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TechnologyNov 9, 2022

Involve clinicians more when developing IT systems in health care, an editorial in The BMJ urges

Urgent action is needed to repair a growing rift separating upbeat government messages about a rosy digital future for healthcare – including artificial intelligence – and the experience of clinical staff who grapple with IT problems on a daily basis.

That is the message contained in an editorial published today (10 November) in The BMJ by Joe Zhang, who is based at the Institute of Global Health Innovation at Imperial College London, and two London-based colleagues.

Referring to a recent 10-day IT system outage at a large NHS trust, Dr Zhang and his co-authors warn that ‘such failures are no longer mere inconvenience but fundamentally affect our ability to deliver safe and effective care’.

Unlike the procurement of electronic health records, for example, investment in IT infrastructure – computers, servers and networks, for example – is rarely prioritised, when it should be seen as an something that increases productivity.


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Clinicians – the people actually using the IT systems – must be involved in developments

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Data security 'at risk' 

The recent signs are not good: a recent survey of NHS clinicians, commissioned by NHS England, found that user experiences of electronic health records were generally poor, because of unreliable, slow IT. Meanwhile, a British Medical Association (BMA) report estimated that about one NHS clinician in four (27 per cent) blamed inefficient IT systems for losing more than four hours a week at work. The BMA report also found deficiencies in investment and a lack of clinician engagement in procurement.

Outdated infrastructure also presents a risk to data security, the authors add. It is unclear how many providers conform to national guidance by keeping multiple back-ups of data, including ‘off site.’ ‘This digital future will not materialise without closer attention to crumbling IT infrastructure and poor user experiences,’ the team writes.

Poorly functioning IT systems are a clear and present threat to patient safety that also limit the potential for future transformative investment in healthcare. Urgent improvement is an NHS priority [Joe Zhang et al]

Quality improvement cycles must become routine

There is no one-size-fits-all solution, but the NHS can learn from approaches taken elsewhere, they say. In the US, for example, the effect of health IT on end users is an active area of research, particularly on how functionality of IT systems affects clinician burnout and effectiveness, while federal oversight of IT in health care infrastructure can help to identify problems and coordinate a response.

To facilitate a transformation of IT infrastructure in the NHS ‘we need to include systematic and transparent measurement of IT capabilities and functionality at the level of clinicians – the people actually using the systems’, the authors explain, ‘as well as at the level of those procuring the systems’.

Armed with this understanding, quality improvement cycles must become routine in IT governance, as they are in clinical care, and government must provide the investment needed to identify and rectify poor performance but also demand accountability, with minimum standards for IT function and stability, they add. 

‘We must not tolerate problems with IT infrastructure as normal’, Dr Zhang and his co-authors conclude.  ‘Poorly functioning IT systems are a clear and present threat to patient safety that also limit the potential for future transformative investment in healthcare. Urgent improvement is an NHS priority.’

To read the full version of the editorial, titled Failing IT infrastructure is undermining safe healthcare in the NHS, doi: 10.1136/bmj-2022-073166, visit: https://www.bmj.com/content/379/bmj-2022-073166

To see a recent PhysioUpdate article on a report titled Developing healthcare workers’ confidence in AI, visit: https://www.physioupdate.co.uk/news/clinicians-could-be-blinded-by-ai-technology-when-making-assessments-hee-report-warns/

Author: Ian A McMillan
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