User Design - Basic Principles

The British National Health Service (NHS) has one one of the largest healthcare IT projects (National Programme for IT NPfIT) in the world rivaling size and complexity in almost any industry. It's no wonder given the size and complexity that there are problems but in some cases these are just plain simple mistakes and getting basic simple things wrongs does nothing to engender the support and confidence with the embattled clinical users

A Recent post from "Phil Hammond 'Medicine Balls' " Confusing for Health highlights the reasons why the NHS Care Record Service (CRS) implementation systems has been "indefinitely postponed". (I've copied the full post below in case this link fails or ceases to work) but it was item 9 that caught my attention.....

Users who select 'died in department' by mistake (which is default outcome if D is used to navigate drop down), do not receive a warning resulting in appropriate letters sent to the GP. For genuinely deceased patients, the code is mapped incorrectly and does not bring up fields to complete, to register patient dead on the spine.

(The spine in this context is the NHS network backbone)

In a cock-up worthy of the Colemenballs moniker the default value for patient outcome is "Died in Department"!! Someone, somewhere is not firing on all cylinders and there there is a chain of people who let this through into a live systems that are diagonally parked in a a parallel universe.

As Phil Hammond states

...you can only succeed by starting as simply as possible and then getting those who have to use the new system to help build it into something fit for purpose

Sage advice!

>>>>> Confusing for Health >>>>>
Original posting should be available here

The NHS Care Records Service (CRS) is a secure service that links patient information from different parts of the NHS electronically, so that authorised NHS staff and patients have the information they need to make care decisions.' So says the Connecting for Health website, but there isn't much sign of it up and running in the West Country. A computer literate consultant tells me that CRS has been 'indefinitely postponed' where he works because 'it cannot migrate data across the system into the correct coding slots which means there is no way for a hospital to record what work it actually carries out and be paid appropriately.'

Our new market driven NHS depends for its survival on the right money following the right patients. And then there's the extra cost not just of installing the new system but paying extra staff to run it properly. A document sent to me for the Royal Free hospital in London shows not just how many bugs still need ironing out in the CRS, but how we all need to learn a whole new language to communicate with each other.

'1. There are problems associated with the use of smart cards to log on, which takes 7 key strokes, resulting in a very long log-in time, as much as 10% of each hour. This discourages use of the system, and encourages staff to leave the card in place, which then prevents the identification of the user when requesting X-rays, bloods etc.

2. The GP letter is very poor quality and requests to change this via the RFC (Referral Facilitation Centre?) have not been implemented. The treatments and investigations form does not support the user in choosing clinically important tests or support HRG 4. The Inbox not emptying automatically leads to significant delays in the system.

3. Clinics must have DNA patients dealt with as DNA, otherwise 18 weeks reporting is a problem. Reporting for the four-hour target is clunky and can only be done in Explorer because of the delay in updating IM200. This still takes up to 2 hours to validate the performance each day, causing 40-50 breaches a day for first few weeks.

4. Data can be entered but may not be visible to other users, and is difficult to find the forms and summaries. Multiple issues raised with LPfIT and BT/Cerner since going live have not been resolved

5. Free text fields on the discharge letter only allow 750 characters, resulting in limited summaries and poor communication with GPs.

6. Excessive time taken for scanning, registering, creating pending admission and GP letter printing. Five extra A & C (administration and coding?) staff have needed to be employed.

7. Discharge time of patient is displayed rather than check-out time (i.e. time patient left department). This makes reviewing 4 hour breaches impossible, since discharge time may be as much as 24 hours after checkout time

8. Manchester Triage does not populate white board. (I've no idea what this means either).

9. Users who select 'died in department' by mistake (which is default outcome if D is used to navigate drop down), do not receive a warning resulting in appropriate letters sent to the GP. For genuinely deceased patients, the code is mapped incorrectly and does not bring up fields to complete, to register patient dead on the spine.

10. The system crashes 2 or 3 times a week.'

I think I only understand number 10 with absolute certainty, but the message is clear enough. Implementing large scale IT projects is unbelievably complex. And you can only succeed by starting as simply as possible and then getting those who have to use the new system to help build it into something fit for purpose (preferably without inventing a whole new geeky language). I'm generally an optimist but I'm not sure about this. How long before we have more coders than doctors? Or are we there already?