Another view: Neil Paul

As we have just had our one nice week of weather for the year we, like many others, had a BBQ for our friends.

Although my wife and I do know plenty of non-doctors, this BBQ ended up being one of those where at least one of each couple was a GP. As sad as it sounds, the conversation soon turned to work and, rather more unusually, to computers.

Normally, talk at these kinds of events revolves around weird patients or odd conditions that we have seen, or crazy rules or regulations that have come along.

However, as regular readers will know, all the GP practices in our area have recently upgraded to Emis Web. In general, this has gone well. There have been no major disasters, and certainly no data loss. However, I can’t say that many are in love with the new system.

New gripes

Personally, I’m finding the customisable protocols and concepts very interesting. I’m really starting to see the potential, particularly for our clinical trials work.

But the tiny text size is driving me mad and there is no way of changing it, which is crazy. Even selecting the large font size in windows doesn’t work, as it breaks numerous menus.

The biggest complaint from the BBQ group seems to be about the tasks system, which I agree is a mess. No one can work out how many tasks they have and which belong to them. The menu bar seems to be a random number generator and makes no sense.

In addition, everybody complained about the way the system has forced them to change the way they do medications.

The problem isn’t so much the on-screen acute prescribing – although it’s bringing on warning box fatigue (yes, I know antihypertensives can lower blood pressure, that’s why I’m giving them to this patient!)

It’s the way Web has changed people’s systems for no good reason. We had a great system with Emis’ old RI system. Now we get a ping as an urgent medication request arrives, taking over the greater part of the screen.

We have to print it out, which is just about ok if it’s ok – but not if it’s not. You can’t reject one medication, only all of them. And there is no way to get a message to the patient, because the button that is meant to do that doesn’t work.

We have a highly trained prescriptions team, led by a prescribing pharmacist, which now seems to be spending loads of time trying to work out in which room a script has been printed – instead of dealing with it and getting it signed, like we used to do.

Too much work seems to have been pushed onto the doctor when the computer system should be trying to take work off the doctor, so we can spend more time with our patients.

It feels as if we are becoming a classic example of a business that is forced to work the way its software works, instead of having software that supports the business. My senior partner, who moved us to Emis 15 years ago, is openly wondering what the other software houses can do.

I hope that any companies writing new Choose and Book software learn this lesson. Interestingly, we are beta testing some guidelines software for Infermed called Arezzo.

The company has spent endless hours watching us use their product – getting feedback from “experts” like me and our most junior registrar. It seems determined to make our lives easier, and the finished product should be worth watching out for.

Old gripes

To be fair, the BBQ talk quickly moved on to a surprising number of old chestnuts. The perennial problem of passwords came up.

We are still no further forward with getting one password. We have all been moved to NHSmail, which has a password that changes all the time. Our Windows log-on changes with equal frequency. IPads have different passwords again.

One positive thing about Emis Web is that people seem to prefer using their smartcard and four digit PIN for access. This doesn’t appear to change; but no-one can understand why we can’t use the same system for everything.

For example, PCTI’s Docman, which we all use, wants its own password. I’ve spoken to some IT people who claim it’s not much work to get the smartcard to function as a central log-on; but nobody seems to think about the end-user.

Other longstanding gripes include the time it takes our increasingly elderly computers to boot (I haven’t had a new PC in six years) and the fact that we are all stuck on IE7 and Office 2003 (when the IT department uses the latest versions for its work).

I noted that my computer had 93 updates waiting to be installed when I ran Windows Update the other day. Some of them were two years out of date.

I love the fact that the IT department has prevented me from using a USB stick with my computer for security reasons; but the computer is so buggy that it crashes or pops up warning boxes several times a day.

Bright ideas (we probably won’t ever see)

Which brought us to another gripe. People have wanted to be able to order x-rays on our ICE electronic order system for years.

They also want to be able to view reported x-rays and investigations, instead of having to ring a radiology secretary for this information.

We know this is possible (some rare users have this functionality; we’ve met them at events) so why doesn’t our local trust roll it out? Do they want to hold us back?

Trying to lighten the mood, and to get my small group to brainstorm instead of going over old ground, I asked my friends to consider development needs.

Someone mentioned the teenager who had made a fortune out of creating a website that summarised websites. Could that technology be applied to notes? Could you create automatic summaries of scanned notes in an intelligent way?

Even more clever, could you create a system that automatically redacted any third party references? Checking notes for these is a pain, and we spend a lot of time doing it for very little thanks.

Automatic redaction that worked, for example, for online notes access might, therefore, be a good idea. But it’s another real help that I’m not going to be holding my breath for.