Cutting the ties to one GP system

Dr Neil Paul

As the monkey in The Lion King says: “the circle of life continues.” This applies not only to the constant reorganisation of the NHS but to how we organise computing.

Broadly, there is a constant battle between the idea that all-powerful mainframe computers with dumb terminals should do all the work and the idea that powerful desktop computers should get the job; only now we don’t talk about mainframes but about servers in the cloud and we don’t talk about terminal links but about web browsers.

I find it intriguing that we have recently seen a move to multi-cored processors – and even the utilisation of the graphic processor to boost processor power and speed – when most of what we do with a computer is increasingly web-based, delivered through a browser and limited by download times.

High-powered computers are really only for running games and encoding videos, which are mainly home activities. But home computing is becoming less operating system dependant. I use an iMac and a friend has just bought a miniature laptop that runs Linux. Neither of us seems disadvantaged by our choices.

One reason is that a lot of software seems to be available for multiple platforms at the moment. Take Evernote, my current favourite utility. It lets you write, scan or even photograph notes and deliver them to your desktop, email or other applications.

It runs on my work PC, my iMac and my iPhone. I can take notes anywhere and it syncs them across all those platforms. However, the company behind it has had to write software for each platform – which must surely be a pain?

On this subject, many people have wondered if Apple would bring out a Windows version of its successful iLife and iWork software. The company has always seemed reluctant, but perhaps they could release it as part of their MobileMe suite of applications and have it work through a browser, avoiding the need to write multiple versions?

This is what Google seems to have done with its applications, which include a word processor and spreadsheet. On the other hand, Google gives these away for free and I only know of one person who uses them. Apple has a subscription model and I know loads of people who use it. Is it a case of you value what you pay for?

This all brings me to the NHS IT programme. I wonder if primary care IT needs to become less dependent on one particular operating system and on client side software. We are already moving towards centralised, hosted systems for our patient databases, so why can’t we just put a browser front end onto them?

My primary care trust already uses a Citrix system that is available securely via Cisco virtual private network from any type of machine with an Internet connection. Once logged on, you can run any of the programs you are authorised to access.

Should the whole of NHS IT become one big Citrix system? You could log on from whatever machine you liked: an iPhone or its equivalent for mobility; a tiny laptop for home visits; a laptop per clinician to act as a portable desk: even a terminal in an office equipped with a browser? You could even your patient’s computer in their home.

We might not even need a separate NHS net. Couldn’t we just rely on fast broadband links? But then, resilience would have to be taken into account. Perhaps we should be investing in a whole of country fast, wireless, secure network that anybody could connect to. Perhaps the NHS could fund it by letting non-NHS users use it?

So, have I just envisaged the future? Well, interestingly, the NHSmail upgrade, which allows access to calendars, contacts, emails and personal directories through Microsoft’s Exchange server and SharePoint technologies, may take us halfway there.

In which case, Microsoft looks well placed to continue to be the backbone of our IT lives, even if it loses a few of our desktops.

I am more worried about whether clinical systems are keeping up. I thought I once heard that EMIS Web (a system for sharing patient information across health communities) would be browser based.

However, at the last conference I went to, people seemed to be talking about Windows-based clients that needed installing on the desktop – and all the problems that entailed with configuration, updates and so on.

I was surprised by this, as EMIS pioneered browser services when they made Mentor (a clinical support tool) web-based because it was a nightmare to update on each desktop. Perhaps there are good technological reasons. But I would like to be able to log on direct from any machine connected to the internet with appropriate security.

One final thought; if we could try different systems just by logging on to their secure web pages, we might start choosing them on the basis of their functionality and ease of use; instead of sticking with something for fear of change. Wouldn’t that benefit all users?

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.