Interview: Mary Hawking

Mary Hawking (right) receiving the 2009 John Perry Prize from Joan Perry

EHI Primary Care editor Fiona Barr talks to veteran healthcare IT campaigner Dr Mary Hawking, following her recent John Perry award.

In 1995, a Bedfordshire GP wrote an article in the Journal of Informatics in Primary Care, outlining her worries about data quality and the safety of electronic medical records.

More than 14 years later, that same GP, Dr Mary Hawking, has become synonymous with the subject.

The British Computer Society’s Primary Heath Care Specialist Group recently awarded her the John Perry prize in recognition of an outstanding contribution to primary care computing.

The award principally recognises the part Dr Hawking played in the development of the shared care record guidelines published by the Royal College of General Practitioners this summer. However, there have been other battles fought and won along the way.

Read codes and alarm bells

Dr Hawking says her interest in the impact that IT could have on general practice began several years before her own practice implemented its first IT system in the early 1990s.

But it was problems with that system – from EMIS – that rang alarm bells and brought Dr Hawking into contact with a whole range of local and national NHS and IT bodies.

She says: “We got our system in February 1992, and in February 1994 we moved from 4 byte Read code to 5 byte Read code. It was a total disaster. I was aware that this was going to be rolled out across the whole country and I thought ‘it needs to be stopped until the problem is sorted’.”

Dr Hawking contacted a whole range of local and national bodies, including her then Family Health Services Authority, the PHCSG, the NHS Centre for Coding and Classification, Computer Aided Medical Systems (the company set up by Dr James Read, the creator of Read codes) and the BMA in her quest to find a resolution to the issue.

Since then, she has maintained a reputation for raising concerns about IT, particularly in the era of NHS Connecting for Health.

She campaigned to get the Acceptable Use Policy for smartcards changed so it was appropriate for general practice and she has worked to make sure that paper referrals are still acceptable for patients who want their demographic details withheld from the Personal Demographics Service.

She says: “At one point it looked as though someone could conceal their demographic details or have access to NHS treatment, but they couldn’t have both – which is not really reasonable.”

Issues with shared records

However, it is her concerns about data quality and the single patient record that have been the focus of much of her attention in recent years, and which led to the creation of the Shared Record Professional Guidance.

Dr Hawking says her main concern is about the management of shared records, particularly where a number of different organisations are keeping their records in a single record.

She argues: “The risks come particularly with medication, where you are prescribing in one environment and you may have to alter prescriptions in a different environment. For instance, if a diabetes specialist nurse initiates insulin, and that dose subsequently needs to be changed, my understanding is that it can only be changed by the organisation that did it in the first place.”

Dr Hawking says the shared record guidance is “extremely useful as a starting point” but says it outlines problems rather than providing solutions. She claims single record systems that include acute trust data could exacerbate the problems further.

She adds: “Hospital records are about activity rather than long term management and hospitals have no interest whatsoever in primary care.

“If you are going to record something inside a trust which can’t be altered, then I don’t know how you are going to handle diagnoses which are subsequently disproved or abandoned. I just think its adding unnecessary complications.”

She says she has had contact with iSoft’s Lorenzo team on the subject, but that she has been told that there is not a problem. “When someone tells me that it’s not as problem, but doesn’t explain why, that makes me worried,” she says.

Still campaigning

Dr Hawking is also focusing her attention on the ramifications for data quality of GP2GP record transfer and has linked up with the University of Central Lancashire to look at how fit for purpose GP records are.

She explains: “If you take a record that’s fit for purpose in the place it’s generated, it doesn’t necessarily mean it’s fit for sharing.”

She says a small audit carried out by the ‘highly qualified’ summariser in her practice concluded that 16% of the records her practice received via GP2GP were “totally unusable.” “By that I mean my summariser had to go back to the paper record to get major diagnoses,” she says.

Now working part-time as a GP, Dr Hawking is also doing some work with the NHS Information Centre and is a member of the PRIMIS+ National Customer Representative Group. Her enthusiasm for medical record data quality issues looks unlikely to be diminished for some time yet.