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The implications of this
change
Enormous investments have gone into CPAS worldwide. The estimated costs
for each large hospital are about £33mln., yet the overall benefits
and costs of hospital information systems have rarely been assessed 17
. “When systems are evaluated, about three quarters are considered to
have failed, and there is no indication that they improve the productivity
of health professionals 17 ”. There are also questions about what to
invest and how financial return will be. There are claims that CPAS may
reduce healthcare cost significantly, but this is still based on sensible
assumptions, and only few studies report on actual savings in expenditure,
which seem to be ever increasing 6,8,9 .
Greater use of IT is key to reforming the NHS UK. It is perhaps the
world's largest IT project, with proposed budget of £12 bln. till
2008, although some reports concluded that spending on technology had
to double at once if the NHS was to reach its targets; the NHS spends
less on IT per employee than any other industry sector 6,11,20 . But
there is more worrying problem in large government IT projects tend to
go wrong. They are often late, over budget, or both; sometimes even abandoned
altogether (e.g. “Pathway” a benefit-payment card scheme involving the
Post Office, Social Security Department and a computer-services firm,
collapsed after 3 years, wasting £300 mln.; Child Support Agency's
system; etc.) 11 . The problem is that these projects are over-ambitious
and government agencies tend to be useless at project-management, normally
handing it over to the firm implementing the project without independent
scrutiny. Such firms usually try “to reinvent the wheel”, rather than
use cheaper, existing technology, which means that only the original
supplier understands how the system works 6,8,11 . “Even when the potential
savings are credible enough, decision makers often remain in the labyrinth
of vendors' claims and reality 2 ”. Even if the government learns the
lessons from previous failures there are other troubles: NHS is not a
single organization, but a loose confederation of thousands of GPs' surgeries,
pharmacies, hospitals and clinics - implementation at local level, despite
central supervision, may be problematic 6,11 .
There are over 20 Patient Management System (PMS) suppliers in the UK
, although only small fraction dominates the market 5 . Yet, their technology
should work alongside health care policy makers and health care professionals
in developing products that benefit doctors, patients and health care
research. This also means cooperation with laboratories and pharmacies
to guarantee that systems are well-matched, e.g. 89% of UK prescriptions
are computer-generated but only 62% are endorsed by pharmacy computing
system 5 . This is the project involving 270-odd health trusts, 18 000
sites, 28 000 hospital doctors, over 30 000 GPs, and 50 mln. potential
patients. Every last detail (including patients' access to their own
records) should be in place by 2010. Contracts worth over £6 bln.
have been placed already 18 . Yet support by the users is critical for
the huge, even technically successful, project. So far only one in eight
doctors said their consultation was adequate, and three-quarters said
they had never been consulted at all 8,18,19 . But at least the heart
of the scheme has doctors' firm support: four-fifths of them told that
providing national CPAS is really important 8,18 . British Medical Association
says the procurement process was rather secretive, and many people in
the NHS do not know the detail of what is happening, even though it will
transform their working lives and have a huge impact on patient care
6,10 . With the introduction of new technologies into the health care
sector, comes the need for training medical professionals in the use
of it, both in order to eliminate errors and negative perceptions, “the
machine is as good as the user 5 ” 8 . “Not ensuring users understood
the reasons for implementation from the beginning and underestimating
the complexity of healthcare tasks are the reasons for failure 20 ”.
Despite the fact many clinicians recognize the potentials of the CPR
in improving the quality of care and reducing the cost, introduction
has been slow. First of all, many of the benefits mentioned are potential
and yet to be assimilated into the system. And secondly, lack of integration
and flexibility in CPR use, which does not motivate healthcarers to change
the working style 2,8 . Nevertheless, it is evident that clinicians play
a crucial role in the quality, content and usability of the CPR 2 .
As it was mentioned, “the technology of CPAS is based on capability
to both improve quality of care and control costs through better information
flow management within the organization and introduce the mechanisms
such as the timeless and spaceless organization of the work place, de-localisation,
and automation of work processes” 11 . Generally this means reorganization
in clinicians' practicing habits as in the UK hospital setting doctors
and nurses spend a quarter of their time on gathering and using information
9,10 . Administrative personnel may face extra burden of scanning documents
or transcribing handwritten forms. Storage of paper records will gradually
be replaced by electronic archiving systems. Computer-based repositories
require decisions as to where data reside and who is responsible for
their management. Such systems bring great changes to the daily activities
of staff 2,9 . Other organizational changes may involve the scheduling
of physicians' time, billing system and service fees 6 .
The security and confidentiality of patient data are of paramount importance
8 . At a ward level this is managed by ensuring that all staff are trained
in the security of data and understands the principles of the Data Protection
Act before they are issued with a username and password, which is changed
regularly for security reasons 3 . Also where the NHSnet has access to
the Internet there are software security guards to ensure nobody can
get access to the NHSnet from outside 3 . Computer viruses are the potential
threats to the security as well. All medical records are registered with
an appropriate data protection registrar and controlled by medical records
department 3 . There are recommendations that at the local level, a senior
clinician should be responsible for ensuring that patient information
is held in accordance with national guidelines (so-called Cadicott Guardians)
3,8 .
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Introduction
-
The
dimensions of the change in the UK
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The implications of this change
-
Conclusion
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References
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