Wednesday, 28 November 2012

British Medical Computing is crap 001: shafting the tax payer and the end user the basics.

Many years ago some UK GPs discovered computers and realized their potential. GPs were once allowed a choice of an IT system but when those less bright than GPs realized the advantages of them to patient care, namely the patient critical task of administrative data collection, the Party and its NHS administrators took over.

 The Party, then led by a public school educated Scot with no experience of computing or medicine, decided that they knew better and introduced a national retardocracy of computing. This included a plethora of initials including the NHS National Programme for IT (NPfIT) sometimes called NotFit.
A central command and control system of NHS non choice and reduce costs system called Choose and Book, and most importantly, a centralized control of access via the Smartcard to the data doctors and others in healthcare create so allowing the Party complete control of what healthcare professionals need to do their job.

Information (Technology) or IT or our and your medical records.

All of this retardocracy was for the benefit of the comrade patients (but only those that are the former great leader's friends and their financial interests) (not).
So history aside, and there are a few more to come, here is a simple Northernshire practice's experience of BMC (British Medical Computing). We do apologize for there are a few naughty grunt words in what follows which is a reflection (of our frustration) of our own practice customer "experience" of BMC.
A few years ago our local computing gurus based at the local Soviet recommended that several local Northernshire practices adopt the all singing all dancing EMUS (Extremely Medically Useless Systems other such systems are available) primary care computing package.
This was because the local Professor Stephen Hawkings in the IT department, all of whom were full of such words of wisdom regarding modern computing such as “we can’t possibly manage without floppy discs they hold too much information”, had been to a hard sell conference.
They had been stunned by a stand alone laptop (they had not seen a laptop before) demonstration which was not connected to the internet showing the benefits of remote hosting of practice information (they had missed the internet).
This is Northernshire where the racing pigeon is still the king pin of advanced local Soviet communication and every local IT techie is a Harvard and Yale graduate (most would struggle to spell Yale) because they have mastered the light switch magna cum laude by the time they had left school at age 47.
This is a challenge to any other healthcare professional out there. How long did your local Soviet and EMUS (or any other NHS computer supplier) take to get your system to work at anything other than at dial up connection speed?
We have had over the many, many years of crap service the following reasons why our system has never worked faster than a 200 year old tortoise with osteoarthritis in each of its 4 limbs that has just woken up from its winter hibernation weighed down with 4 packs of bricks on its back speed and that is before it gets its first fresh lettuce leaf of the season.
From EMUS (and any other willing shafter of the NHS) you get at the taxpayer’s expense with the local PCT “safeguarding” your multi billion pound investment, excuses like:
1) there is no problem. Do we give a sh*t as we are coining it in?
2) your expectations are too high. Interesting as our expectations are based solely on your salesperson presentation and your trainers’ comments which include them "feeling our pain" suggesting a very large account with Kleenex and many flexi jerk off moments at a senior level in contrast to fixing the problem(s).
3) it will get better with the N3 connection. N3 = New National Network = very expensive but crap broadband connection unless you are Patricia Hewitt when it is a nice little earner. Did it heckers but you ripped our and our patients' tax dollars off wicked.
4) it is the PCT’s server. Nothing to do with us guv honest.
5) it will get better on an EMUS (other willing sh*fters' servers are also available) hosted server. Did it heckers but more wonga for us from you suckers year on year via service charges with added worse year on year service for free.
6) after many years we will come and do some timings. Only takes 10 years to get to this stage when we sent these same timings to you some 10 years ago?And guess what they haven't changed in 10 years.
N3 at your expense say:
1) there is no problem
2) there might be a problem with your router. We will send several engineers out and change for it and charge for it several times with no improvement but considerable disruption.
3) there is a problem with the line (we will do nothing)
4) there is a problem with the local exchange (we will do nothing)
5) there is a problem with your internal wiring contact the PCT (we will do nothing)
The PCT say on our behalf to the above other two parties:
There is no problem.
The PCTs (soon to disappear) have for years as the purchasers of NHS IT spoken (allegedly on our behalf) and "represented" us to EMUS (other suppliers are available but they are the biggest) and N3 (who do not now as part of customer service talk to customers) and tell them there is no problem (as far they are concerned for none of them ever use the systems they peddle/purchase)
It is the PCTs who tell the suppliers that there is no problem and hence there is never any solution for as far as the PCTs are concerned they never use the computer systems they purchase and so there is never a problem. Bit like asking your pet goldfish rather than a pilot why a jumbo jet isn't working?
So millions are being siphoned off by computer companies all of whom think they are doing something useful like making money out of Government suckers while the consumers, sorry end users, GPs, nurses, receptionists and patients get a crap system.
"I am sorry it is taking so long to book you appointment the system is running at slug speed." Any patient not heard that at a practice with data transfer supposedly taking place at the speed of light but daily overtaken by the local slug population?
If you say there is no problem you don't have to do anything and you still get paid. If you then refuse to speak to those who say there is a problem things only get better (for you) but not the patient or the end user.
BMC in a nutshell. There is no problem.
Unless you use it.
Praise be to the Party for creating BMC and delivering fat pickings for a few but lean productivity gains on the ground for those that it was meant to help. And paying an army of retards to do nothing other than say there is no problem.

Saturday, 17 November 2012

Tick a box train a doctor.

Many many years ago when you were trained as a doctor you were given information, it was called training and you spent time in different areas of medicine in order to see how different specialties worked and in doing so you learned. This is not a difficult concept for it is  a simple system which worked once and amazingly continues to do so.

 There are, however, those who benefited from this simple system but who now practice self colonoscopy the process by which by staring deeply into your own dark black hole full of Sierra Hotel India Tango you gain enlightenment by completely ignoring the wider world. As a result of such practices they change medical education not for the better but for the worse as we hope a recent experience will illustrate.

An email from one of our doctors in training has prompted we elderly grunts to pass comment for many years ago we did something called audit.

It was not called audit then it was called good medical care and analysis. As a junior grunt we were once asked by a very learned Professor to keep a record of all their patients admitted over a 3 month period either as an emergency or a routine admission and to record every procedure done and every complication a patient had so that they could see how well they were doing (or not).

We were then asked to analyze this information which we did and discussed this with our seniors called registrars who suggested ways that we could present this information.

We did so to a group of fellow medical teams at our first world university and it generated loads of discussion regarding the results. What followed was a discussion between professionals, not managers, regarding the results and the team we were on did rather well and it led to changes for the better.

We did this because we were asked to and it was to our and to our future patients' benefit(s). We still have this presentation and its results.

We did this because it was right. The paper records and acetate slides could form part of a historical record of medical practice at that time and we guard them well for there is the issue of patient confidentiality of the cases presented. Please note patient, not commercial, confidentiality.

Fast forward to the "new" NHS training of junior doctors and we have been asked to complete an electronic template for an audit, not an analysis, presented at a meeting we were not present at in order to satisfy an electronic tick box exercise that achieves what?

We did not do that decades ago so what has changed? Do an audit present and learn from it then move on. Now do an audit present and learn from it then move on but ask everyone at the audit (or not) to waste time filling in an electronic tick box. Is this for the better or for the worse?

What matters is the analysis of the data not collecting a load of electronic ticks on an e-portfolio afterwards. Afterwards one should be concentrating on the results and looking for improvement in patient care not looking up a dark passage at an e-portfolio.

And worse we were not present at the presented audit. So if we complete the template how good is the e-portfolio at representing that doctor's medical "training"? Tripadviser medical education anyone?

Praise be to the Party for continuing to improve medical standards by training new doctors to tick boxes and ignore patients. A complete waste of time and a useless exercise of no benefit to the doctor to be or their patients.

Still it is cheaper than treating patients or teaching doctors face to face. And you can be assured that if the box is ticked that the doctor will be a good one won't they?

Monday, 12 November 2012

Why being NICE ain't always right.

The Party loves to control and one of its more limp organs of control is called NICE which stands for the National Institute of Clinical Excellence, sorry comrades, it actually stands for the National Institute of Health and Clinical Excellence (NIHCE).

Several of the team at ND Central have been disturbed recently by pharmacists refusing to dispense some prescriptions which we have issued. We here at ND Central have been critical of certain groups of pharmacists but on this occasion we cannot fault them for they were spot on right.

So here is a quick look at the "game" that GPs have been playing with NICE advice and more importantly the safe treatment of our patients. Remember NICE is always right, if you believe the Party and must always be followed by a "good" well appraised doctor so our appraisers tell us. Let us tread backwards through the mists of time and how we as a group of Northernshire GPs' have treated our patients over the last few years and the Party's role in it.

A few years ago a group of drugs called statins were launched amid claims that these were the new aspirin although in contrast to aspirin at less than a £1 a month these cost a minimum of c £20 a month.

Our radical pharmacist "friends" at the local Soviet said yes, they could be life saving, but they were too expensive, and so quoting the great prophet Keele said that for a simple unenlightened, uneducated GP to prescribe them on the basis of scientific research alone was a mortal sin that would severely harm the patient (PCT drug budget).

The prophet's wisdom applied for all time until the first holy statin patent for the evil drug Simvastatin expired and these drugs became almost as cheap as Aspirin when the followers of the great prophet decreed that all should be prescribed them until they came out of their back passage, which in quite a lot of cases they literally did.

This combined with widespread muscle aches which pharmacists never see made the followers of the prophet happy for these drugs were now doing good in contrast to the great evil of harm they did to patients (PCT drug budget) when they were expensive.

When we were young grunts we were taught that the management of high blood pressure was once a diuretic, then a beta blocker, then a calcium channel blocker and then, only after hospital admission, an ACE inhibiter. All worked but some were cheap and others expensive.

Another group of (politically) inspired zealots called the NICE(ntralization) guys decided that in contrast to those grunts who taught us we should prescribe the more expensive drugs first for what was once cheap, cheerful and worked is now decreed to be ineffectual and not NICE.

Hence another new prophet called the NICE guy, he of shiny teeth and no medical knowledge, decrees and dictates that Amlodipine and ACE inhibitors are now first line blood pressure treatment and should be prescribed by all true believers of the NICE guys (or else you won't get revalidated by his new political organs) for to disregard a good shaft by a NICE guy (your appraiser) is now heresy.

However, as practicing doctors we do not do NICE guys, we didn't go to their type of school, and people not just here but across the world realized that the once expensive and evil not to be prescribed statins are not that safe because someone had not actually done the real experiment with a statin and given it to a really large group of patients over several years outside of a clinical trial (until it became cheap).

And that was before the latest MRHA advice which means that once again following one set of guidelines to prescribe statins and amlodipine will dump GPs in some nasty smelly brown stuff.

As doctors we were once trained to evaluate research and form an opinion for an individual patient. The Party does not like this so it expects all of us to slavishly follow their advice via the prophet and the NICE guys blindly which could harm our patients but that is not important as long as Party diktat is followed.

Now as simple GPs we have had guidance from the NICE guys and the prophet Keele contradicted by the MHRA. So what do we as simple GP grunts on the ground do?

Continue to prescribe NICE blood pressure treatment and drop the statin?
(Our appraisers would not have us do so to ensure continuing compliance with Party policy via NICE guidelines).
Or keep the NICE statin and drop the NICE blood pressure treatment?
(Our appraisers would not have us do so to ensure continuing compliance with Party policy via NICE guidelines).

Or do we prescribe a not NICE once more expensive alternative statin (Atorvastatin) which is now cheap as its patent expired earlier this year? We do not know if by doing so if we may later have the same problem as with Simvastatin. Why?

Up and to now Atorvastatin has been prescribed restrictively in the UK due to its cost only, not its effectiveness, and we do not yet know if the MRHA identified problem with an interaction between simvastatin and amlodipine is to be an all statin drug class effect as opposed to an individual statin drug effect.

The drug industry have already seen an opportunity and are recommending that we prescribe more expensive statins that have not been prescribed widely and so as yet have not been outed as possible problem medications due to interactions.

Tick box medicine is not the way forward for whenever NICE and other bodies (bullies) publish guidance it is invariably out of date. Medicine is a dynamic subject and grunts on the ground have to respond to changes long before NICE can even get out of bed and put its myopic glasses on to read long outdated research, analyse it and after political and economic santisation published its retarded "guidance".

The grunts on the ground need a degree of autonomy not Sovietization via NICE for sometimes we notice things that we send into the MHRA that turn out to be true long before the true pattern emerges.

However they do eventually listen and act. And then we all have to change tune again which means once again explaining to patients why being NICE is actually being wrong and nasty for it wastes everyone's time except the NICE guys and the prophets.

For none of them ever see patients just like the politicians whose every wish they comply with.

Praise be to the Party for its plethora of guidance which if you slavishly follow will always dump you as a doctor, your staff and worse your patients in it. Whatever every happed to professional freedom of thought and expression when balanced with good training and ability?