Monday, 21 September 2009

Electronic is best? Not Necessarily.

Here in Northernshire our local laboratory services (haematology, biochemistry and microbiology) have been happily sending us their results by a Party forbidden means of communication called paper.

A recent edict has decreed, from sources as yet unknown, that all the above lab results will now no longer be sent via paper.

One can see the angst in the hours of committee time in the various departments involved discussing the vexed question of how do we save money, not improve services, that must have occurred at Northernshire PCT plc.

Can we pay lab staff the same rate for working out of hours?

Any junior grunt in the UK will know that lab staff earn most of their money by working anti social hours for more than junior doctors did (then) and still got upset if their sleep was disturbed. No, it will cost us most of our income.

Can we change the letterhead?

We could but no one from the logo section commissariat, sub commissariat lab letter heads, sub commissariat letter head design (new) section was present.

Or why not stop sending our results out on paper? Yes that will save us a few pence on our large pounds millions budget. We will do that as it is no skin off our nose.

Result an anonymous email saying that from date X no paper lab results will be sent.

A classic result of the law of unintended, or more likely unthought through, consequences. Electronic results does not necessarily mean better.

Most GP computing systems in the UK handle lab results in a completely crap way. You can read them slower than your pet snail can deposit a mucous trail across the width of your computer screen. And when you read them, and post them, the whole computer freezes until the result is posted from your inbox to a patient’s records several very long seconds each time.

The current paper systems allows GPs to see at a glance at least 5 separate lab results on a single page of A4 for example a FBC (Full Blood Count), ESR (Erythrocyte Sedimentation Rate, a non specific indicator of inflammation), U&Es (Urea and Electrolytes measures kidney function and basic blood chemistry), LFTs (Liver Function Tests tells us how your liver is), Calcium, TFTs (Thyroid Function Tests) on a single page. This can be scanned, analysed and acted on in a matter of seconds and provides in no more than 2 A4 pages max a complete lab screen for an attending physician.

Compare that with the slug that is electronically provided lab results.

Each individual result, for example a FBC, has to be selected read and then posted. Then you have to do the next result for example a U&E and so on. Instead of a complete scan of all of the results you can spend an hour just reading and posting a days lab results one slow test at a time doing what may have taken 10 minutes to do if the results were sent on paper.

So now, because electronic reading and posting of results is so very slow, to enable us to read the next set of results and see the odd patient during the working day as well we have to print off each individual result.

Not as the labs did printing off the results 5 sets at a time on one page of A4, oh no, nothing is ever that easy with NHS change for the better. We now have to print off 5 sets of results 5 pages of A4 at a time. A ream of paper (500 sheets of paper) a day versus may be 100 sheets from the labs.

So instead of a doctor in a matter of seconds being able to scan one patient’s complete results on one page of paper we now have at least 5 separate pieces of paper.

So what was a very simple and efficient process at the General Practice end is now an incredibly inefficient paper wasting, staff time wasting, doctor time wasting exercise.

No doubt there will be some cretin at the hospital putting on their CV how they helped saved the rain forests of the Amazon by stopping the labs printing results off on paper little realizing how much more paper is now being used and how much more electricity is being used to do things electronically than the old system.

Better still he, or she, will be writing in their CV, with their best crayon and using a fist grip, how they saved the lab budget money by abolishing paper results and marched progress forward using electronic delivery of lab results. Most readers of this blog probably last used their best crayon writing in their infant school but this is advanced NHS management we are talking about here. Crayon is the new supersonic electronic way of communication especially if it is red.

Paper has other advantages for example if you see some results ordered by a colleague that might be of interest to them you can take the paper and leave it on their desk for them to see.

I look forward to disconnecting my computer and leaving that on someone’s desk. Alternatively I will have to leave them a piece of paper telling them to boot up their computer, log in and look at the abnormal results one at a time. This will take about 3-4 minutes (just to boot up your average NHS PC speed machine before you start looking at the results) compared with the seconds to scan a piece of paper.

Isn’t technology wonderful dear reader? All the time it saves us.
Illustrates the ND law of NHS computing which states any new idea that claims to save time or improve service does not. Just think Choose and Book (or perhaps not even go there if you work in GP land in England?) you get the point we are sure.

Praise be to the Party for when it says things will only get better we know we get closer to the Stone Age with each new innovation it and its managers come up with especially in matters computing. Why go forwards through technology (vorsprung durch technic) when you can go backwards (Rücksprung durch technik )?


Quasi Serendipita said...
This comment has been removed by a blog administrator.
Anonymous said...

You need EMIS mate, I get through 30 bloods results in 2 minutes, all filed or actioned, easy to view idividually or all together.

Choose and Book however, don't get me started......

Northern Doc said...

First comment removed at request of poster.

You can't be using EMIS?!

It takes 2.5 minutes to load a 5 sheet A4 template here in t'North. We think because the speed of light is slower here so EMIS tell us after 5 years of snail system.

C&B don't get us started . . .the Sinclair C5 of modern computing.

Prisoner of Hope said...

'Twas ever thus: In 1982 while at Barts I had to attend user group meetings at the London Hospital (Whitechapel) where their labour intensive and leading edge Hospital Computer System was deemed too large to fail (like Casino banks 20 years later!). Clinic cancellation letters could for example be printed at lightening speed - all very impressive .....until a team visiting from another hospital on one occassion noticed the cards to be posted that afternoon were informing patients of THAT morning's clinic being cancelled!

At one meeting there was a request for a third reference print out of all Lab results to be produced for the main out patient hall. Why a third reference copy? Well given the delay in results finding their way into the records of patients being seen in clinic some enterprising staff had gone to the reference print out, found the results they wanted and cut them out to paste into the case notes so the consultant could see them. This became accepted custom and practice!

Some staff then complained that when the same patient turned up at their clinic - but still before the lab report had been filed in their notes for that patient - they could not even cut a copy out of the reference print out because someone had got there earlier! So a second reference set had been produced. Not surprisingly even this didnot work out on some occassions - so a third set was requested!

What dismayed me was that their solution was to request a further reference copy be printed rather than streamline reporting processes to ensure they were timely.

Anonymous said...

And just wait until your server crashes, or is hit by lightening, or theirs is, and there are no lab results for days.......and then hundreds. In semi-rural Canada, I still get both electronic and paper lab results, to ensure I get them at all.

Anonymous said...

Certainly am using EMIS but results are not scanned on, they are sent electronically via EDI lab links, been that way for 4 years or more. Soon to get radiology results that was as well.

Try asking PCT if they can organise this for you, good luck!