DOWN TO THE WIRE

Last Saturday, my seven-yearold son returned from another needle match for Cuddington under-eights soccer team, grinning hugely from ear to ear. 'Did you win?' I asked. 'Well', he replied '. . . nearly'. 'So what was the score?' 'Um, 7-2 to them, I think.'And off he hopped.

He has the optimism gene, no doubt about it. And he got it from me.

Sometimes, readers tell me I seem a little gloomy. That couldn't be further from the truth. I couldn't be more hopeful about the possibilities for IT in the NHS. I think it could bring the most extraordinary benefits to patients, clinicians and managers, if we make some sensible decisions for the future.

That is why I get frustrated when the same errors are made again and again by an unresponsive central bureaucracy: the sheer waste of potential is what hurts.

But the potential is real enough.

Let me take you to a real hospital, somewhere in England. It has an electronic patient record system.

This was provided by a private company but implemented in partnership with managers and clinicians on site.

Every day 4,000 electronic notes are opened, and 800 people regularly use the system.What a transformation there has been since the system went live.

House officers no longer search for paper reports, phoning the laboratory for copies or even asking for the test to be done again. Instead, they can simply look at the nearest PC screen or receive the abnormal result as an e-mail attachment. Every EPR is immediately available in accident and emergency and in the admissions wards to provide background information where patients'memories fail them or where the results of particular investigations have never been passed on.

Consultants telephoned by GPs for advice no longer flounder, trying to remember past tests and consultations and future plans.

They have immediate electronic access to all relevant information.

They can advise the GP at once, and the GP can, in turn, let their patient know immediately faceto-face what needs to be done.

Clinicians no longer spend the day bleeping each other or playing telephone tag. Instead, they can guarantee rapid delivery of vital clinical information using an e-mail system incorporated into the EPR. In a hospital where pressure on beds means a single team's patients may be on 10 different wards, the new system is the only efficient way to keep track of investigations. An online diary, shared with secretaries and immediate colleagues and accessible from the ward, the office and the clinic, makes it possible to organise ad hoc clinical appointments and management meetings.

Easy access to the internet also makes a big difference. Patient guides can be found and printed in moments.

Information on rare syndromes may be available immediately through search engines.

The system even offers support with prescribing. For example, the computer can help with complex multi-drug regimes, allowing drug doses to be automatically calculated, helping to avoid undesirable interactions between different drugs.

In the laboratories, technicians no longer struggle to answer telephone enquiries while trying to conduct new tests. Their results are reported immediately and electronically, and clinicians around the trust can access them.

Secretaries no longer use word processors to type clinic letters, sometimes pasting in the GP details from previous letters, saving the result on a hard drive which is inaccessible to anyone else. Instead, they are presented with a letter already formatted with all relevant administrative and clinical content. They can quickly add a few further lines and save the letter where it is accessible to everyone else looking after that patient.

The EPR system has become an ideal tool for managing cancer multidisciplinary meetings.

Patients whose cases need to be discussed have their details added online to the meeting lists by their clinicians.Management plans can be entered into the EPR as soon as they are agreed.

How do I know this system works? Well, one test takes place whenever a PC malfunctions.

Expletives rend the air - because the information the PC should be providing is seen as central to everybody's work.

But let us not pretend that everything is peaches and cream.

The EPR system is available across the hospital. It has obvious management and clinical benefits. But one-fifth of clinicians do not use the system directly, relying on others to do the work for them. I am reminded of the study once done at IBM, which showed that the company wasn't getting the full management benefit from its internal IT system, because senior managers simply wouldn't use it.

So, as my son would say, we are nearly winning. But We are not there yet.