Why can’t my computer be cleverer?

Dr Neil Paul

In his latest column grassroots GP Dr Neil Paul seeks a computer that can do more.

Recently a colleague emailed to say she could not open one of my email attachments. I tried opening the Word document myself, and it worked fine for me. But when I re-sent it, the same thing happened.

It was only after I sent myself a copy that I realised the file had been saved without an extension. The .doc bit was missing, and although my home computer knew what it was and would open it, my colleague’s computer did not and would not. Adding .doc to the file sorted the problem.

Now this strikes me as a classic example of how the inflexibility of computers can ruin their usefulness. Why didn’t Word warn me it was saving the file in a format no one else would be able to understand? Why didn’t the email programme tell me “you are sending a file no one will know what to do with” or even more cleverly add the .doc without bothering me about my mistake?

And perhaps more fundamentally – why has the world become dependent on three letter abbreviations? Couldn’t the header of the file include, in a standard form, the type of document it was and how to deal with it without having to have the extension right?

Anyway, the amount of time I had to spend doing what I consider to be the computer’s job reminded me of the IM&T direct enhanced service (DES). This rewards GPs for using IT in defined ways, such as keeping data up to date, improving data quality and using some national services.

Now, I am all for data quality, have been a keen champion of it. I just wonder why so much of it needs to be done by humans when computers could make life a lot easier.

For example, one of the items to look for in the IM&T DES was double coding of hysterectomies. We had to manually search and edit all records with more than one entry to delete extra codes or amalgamate them into one. No, why couldn’t the system do this automatically? Asking which date was the correct one or making an intelligent guess?

As women can only have one hysterectomy, it’s natural to ask how it can be recorded more than once. Well, it is often because we get multiple copies of the operation note. We might be faxed a copy of a hand written note; the patient might hand in a copy of the same; we will get a typed letter some months later; and because we are all conditioned to make sure we enter codes it gets added multiple times.

The data cleansing exercise was carried out with a view to making sure the manual system is robust enough to stop double coding. But to my mind, the answer isn’t to have a manual system that works – it is to have the computer do it for you. Why can’t the system let you know you can only have one entry, and complain every time you try to add more than one – or simply stop you?

Even cleverer would be for the hospital computer to tell my computer immediately after the operation has happened – once and only once – and bill the primary care trust at the same time. I constantly hear that the future is fridges that will reorder milk over the internet, so why not this?

A journalist patient who was with me when my computer crashed recently shared his loathing of big IT departments. He felt – and I am starting to agree with him – that an IT department will always take the most complex route to doing something.

He cited an example of working in a production company that wanted to get some audio files to the BBC every day at the end of the day. The IT department came up with a plan that involved multiple, fixed ISDN links with encryption and passwords and satellite backup. It required four companies as intermediates. His suggestion was to save the files onto a CD and to get a researcher to deliver it on her way home.

I thought this story very apt as our clinical communication project progresses. Each hospital involved now has its own patient administration system. They all need a way of generating electronic discharge information and sending it into a centralised electronic bucket. Each practice then has its own way of dipping into the bucket, depending on the system they are using. And each then has a different way of attaching the information to their clinical record.

About four companies are involved and we are currently attempting some end to end testing. I’m sure each step is necessary and hopefully it will be great. But each company along the way is making a profit – how much could be saved if all health care providers’ clinical systems could talk together in a secure, reliable way without so many intermediaries?

Dr Neil Paul is a full time GP working at the Ashfields primary care centre in Sandbach. He sits on his primary care trust’s professional executive committee and has a lead role for IM&T and practice-based commissioning

A version of this article first appeared on the Microsoft NHS Resource Centre. www.microsoft.com/uk/nhs.