apple pods 

Sharp Scratch episodes to recommend:

The Sharp Scratch Panel:

Nikki Nabavi, The BMJ, University of Manchester

Andrew MacFarlane, third year medical student, Scottish Graduate Entry Medicine (ScotGEM) course.

Chidera Ota, junior clinical fellow in neurosurgery at Charing Cross Hospital, London.

Follow us on Twitter: 

Panel: @nikkixnabavi @andrew_mac94 @chidera_ota

Guest: @sarahblackst0ck @sarah_sheikha @SArmstrong1984

Brought to you by: @bmj_latest @BMJStudent

Sponsored by: @MPS_Medical


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