Thursday, 17 May 2012

Depersonifying technologies – Healthcare ICT failures...

A call to a mobile phone was recently received from a north London hospital.  The call was an automated call, stating that an appointment had been made for a person at a time and location.
As this happened to someone I was with at the time of the call, I think it is important that this is illustrative of many ICT failures within the NHS and many other businesses.

Let’s look at some of the core problems of which I see three main issues. 

  1. The call was automated and therefore the receiver could easily assume it is a crank or spam call from some sales company in a distant country.  This means the receiver of the call is unlikely to listen beyond the five to ten second rule.
  2.  The call was from a hospital about a hospital appointment.  This, to me, and I am sure to many others, would be considered personal information, yet no attempt was made to ascertain that the caller (the automated caller) had actually got the correct person.  No attempt was made to see if the person on the other end of the phone was capable of taking the call. Were they hard of hearing? Were they driving in a car? Were they on a building site?  The auto-calling system assumes too many things about the receiver of the call.  I still think that the basic of getting the correct person is the most important though.  To me not doing this breaches all areas of confidentiality.  What if the call had been a private matter which they did not want their partner to know about?  What if their child picked up the call?  When you start thinking on this line the whole system is too ridiculous for words.
  3.  The caller informs the receiver of an appointment. This is fair enough, apart from the fact that the receiver no longer lives in London and although on repeated occasions has informed the hospital concerned, and the people at the hospital have noted that she moved two years ago, she still gets appointments.
This point is a really important one.  It shows a wealth of failures in the NHS ICT systems. 

a)      The system does not allow the receiver of the call to respond to the message.  It basically tells the receiver of the appointment.

 b)      The computer systems at the hospital are such that although the person’s has told the hospital on many occasions she has moved the hospital system to not allow her records to be taken off their system easily.

 c)       This calls into question whether the said hospital has passed her records to her new hospital or if they are still retaining them due to a computer error or human error.

d)      The time and money spent on getting an automated system that does not work well is not saving the NHS money it is costing them money by making the NHS look stupid to the general public.

The most concerning thing is that the NHS is a health organisation and one that should provide the potential patient with confidence and a feeling that they are being cared for. But none of this comes through using an automated electronic voice that provides no real connection of two way communication with the patient. 

It seems this one thing is illustrative of a greater decline in the inappropriate use of technology to  be used where real people would do a better, more personal and efficient job.  I have little doubt that the response to this is that a computer can dial thousands of numbers and book millions of things in a fraction of a second.  Perhaps... So what?? 

In business, you are only as good as your reputation.  If a telephone system means your reputation suffers this is more costly than the savings accrued through its use.  If a system is so inflexible and cumbersome that it cannot all for two-way interaction then the organisation needs to consider if it is the correct system.

This harks back to an old argument of quality versus quantity. I suspect that often computer systems are used for quantity and economy without thought to the quality.  The implications for EHRs and shared systems is worrying if this example is anything to go by. Certainly, the  message from this hospital seems to fail on so many levels, the hospital and the NHS should rethink using systems like this.

Since posting this the hospital have contacted us over four times about different missed appointments and each time are told that we have moved some years before. The cost to the health authority must be ludicrously high and the health records that should have been transferred to the new health authority are clearly still at the original one. This is a simple thing that has cost the HA a lot of money and could be easy to solve.  So why haven't they?