In message <[log in to unmask]>, Ahmad Risk
<[log in to unmask]> writes

>Changed the thread title to spare Toby and be more relevant :-)
>
>On Sat, 25 Jul 1998 07:25:39 +0100, Mary Hawking wrote:
>
>>OK, I appreciate that *any* selection of any software *will* have
>>problems .. but .. what's the alternative?
>
>
>'The Managed Desktop':
>
>- centralised online distribution of software
>-  automatic install so that the user does not bugger it up
>-  central version control so that everybody is upgraded at the same
>time
>-  ensures compliance with copyright laws etc
>-  cheaper to acquire and administer
>-  builds on coherent and efficient support and bug fixing systems
>-  makes enterprise-wide IT uniform but allows for individual
>creativity

but that's what I was saying! What you are advocating is centralised
control!
No arguements with individual creativity.. provided it doesn't make
communication impossible!

>
>>In a large organisation, is it better (however that is defined) to have
>>identical systems, or to let everyone "do their own thing"?
>
>I know not of any large organisation that does not have consistency in
>its organisation-wide IT solutions
>
>>Would any bank introduce IT by sending out the tellers to buy a PC in
>>Dixons?
>
>No,  but the Bank wouldn't go out either to buy a motley collection of
>things that run on incompatible operating systems with little or no
>trans-system communications at all.
>
>The Bank,  The Firm,  wouldn't have boss,  doss,  mumps,  windows, 
>mac/os,  unix etc.  across its desktops ;-)

In retrospect, I don't suppose the NHS would have had either - *if* we
had been able to forsee the future .. at anyrate until 1998! .. in
1990...
Think of it like this, Ahmed. The NHS is (as far as IT goes) in the
position of a company that has taken over a number of buisnesses - all
with different IT structures, using different commercial and/or bespoke
software and systems - and has to integrate all of them into a coherent
infrastructure, allowing *all* of the elements to communicate freely
with all of the others(whether or not they have had any need to do so in
the past) *and* allow for a coherent policy for future development.
Unfortunately (from the point of view of Management), not only are there
an awful lot of dreadful systems in the conglomerate (and all
different), so that there is a Cultural Problem (among the people who
don't trust the systems *because* they are so terrible), but there are
also a number of Franchised Buisnesses esssential to the Business Plan..
all different, and none prepared to change their possibly somewhat
unsatisfactory.. but functional systems .. *especially if they are
expected to do so, not for their own businesses, but for the Greater
Good* - and pay for it!
Problems..
>
>This farce was fostered by a discredited system of reimbursment. 

Fostered, maybe, but not created.
You came into General Practice (I think, from a previous thread?.. ?)
*after* 1990 - when reimbursement was introduced (at max.50%) - and the
SFA altered to make sure that any group praactice would *have* to be
computerised to survive...
In Scotland, they had GPASS; we considered it in 1991 .. briefly.
Do you think this approach would have been preferable to the current
anarchy?

> In
>the land of 'The Firm',  IT is built upon a coherent strategy where
>specs are defined,  solutions identified and sourced and procurement
>takes place under industry standard ground rules.
>
>'The Firm' *must* have an IT Chief at Board level,  responsible for all
>the above as well as maintaing the integrity and the security of the
>system.  Firm-wide.
>
>Anything else would be a retrograde step.
>
>In summary:
>
>1.  Firm-wide IT strategy,  specification and procurement
>2.  Board level IT Chief
>3.  Managed desktop
>4.  IT expenditure has call on unified budget in a unified manner
>5.  Hence,  dump reimbursement :-)

Ahmed, you're thinking of a greenfield site - *much* easier to organise
;->>
I'm in a Locality with practices with Meditel 6000, Vamp Vision, EMIS -
and nothing..
The NHS appears to use Outlook for email..
Health Authorities se Microsoft Office (but not the latest version..) -
and the NHS Executive use Wordperfect..

I have endless problems reading attachments.. it can take a long time to
find software capable of opening files labelled .doc or .rtf...

Thinking of early retirement .. if only I could afford it!
Mary
PS adopting the motto "Don't let the buggers get you down"!
Mary Hawking Kingsbury Court Surgery Church Street Dunstable LU5 4RS
tel:01582 663218 (surgery)fax:01582 476488 (surgery)
Member of British Healthcare Internet Association
Dunstable and Houghton Regis Locality Commisssioning Pilot


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