When you walk into my GP’s surgery, the first thing you see is a screen on the receptionist’s counter. Displayed on it are the words (all in capitals) “TOUCH THE SCREEN TO ARRIVE FOR YOUR APPOINTMENT”. Being pedantic, the first time I saw it I pointed out to the receptionist that I had arrived for my appointment. She grimaced. I then asked if the medical implications of asking every patient to use the same touchscreen during, say, a flu epidemic had been considered. Another grimace. It was, she explained, “a new system”.
This system was provided by Epic Systems, a US corporation based in Wisconsin, which may explain why its software designers seem unfamiliar with the verb “to arrive”. It’s one of eight major vendors of healthcare information systems, all of which are based in the US, and it got its foot in the NHS door quite a long time ago. My doctor’s surgery has been using it for a while. At the beginning, the system’s user-interface was abysmal and dysfunctional. Now, several years on, it’s merely ugly. But at least it works.
On 26 October, our local hospital, Addenbrooke’s, which is run by Cambridge University Hospitals Foundation Trust (CUHFT), made an excited announcement on its website. “A new patient record system to improve patient care at Cambridge University Hospitals has been switched on. eHospital went live across the Trust this morning at 02:00. The new system will improve the quality of care for patients by ensuring that doctors, nurses and other clinical staff can access relevant patient information wherever they are, at the click of a button and on bespoke software that has been designed by and for clinicians.”
The hospital’s chief information officer declared that he and his colleagues were “delighted that this revolutionary new system has now gone live. It is the biggest single investment the Trust has ever made in the quality of patient care, and will make a real difference for everyone who comes into the Trust… Instead of having to wait for paper records to be delivered to the ward, nurses are able to bring up patient notes on their handheld devices. Patients will get their medication quicker, nurses can spend more time with their patients and people who are treated here will get home sooner.”
Now spool forward to 2 November, when I received an email from a friend who had broken her foot and gone to Addenbrooke’s.
“I had the bad luck to arrive the day after the hospital switched on to its ‘revolutionary new patient record system’, eHospital,” she wrote. “My son and I got to A&E at about 9pm to find posters up everywhere boasting about this, the usual endless queue of waiting patients and most of the staff clustered around computers, unable to do anything until they had logged on, and apparently finding constant glitches.
“Both patients and staff were really struggling,” she went on. “It’s not just teething troubles. The staff I’ve spoken to have huge doubts about the system itself – they say there was some consultation with them, but their responses were very selectively received. I doubt if they consulted patients. From the patients’ point of view,” she wrote, “it is quite dehumanising. Staff now approach [while] gazing at a mobile device and trying to find you on it; then they check you in with a wrist barcode. There is no time for conversation or even often for eye contact. Some of this might improve as they get more confident with the system but they are deeply unhappy with the change in culture and they say all the real nurses will leave.”
My friend’s observations cannot be dismissed as the biased grumblings of a pissed-off patient. They are confirmed in an official report to the local health committee by Jessica Bawden, director of corporate affairs, Cambridgeshire and Peterborough Clinical Commissioning Group. “On the evening of Saturday 1 November,” Bawden reported, “the Epic system became unstable. The decision to switch to a read-only version of the software was taken at approximately 11.15pm. Following expert technical advice and action from suppliers, the system was restored at 2.27am. Business continuity plans were deployed and a ‘major incident’ across the system was declared. All agencies came together during the night to support CUHFT; for example, all ambulances were rerouted to different hospitals for a five-hour time period.”
Just for the avoidance of doubt, this is not an anti-NHS rant. Addenbrooke’s is a pretty good hospital. And the NHS badly needs a paperless health-records system. This is just the latest instalment in a long-running saga in which British public institutions display their inability to introduce complex IT systems without causing chaos and distress.
We’ve been screwing up like this for two decades. Isn’t it time we tried learning from our mistakes?