I could just tell you that, despite it being 2017, NHS IT software is still terrible. I could tell you that the amount of time taken contending with this badly designed garbage is often more time than it takes to see the patient. But instead I'll tell you a story...
Picture a damp Tuesday morning, sometime in early February. A balding pot bellied man in an ill fitted suit scurries across a road, dense with early morning traffic. Using some soggy documents as cover from the rain, he hurries towards the doors of a shiny PFI built hospital. He enters the building and finds his way to the Corporate Board Room, wherein several important hospital executives sit.
"I'm terribly sorry I'm late", says the man (whose name is Baldo) dabbing hot dog mustard from his shirt with a damp contract agreement "car broke down"
"No problem", replies the CEO of the hospital, "Have you got the presentation to show us?"
Baldo withdraws an ageing IBM ThinkPad from his battered satchel bag and struggles with trying to connect its old style VGA connector to the video projector. Eventually, he manages to get his presentation to open.
On the projector screen, in large WordArt lettering, the title reads "Welcome to the future of hospital computing..."
Fast forward a few months.
"Good news everyone", declares the clinical director at morning handover, "tomorrow we shall implement iPatient, our new hospital management system. It's fantastic in every aspect, and will connect all of our IT systems together in ways never dreamed possible."
His enthusiasm is an immediate cause for suspicion.
"But, Dr Bowser," I respond "isn't this the same system that was trialled in Kettering Royal Infirmary but quickly withdrawn as it somehow managed to give the entire clinical staff botulism?"
"The very same", Bowser replied, bouncing up and down on his tail "Don't worry though. We've made sure that it works smoothly here by the clever and always sensible plan of throwing money at the problem."
"In what way exactly?"
"We've upgraded all the computers to Internet Explorer 9.0, and equipped them with extremely pricey duel screen monitors. In addition we've laid on 24/7 cover from the IT services department to support you. And when I say you, I mean you Geoff Burnhill. We're putting you on call tomorrow".
Fabulous.
Over the course of the day further ominous warnings occur. At 11:40 I receive an e-mail:
"Dear Clinical Staff,
Initial testing of iPatient has been a huge success. However, for no specific reason, could those clinical staff attending ED for implementation of the new IT system tomorrow please ensure they have a 48hr supply of food, water and caffeine tablets
Kind Regards
IT Services"
At 13:45 I walk past the IT services office and can hear a muffled argument. There is a loud thump and all falls silent.
At 14:30 I chance upon a computer technician ashen faced in the corridor, clutching a computer keyboard. He sits in the foetal position, sobbing. I ask if he wants to be taken to ED but he just screams "anywhere but there, it's not safe" before running off into the shadows.
At 15:24 a crash call goes out for the adult cardiac arrest team to please attend to a member of the IT services department who has apparently gone mad and jumped from a 3rd storey window. Marital problems are heavily opined to be the cause by the management team.
I go home and spend the evening working on my solution to child poverty, before bed I quickly train for my ironman triathalon and then save some kittens from a burning building.
The following day I arrive at work to find pandemonium. One consultant is shaking a computer monitor, seemingly to death, another is running around in small circles repeating "next please, next please" whilst the team of SHOs is lurking in a corner, probably doing hard drugs. On the wall, in blood, is daubed 'no escape'.
"Geoff thank God you're here", cries the nurse in charge, "There's 45 patients in the department and n waiting to be seen"
"What do you mean, n?", I respond
"I don't exactly, know, it's just what the computer says, I really don-"
She is interrupted by another consultant - "Right, plan is we're going to use this whiteboard to write down every patient in the department to keep a track of what's going on. Trouble is we don't know who they are so we'll start alphabetically; do we have anyone called A. Aaronson? No? Right then A. Aardvark? Man this might take a while. A. Aantidisestablishmenairianism...."
Wondering what all the fuss is about I tap my smartcard on the reader. SIDENOTE: Smart Cards are not smart. They are the worst invention in the history of mankind. You know the A-bomb? Well this is worse. You remember good old usernames and passwords, the kind that only you know and were stored entirely in your own head. Well a smartcard takes away your username and replaces it with an easily lost piece of plastic. Combining this plastic card with a, count them, 4 digit passcode generates an allegedly super-secure GCHQ-hack-proof authentication system. Unless someone leaves the card in the computer. Which they ALWAYS DO. Because humanity. Three words for you NHS IT... Two. Factor. Authentication. Jesus CHRIST.
Where was I. Oh yea, I tap my smart card on the reader.
"Good Morning, G,BURNHILL(Docter), Unfortunately your user profile does not exist"
I am too appalled as to how my name has been laid out to really care about the rest of the error message. I try again:
"You're smartCARD has been disabled due to too many unsuccessful logins. Please see a smartcard administrator"
I go to find one of the many, MANY, yellow tabard wearing IT support dudes.
"Hey man, can't get into the system"
"Hmmm", he replies, in a way that only people who have but the thinnest understanding of computing do, "Did you put your passcode in correctly?"
"Yup"
"Did you try tapping it at a different angle?"
I bring up the Wikipedia article on "How NFC works" on my phone and use it to beat the man to death.
Eventually, someone who has previously seen a computer before in their life steps over the corpse of his fallen comrade and is able to offer me some assistance. "It seems your smart card was disabled and we made you a new one. We didn't tell you about this because we figured, where's the fun in that?" Before I am able to explode into a ball of gas, he presents me with said card and we're on our way.
"Welcome to iPatient" The screen reads "We've got fun and games"
With great disdain I note that the copyright date reads 2004. It is currently 2017.
"Now the first thing that everyone does", says the overly chirpy IT services person, rolling their eyes as if to imply that every member of staff is an idiot "is that they try to click on the patient's name to access their clinical record."
"And..... we DON'T do that?"
"Oh HEAVENS, no. Clicking the patient's name deletes them entirely from the NHS spine and shuts down the computer permanently, of course.", there is excessive eyebrow wiggling, "To access the patients record you click. HERE."
He points at a nondescript area of the screen.
"Where, sorry?"
"Right here", the man is gesturing at a 10x10 pixel area that faintly resembles a bar chart
"On the bar chart?"
"EXACTLY"
With a sigh, I click on the bar chart icon. In retrospect, clearly if you want to write a note about a patient the obvious choice for an icon is a bar chart. Why was I being so stupid.
Before I can get any further a 5th consultant appears. "Right, plan is we're going to use individual sheets of paper to write down every child that's in the department. Does anyone have a pen? No pens? Anyone...". She scurries off, scattering sheets of A4 everywhere.
Upstairs, a lone child sits alone on the empty ward. "Hello.... is anyone there? I think my appendix is about to explode.... anyone?".
Back in ED. For reasons unknown, a siren is now going off. The SHOs are now playing hackeysack whilst the 8 strong team of consultants argue over which failsafe plan is the most safe, or most likely to fail, or something. A nurse runs past on fire. Children are screaming all over the show. A soldier wanders in "We're in some real pretty shit now, man, it's game over! It's GAME OVER".
I log back into iPatient and it immediately crashes.
I try again, and this time I am able to view a patient. Except that their surname is printed in Cyrillic.
On the third attempt I'm able to get into a patient record. I see the patient who, like everyone in ED has a mild cold, but who, because litigation, somehow needs blood tests. I attempt to use iPatient's helpful blood-o-matic blood label printing feature.
El Zilcho.
Finding an IT services member, and dragging him by the tragus to the machine, I ask him politely and in a professional manner. "WHY. THE FUCK?". After LITERALLY THIRTY STRAIGHT MINUTES he realises that my profile was never set up with printer support. I mean why would it be? Totally reasonable. When he does implement the support, the printer doesn't work.
I'm told to try another computer, with a printer. Also this doesn't work. And another, eventually this tries to work but is out of paper. I write the labels by hand. It takes approximately an hour less time than the automated system.
By the time we clear the department of patients, most of them have breached the four hour target. One consultant has had to be taken to Bradmore Maximum Security Mental Hospital, another has run off with one of the nursing staff. Of the 8 SHOs, one is now pregnant, another has gone to Adult ED with suspected overdose and the remainder are sleeping peacefully in the corner.
I go to talk to the clinical director, and find him sitting in the abandoned restaurant, eating melting ice cream. "Bowser, This IT system is a fucking disaster."
"You know, when they opened Disney World, none of the rides worked, it was awful"
"Yea but at Disney world, the rides didn't crash and stop us from seeing patients in a timely fashion" (for some reason this line seemed like it would work better in a different scenario)
"I know, next time we'll do it better. We'll spend even more money and buy even more screens and it will be glorious"
"Please make sure I'm not on call", I reply, digging into some melting ice cream "Man this tastes good"
"Spared no expense", he replies.
In the end they shut down iPatient and went back to the old software (I say old, it probably predated iPatient by about 6 months) and plan to reimplement it on April 27th. My birthday. When I'm on nights. In the meantime North Korea-esque propeganda posters appear throughout the hospital. Scantily clad nurses are pictured with quotes such as "I love iPatient, it saves me time AND energy" or "With iPatient all my patient information is carefully stored in a cutting-edge FORTRAN database, for interpretation by the latest IBM Digital Computation Machines". If you stare at them closely enough you can just about make out the image of the nurses husband with a gun pointed at their head reflected in their shiny white teeth...
And THAT is why the NHS is doomed to fail.
Picture a damp Tuesday morning, sometime in early February. A balding pot bellied man in an ill fitted suit scurries across a road, dense with early morning traffic. Using some soggy documents as cover from the rain, he hurries towards the doors of a shiny PFI built hospital. He enters the building and finds his way to the Corporate Board Room, wherein several important hospital executives sit.
"I'm terribly sorry I'm late", says the man (whose name is Baldo) dabbing hot dog mustard from his shirt with a damp contract agreement "car broke down"
"No problem", replies the CEO of the hospital, "Have you got the presentation to show us?"
Baldo withdraws an ageing IBM ThinkPad from his battered satchel bag and struggles with trying to connect its old style VGA connector to the video projector. Eventually, he manages to get his presentation to open.
On the projector screen, in large WordArt lettering, the title reads "Welcome to the future of hospital computing..."
Fast forward a few months.
"Good news everyone", declares the clinical director at morning handover, "tomorrow we shall implement iPatient, our new hospital management system. It's fantastic in every aspect, and will connect all of our IT systems together in ways never dreamed possible."
His enthusiasm is an immediate cause for suspicion.
"But, Dr Bowser," I respond "isn't this the same system that was trialled in Kettering Royal Infirmary but quickly withdrawn as it somehow managed to give the entire clinical staff botulism?"
"The very same", Bowser replied, bouncing up and down on his tail "Don't worry though. We've made sure that it works smoothly here by the clever and always sensible plan of throwing money at the problem."
"In what way exactly?"
"We've upgraded all the computers to Internet Explorer 9.0, and equipped them with extremely pricey duel screen monitors. In addition we've laid on 24/7 cover from the IT services department to support you. And when I say you, I mean you Geoff Burnhill. We're putting you on call tomorrow".
Fabulous.
Over the course of the day further ominous warnings occur. At 11:40 I receive an e-mail:
"Dear Clinical Staff,
Initial testing of iPatient has been a huge success. However, for no specific reason, could those clinical staff attending ED for implementation of the new IT system tomorrow please ensure they have a 48hr supply of food, water and caffeine tablets
Kind Regards
IT Services"
At 13:45 I walk past the IT services office and can hear a muffled argument. There is a loud thump and all falls silent.
At 14:30 I chance upon a computer technician ashen faced in the corridor, clutching a computer keyboard. He sits in the foetal position, sobbing. I ask if he wants to be taken to ED but he just screams "anywhere but there, it's not safe" before running off into the shadows.
At 15:24 a crash call goes out for the adult cardiac arrest team to please attend to a member of the IT services department who has apparently gone mad and jumped from a 3rd storey window. Marital problems are heavily opined to be the cause by the management team.
I go home and spend the evening working on my solution to child poverty, before bed I quickly train for my ironman triathalon and then save some kittens from a burning building.
The following day I arrive at work to find pandemonium. One consultant is shaking a computer monitor, seemingly to death, another is running around in small circles repeating "next please, next please" whilst the team of SHOs is lurking in a corner, probably doing hard drugs. On the wall, in blood, is daubed 'no escape'.
"Geoff thank God you're here", cries the nurse in charge, "There's 45 patients in the department and n waiting to be seen"
"What do you mean, n?", I respond
"I don't exactly, know, it's just what the computer says, I really don-"
She is interrupted by another consultant - "Right, plan is we're going to use this whiteboard to write down every patient in the department to keep a track of what's going on. Trouble is we don't know who they are so we'll start alphabetically; do we have anyone called A. Aaronson? No? Right then A. Aardvark? Man this might take a while. A. Aantidisestablishmenairianism...."
Wondering what all the fuss is about I tap my smartcard on the reader. SIDENOTE: Smart Cards are not smart. They are the worst invention in the history of mankind. You know the A-bomb? Well this is worse. You remember good old usernames and passwords, the kind that only you know and were stored entirely in your own head. Well a smartcard takes away your username and replaces it with an easily lost piece of plastic. Combining this plastic card with a, count them, 4 digit passcode generates an allegedly super-secure GCHQ-hack-proof authentication system. Unless someone leaves the card in the computer. Which they ALWAYS DO. Because humanity. Three words for you NHS IT... Two. Factor. Authentication. Jesus CHRIST.
Where was I. Oh yea, I tap my smart card on the reader.
"Good Morning, G,BURNHILL(Docter), Unfortunately your user profile does not exist"
I am too appalled as to how my name has been laid out to really care about the rest of the error message. I try again:
"You're smartCARD has been disabled due to too many unsuccessful logins. Please see a smartcard administrator"
I go to find one of the many, MANY, yellow tabard wearing IT support dudes.
"Hey man, can't get into the system"
"Hmmm", he replies, in a way that only people who have but the thinnest understanding of computing do, "Did you put your passcode in correctly?"
"Yup"
"Did you try tapping it at a different angle?"
I bring up the Wikipedia article on "How NFC works" on my phone and use it to beat the man to death.
Eventually, someone who has previously seen a computer before in their life steps over the corpse of his fallen comrade and is able to offer me some assistance. "It seems your smart card was disabled and we made you a new one. We didn't tell you about this because we figured, where's the fun in that?" Before I am able to explode into a ball of gas, he presents me with said card and we're on our way.
"Welcome to iPatient" The screen reads "We've got fun and games"
With great disdain I note that the copyright date reads 2004. It is currently 2017.
"Now the first thing that everyone does", says the overly chirpy IT services person, rolling their eyes as if to imply that every member of staff is an idiot "is that they try to click on the patient's name to access their clinical record."
"And..... we DON'T do that?"
"Oh HEAVENS, no. Clicking the patient's name deletes them entirely from the NHS spine and shuts down the computer permanently, of course.", there is excessive eyebrow wiggling, "To access the patients record you click. HERE."
He points at a nondescript area of the screen.
"Where, sorry?"
"Right here", the man is gesturing at a 10x10 pixel area that faintly resembles a bar chart
"On the bar chart?"
"EXACTLY"
With a sigh, I click on the bar chart icon. In retrospect, clearly if you want to write a note about a patient the obvious choice for an icon is a bar chart. Why was I being so stupid.
Before I can get any further a 5th consultant appears. "Right, plan is we're going to use individual sheets of paper to write down every child that's in the department. Does anyone have a pen? No pens? Anyone...". She scurries off, scattering sheets of A4 everywhere.
Upstairs, a lone child sits alone on the empty ward. "Hello.... is anyone there? I think my appendix is about to explode.... anyone?".
Back in ED. For reasons unknown, a siren is now going off. The SHOs are now playing hackeysack whilst the 8 strong team of consultants argue over which failsafe plan is the most safe, or most likely to fail, or something. A nurse runs past on fire. Children are screaming all over the show. A soldier wanders in "We're in some real pretty shit now, man, it's game over! It's GAME OVER".
I log back into iPatient and it immediately crashes.
I try again, and this time I am able to view a patient. Except that their surname is printed in Cyrillic.
On the third attempt I'm able to get into a patient record. I see the patient who, like everyone in ED has a mild cold, but who, because litigation, somehow needs blood tests. I attempt to use iPatient's helpful blood-o-matic blood label printing feature.
El Zilcho.
Finding an IT services member, and dragging him by the tragus to the machine, I ask him politely and in a professional manner. "WHY. THE FUCK?". After LITERALLY THIRTY STRAIGHT MINUTES he realises that my profile was never set up with printer support. I mean why would it be? Totally reasonable. When he does implement the support, the printer doesn't work.
I'm told to try another computer, with a printer. Also this doesn't work. And another, eventually this tries to work but is out of paper. I write the labels by hand. It takes approximately an hour less time than the automated system.
By the time we clear the department of patients, most of them have breached the four hour target. One consultant has had to be taken to Bradmore Maximum Security Mental Hospital, another has run off with one of the nursing staff. Of the 8 SHOs, one is now pregnant, another has gone to Adult ED with suspected overdose and the remainder are sleeping peacefully in the corner.
I go to talk to the clinical director, and find him sitting in the abandoned restaurant, eating melting ice cream. "Bowser, This IT system is a fucking disaster."
"You know, when they opened Disney World, none of the rides worked, it was awful"
"Yea but at Disney world, the rides didn't crash and stop us from seeing patients in a timely fashion" (for some reason this line seemed like it would work better in a different scenario)
"I know, next time we'll do it better. We'll spend even more money and buy even more screens and it will be glorious"
"Please make sure I'm not on call", I reply, digging into some melting ice cream "Man this tastes good"
"Spared no expense", he replies.
In the end they shut down iPatient and went back to the old software (I say old, it probably predated iPatient by about 6 months) and plan to reimplement it on April 27th. My birthday. When I'm on nights. In the meantime North Korea-esque propeganda posters appear throughout the hospital. Scantily clad nurses are pictured with quotes such as "I love iPatient, it saves me time AND energy" or "With iPatient all my patient information is carefully stored in a cutting-edge FORTRAN database, for interpretation by the latest IBM Digital Computation Machines". If you stare at them closely enough you can just about make out the image of the nurses husband with a gun pointed at their head reflected in their shiny white teeth...
And THAT is why the NHS is doomed to fail.
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