Magic and Mayhem

40 years experience with the problems of Shared Community/Acute Hospital IT in Maternity Care

Rupert Fawdry FRCS FRCOGHonorary Consultant Obstetrician, UHCW (IT Research)

Potential advantages of electronic records

• Easier access to previously recorded individual patient data

• Faster transmission of letters, reports, memos

• Reduced duplication in recording of data

• More reliable communication

• Reducing medical errors

• Better quality data immediately available

The dream: a paperless office?

Chasm of partially explored but virtually uncharted territory

Some reasons for – and results of – the Chasm

• 1984 Booking clinic printed items.– 42 UK teaching hospitals generated 571

printed history data items, of which• Only 12 items present in >75% of case records• Only 52 items present in >50% of case records

• 2005 Analysis of C-section Proformas– 8 UK hospitals generated >280 printed items,

of which only 3 items had (nearly) identical wording.

Computers are

• Extremely flexible in creation

• Extremely rigid forever afterwards

• Not Magic!

“Paperless” records? When…

• Hand-held and not reliant on wiring, power etc.; Crash proof & Virus proof

• User-friendly, reliable way of entering free text

• Portable but theft-proof / not worth stealing

• Open source, not reliant on proprietary systems

“Paperless” records? When…• Easily readable by any authorised person,

including the patient

• Easy for authorised person to make context-sensitive amendments any time, any place, anywhere

• Easy access without complicated password procedures

• As secure as paper record held only by individual and health provider

And When…• A single chronologically-arranged, flow-

patterned set of every question and every allowable answer option is– Internationally standardised– Takes full account of all interested parties– Workload/cost classified and logically

prioritised

Are we climbing the right mountain?

Never forget that ifcomputers had been invented

first, and paper & pen later;the latter would probably

have been regardedas the world’s greatest

breakthrough in the historyof Information Technology