Next time you visit your doctor, observe something remarkable. The GP will carry out most of the consultation sitting at a computer, updating your records as she goes along.
Big deal: doesn't everyone use computers at work nowadays? No. If the GP refers you to hospital, the chances are that the consultant who examines you will write your case notes and prescriptions by hand.
In the NHS today, almost all GPs use computers in their consulting rooms but most hospital doctors do not. Although three-quarters of hospital doctors now have PCs with email and web access, only a handful use IT while seeing patients.
By contrast, all GP practices, save a few, were fully computerised by 1996;in the brave new world of primary care trusts, even those few have gone. More importantly, these computers are used directly in care, for storing medical records and ordering tests and prescriptions.
This contrast in IT usage between professional colleagues working for the same organisation is significant. If Tony Blair is serious about modernising the public services using IT, he will have to overcome it. But first, we must understand why it happened. An interesting paper in a recent British Medical Journal suggests two basic reasons: one to do with technical limitations, the other with more human factors.
According to the paper's author, Tim Benson, a veteran of 30 years of attempting to computerise the NHS, the human factors have their origins in politics. The NHS began investing in computers for hospitals long before GPs. But it treated the two types of IT very differently. From the early 1970s, NHS accounts classified computers as an administrative overhead, like paperclips. IT staff were graded as lowly administrators and clerks, and their pay fell behind that of private sector specialists.
Few senior doctors had anything to do with them or their machines. When administration and computers became politically unpopular after a series of disasters in the early 1990s, the government froze spending. "IT investment plummeted and the healthcare computing business was decimated," Benson says.
Computers for GPs escaped this roller coaster because they were classified not as an overhead, but as a core component of a GP practice. More important, GPs had a direct financial incentive to use their systems. They are paid according to the size of their patient list and the number of set procedures carried out, such as vaccinations.
Most learned quickly that the way to maximise income was to monitor and control everything on computer. Hospital consultants, by contrast, have a fixed income from the NHS. Time spent on computers does not increase their income. When they work in private practice, it's different. One of the most innovative hospital IT systems in Britain is at the private Princess Margaret Hospital, Windsor.
It allows visiting consultants to call up their patients' test results on the web, cutting the time they need to spend managing clinics. It's a big incentive. But the gap between hospitals and GPs is not all about money. The second obstacle, according to Benson, is the difficulty of scaling up systems designed for small organisations such as GP surgeries to hospitals or wider health communities. GPs work mostly in their consulting rooms, seeing one patient at a time. Hospital doctors work in teams: roaming around wards, clinics, theatres and offices. GP paper records are concise and structured, and lend themselves to computerisation: hospital records contain the input of many different professions.
Benson warns that all this means that the government's dream of integrated care records will not be easy. "On the other hand, we now know that traditional methods will not do the job, so innovation is the only option. "
New technology may help, especially when it comes to using computers on ward rounds. Doctors at the Brompton Hospital in London are already using Microsoft's new Pad computer. But the real lesson after 30 years of NHS computerisation is that the human factor is paramount. Public sector modernisers everywhere, take note.
