IT side-effects at the NHS

My mother has a a phrase – professional illness. It’s the moment that she (an environmental engineer) walks into a random building and promptly looks at the air ducts. I suffer from the same thing – only around tech. Before and after the birth of my daughter, I have had more chances than ever to deal with the NHS. In that time, I witnessed a couple of events that made me step back and think about the way that IT in general conducts itself.

I don’t work with end-user business apps these days, but having spent years doing just that, still feel the pain of those that do. While agility and user input are all the rage, the reality is that we as developers are often so disconnected from end users that we just don’t feel that pain, and some things don’t fit in neatly into bug reports. Add to the normal IT project multiple layers of go-betweens, project managers, business analysts, ivory tower architects, and things of concern fall through the cracks.

At a late stage appointment with a midwife, we had the pleasure of arriving on the day of the rollout of a new patient record system. We have all heard about these things, mostly because they’re delivered way over time and budget. It was interesting to see it from an end user perspective. Having spent an hour or so doing what midwives do, we sat down while for the first time a mid-50’s lady set down in front of a system she’d only ever presumably seen in an “induction”. Like code handovers, these involve a dreary talk to a group of people with some vague handwaving, all moving too fast for anyone to get a sense of what’s really going on. Then a pat on the back and “off you go”.

It all seemed so straightforward, a menu on the top all looking very Office 2010, a list of appointments in a side pane and forms to fill out. Everything looking uniform, and as a result fairly difficult to navigate without reading it all out. To the developers it must have all seemed so obvious, it’s just a forms application, and of course Checkup B follows Investigation A. It’s easy to think this way when you have been looking non-stop at the same app for weeks/months. A quick usability test with a fresh pair of eyes would have made life so much easier for a new user.

Coming in towards the end of the pregnancy we arrived, as you do, with a folder of paperwork from previous scans and checkups. Presumably this was exactly what this record system was to replace. You carry these collections of paper around the whole time, just in case something happens, so that the relevant health professionals can at a glance get your background details. It seems there was a bit of a hitch. In order to record details of a final scan, you obviously need the details of all the previous appointments. The system wouldn’t let you submit just that form. Cue 45 minutes of a midwife copying paperwork into the system, all while our eyes glazed over and other patients were filled up the waiting room. Major own goal, and yet so simple to deal with. Presumably since getting the data imported from paper would be impractical (mums aren’t going to hand over their potentially needed baby notes to get sent to an offshore data entry shop), either use the system for new pregnancies only, or loosen the constraints such that the workflow can be entered into in the middle.

Our next IT speedbump got me thinking about open standards/data, when a pediatric doctor checked Alex before discharge. The doctor had come from another hospital, and had no idea how to use the software at the one we were in. Presumably, both systems had access to the same data, though managed it differently. Open standards are often touted as a “Good Thing”, providers can develop systems that operate against those standards and consumers (hospitals, GP surgeries and the like) buy the “best” solutions (from an indistinguishable selection). On the face of it, the idea is actually quite good – increased competition yields better prices, and innovation (though I’m skeptical as to how much of that you can have filling in forms). I get the impression that side-effects such as the one of staff moving around having difficulties are the tip of the iceberg. Centralised procurement often yields sub-optimal results, and massive cost overruns from kitchen sink requirements. Building 95% similar systems over and over seems like it has its own problems. I don’t know what the answer to that one is, or whether one in fact exists, but I have no doubt it’s worth thinking about.