" I'll ask an IT expert for that (and the NHS isn't a place to find
exemplary IT case studies)."

I think you will find on closer examination that the three people you are
debating with, myself, Mary and Adrian, and the others who have contributed
(Robert, Russell, Jel and Chris) are about as expert a group of primary care
medical IT people as one could get. We all have over 15 years experience in
the field, and variously have written books, and programmes, taught at
masters level, advised Government and own or owned software companies at
various times.

But do keep the debate going, I am interested. I will try and answer your
questions later, I have clinical work to do first

Trefor


-----Original Message-----
From: GP-UK [mailto:[log in to unmask]] On Behalf Of Mary Hawking
Sent: 30 July 2011 09:00
To: [log in to unmask]
Subject: Re: Current GP computer systems

I'm not sure of the levels of understanding - and understanding of which
aspects of a GP's role - you want individual GPs to demonstrate, or whether
it is necessary for all GPs to understand the workings of the system in
order to perform their roles safely and satisfactorily.
I drive a car: should I stop because I do not understand the complexities of
modern cars? Economic necessity made me take an interest in 2-stroke engines
when I was a student.

SP
2. Closed-source software? Irrelevant.  Perhaps I didn't make my
requirements clear: software is irrelevant.  I want transparency of
so-called 'knowledge' and I want it challenged - i.e. science.

Sorry, you've lost me here: is this a requirement to access the evidence for
every clinical decision and only make decisions when there is good quality
evidence?
Medical care evolves over time: in asthma I've seen it go from treating
attacks with s/c epinephrine to i.v. theophylline (given very slowly), to
oral and then inhaled salbutamol, to nebulisers with salbutamol, to an
emphasis on prevention using inhaled corticosteroids.
I don't recall any time at which there was a sensational theoretical
breakthrough presenting the evidence for any of this.

Asthma is only one of many conditions managed in general practice: do you
think that every GP should go back and access all the original work (if it
exists) on the optimal management of every condition GPs manage?
One has to be selective..

SP
3. I do not want, and I did not ask for, an opinion on IT or software.  I'll
ask an IT expert for that (and the NHS isn't a place to find exemplary IT
case studies).  I want to know what GPs' model(s) of the world is/are.
Pre-Galileo or not?

The GP model of the world depends, as it does in other settings, on a
combination of the role they are asked to fill (a GP in an inner city will
have a somewhat different view from one specialising in care in remote
highlands or islands), the society and environment in which that role is to
be enacted (e.g. differences between UK, USA, Canada and the various
countries in the EU) and the financial and regulatory structures and
requirements under which they work - and which they have been educated to
consider to be natural - but actually differ widely across the developed
world.

There is a problem in asking IT experts for opinions on a domain-specific
bit of software: just look at the mess IT experts have made of HMRC and
other government - and private - IT systems because of lack of understanding
of the domain and user requirements: don't make the mistakes Richard Granger
made in this area! ;-<

And how does "transparency" and "accountability" get into this thread?


Mary Hawking
 
-----Original Message-----
From: GP-UK [mailto:[log in to unmask]] On Behalf Of Sandra Pickering
Sent: 29 July 2011 23:50
To: [log in to unmask]
Subject: Re: Current GP computer systems

1. I'd like to know how much GPs know about their equivalent of
thermodynamics. That would be a start. The best way to make sure that YOU
understand something is to explain it clearly to someone else. 

2. Closed-source software? Irrelevant.  Perhaps I didn't make my
requirements clear: software is irrelevant.  I want transparency of
so-called 'knowledge' and I want it challenged - i.e. science.

3. I do not want, and I did not ask for, an opinion on IT or software.  I'll
ask an IT expert for that (and the NHS isn't a place to find exemplary IT
case studies).  I want to know what GPs' model(s) of the world is/are.
Pre-Galileo or not?

4. Negligence/responsibility/ethics - too vague and woolly? Ah, but I FEEL
like having it answered.  And my feelings count for at least as much as
yours.  And, interestingly, the UK medical profession does purport to answer
it. A simple search will find the profession's answer.


Just to be Devil's Advocate: I suggest that GPs use problems with
IT/computers to obfuscate on challenges to their 'authority'.

As the Guardian said recently: questions have not been adequately answered.
Not 
Good
Enough

Nothing to do with IT.  All to do with transparency and accountability.

Sandra