Tuesday, 8 November 2011

A trip to the attic and some thoughts on NHS computing.

There are certain things that as an oppressed minority in general practice you can only do when the memsahib is away and one of the team did just this at the weekend.

They went up to the attic (disgusting) to retrieve a computer from almost 20 years ago. The dust on all the components coated their fingers and as they pulled the pieces from the attic they saw many things that were once the workhorse of their general practice and which still held useful information which was the purpose of this quest to answer a patient’s query.

The computer was reassembled without a single USB or PCT IT technician (delta grade triple star the NHS’s IT elite able to connect a monitor to a computer in less than 3 days and disable a practice as a result) but with lots of screwing (disgusting) of old fashion cable connections. When fired up the screen only displayed the message on the massive Cathode Ray Tube (CRT) screen of no video input with associated muscle ache from carrying it downstairs.

Disaster no flat screen light weight flat screen here but another trip to the attic found an even smaller CRT screen (bigger than the local Soviet allows their doctors to watch today) and on connecting and with a bit of experimenting and remembering the correct firing sequence for the cylinders of this particular piece of electronics the screen lit up.

The screen boasted of its massive 16 000 kb of RAM, its 90 MHz processor combined with a stonking 500Mb hard drive. Cutting edge in its time this brute of a machine ran a business for more than 5 years. The data required was extracted over a couple of hours and transferred to a more modern machine but what struck us was how easy it was to access this aged computer.

There was no password to gain access to the windows program for this computer ran using the DOS program (not the useless D(r)OS of Choose and Book) and you had the C: \ prompt which you followed with the hallowed secure password “win”. Access was almost instant.

No Smartcard, only one password for the most secure of files and the whole box that contained the PC weighed less than one of our current laptops. And what is more the whole boot process took less than 2 minutes which was like warp speed compared with today. All you needed to run a GP practice was still there and functioning.

Would we here at ND Central be able to access our current PCs in 5 years time? What about 20 years? Clinical systems demand regular password changes every 2 months. NHS Smart (Dumb arse) cards we believe automatically exclude users after 2 years until their local Soviet redefines them as suitable users of the clinical data that they create and record to enable them to treat patients.

The centralization of medical data although by some may have been seen as a relief to GP Practices but increasingly we see it as part of the control of the medical profession. In order to do your job as a doctor you need access to medical records. No access to medical records = can’t do job.

The NHS Smartcard is there not to keep people out of the medical records you create but to control which doctors are allowed in and hence able to work. We no longer have control over our access to the records that we create in the same way we had with paper or practice hosted computer systems even though the paper records were technically the property of the Secretary of State.

The data we required was easily extracted and most of the time spent doing this was with getting the hardware up and running from the attic. The same would be so of paper records.

Could you as a GP answer a complaint from 20+ years ago when the records may be on a computer? Can you remember your passwords or even your PINs from 20 years ago? Could you if you had ever assembled/built a computer yourself remember how to do so and get it to work?

Where do you your computer’s hard drives go to when replaced (Africa perhaps?) and given that now the Party has so generously relieved GPs of their financial responsibility for computers who defends GPs in the event of complaints? No records we believe means no defence. Are the centrally held server records so beloved of the Party still going to be there in 5, 10 or 20 years? Our old hard drives from various clinical systems still are.

Do you know where your hard drives from 20 years ago are? Can you access them? Can you remember the passwords?

Of course the benevolence of the Party is such that this will all have been thought of but issues of different coding of information from system to system means that data accurately recorded once may be inaccurately transferred over several years of changes of clinical systems which may well haunt us as GPs for years to come.

Paper records although bulky are easy to read (subject to doctor’s writing), are very personal and they need no electricity, no password, no dumb arse card and it is most satisfying to be able to answer a patient’s query about something that happened to them 50 years ago without going into the attic (disgusting) for the information was available from that time and was accessible to anyone able to read which would rule out most who work for local NHS IT.

Can today’s doctors say the same about what happened to someone in 50 years time? Paper has stood the test of time will NHS IT do the same?

Praise be to the Party for ensuring that a trip to the attic (disgusting) means we have experienced more advanced and secure IT on a desk 20 years ago than we do at work today for there was no internet or Party attempted centralization of records via a central summary care record which holds information as securely as a sieve holds water.

Furthermore these were “our” records and we as professionals knew where to find them and controlled access to them. This is no longer the responsibility of doctor but we are sure that other professions like lawyers and accountants will not have Smartcards or a national network of lawyer or accountant records to share with the world wide web as doctors are forced to do.

You have been warned.

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