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A healthy way to computerize hospital records.

A healthy way to computerize hospital records

Seamless care when a patient moves from one doctor or from one area of the country to another, speedier treatment, fewer medication errors, improved patient safety and lower costs - those who favour large-scale computerisation of health records are not short of strong arguments to back their case.

Yet the benefits of these schemes have been hard to realize in practice. Take the UK's £12.7 billion progamme to create a single electronic-records system for 50 million National Health Service (NHS) patients in England. The Government has so far spent around £400 million on the so-called National Programme for IT (NPfIT), which is reputed to be the largest non-military IT project in the world. Ministers have estimated it could save the NHS £1.14 billion by 2014.

But that is just a projection. With public-sector borrowing forecast to reach £178 billion in the current financial year, and Chancellor of the Exchequer Alistair Darling admitting on television that the scheme is 'inessential to the frontline', the Labour Government may see it as a relatively easy target for cuts. The Conservatives, meanwhile, have said they will freeze Government information-technology projects, should they win the next election.

The Times newspaper reported in December 2009 that fewer than 20 hospital trusts in England had installed electronic medical records under the project, despite an initial deadline for the whole country to have done so by 2010. The National Audit Office, the Government-spending watchdog, criticised the 'serious delays' in applying new software to individual trusts.

The computerization of health records is a hot topic across the world, probably because it has such a direct impact on the lives of individuals. Costs, complexity, timescales and the problems of keeping health records secure are among the issues most frequently raised.

Even relatively modest schemes are not immune from difficulties. In Volume 54, Issue 5 of the Journal of Healthcare Management, published in 2009, Spetz and Keane recount the cautionary tale of a 100-bed acute-care rural hospital in the USA that planned to create an integrated IT system. The first signs of trouble emerged within two years of the start of the project, in 2004. By the third and fourth years, these worsened and the system fell into chaos.

There were problems with the system's vendor, despite the fact that the hospital had worked with it since the late-1990s in developing a computerised financial system. The main difficulties, though, centred on shortcomings in clinical leadership, staff scepticism, executive turnover and implementation scheduling - the so-called 'soft' issues, rather than the 'hard' technological ones.

When sufficient attention is paid to the soft issues surrounding the adoption of health-care information technology - and particularly the role of doctors - the schemes can be successful.

In the Journal of Healthcare Management, Volume 54, Issue 5, Cohn et al. demonstrate this in a case study based on the 230-bed Concord Hospital, New Hampshire, USA. The hospital set up a project team that concentrated on understanding how doctors thought about and cared for patients. It appointed 'physician champions' who played an integral role in designing and implementing the system and helped to prevent an 'us versus them' mentality from emerging.

The result is that, far from having to be encouraged to use the new information technology, doctors at the hospital are asking for more functions to be added to the system.
The authors conclude: 'The success of health-care information technology adoption and implementation are as much a matter of organizational culture as engineering design. Healthcare organizations that welcome innovation, rather than view it as a threat, can reap gains in quality, safety, and co-ordination of care.'