[log in to unmask],Net writes:
>Rigid
>conformity, such as the present state of computer development entails,

George, which computer system do you use?

There seems to be an article of faith - or rather a noxious meme
circulating - that GP systems and GPs use of them must compell them to
do everything in some single rigidly enforcd way.

Not so, either in specific terms at present, or in general in theory...

Is e-mail a way of communicating which rigidly imposes constraints that
prevent us communicating in the fashion we choose?  WHereas the
telephone nd bleep is a freeform system that allows us free unettered
rein on our creativity?  I think not, indeed more the reverse.

Is the FP7 a system of recording notes which gives us great freedom
compared to for instance using voice dictation, handwriting
recognition, gestures in a sensitve volume or even - typing - into
(conceptually) a copy of Word for Windows (or the e-mail editor of your
choice)?
Again, I incline to the opposite view, that the freedoms to read what
has been added to the note are greater with electronic storage of typed
notes than with shelf storage of handwritten notes, and that even if
one chooses to use paper as both an archival medium and a retrieval and
display device, typed notes are easier to read than handwritten ones.

THis does of course depend to a degree on the competence of design of
the computer program in use, and there are only a small number of
programs around which approach the degree of usability of Word,
TUrnpike or FIrstClass, but this is best approached by such items of
conversation as TextBase, XML, and the freely movable patient record -
thus allowing a situation where my patient record could reside within
my consulting room, and yours within your room, and yet be accessible
to our hypotehtical partners for their proper use, without disturbing
us or having to pay staff to find and carry paper.

The imagined rigidity of electronic records is in fact the rigidity of
the card index system, carried into electronic format in simple
databases.  THe speed and amount of development has been disappointing,
and the reasons for this are many, including a cartel of firms in
volved in supplying them, who are predominantly lead by salesmen; an
uninformed and amazingly tolerant (though unsatisfied) breadth of
users; an uninnovative political/adminstrative leadership with much
money and status tied up in the Byzantine elaborations of the current
ways we work; and the introduction of standard setting and compliance
checking procedures which stabilise the whole mess.  

Underfunding is not part of it!
But artificial constraints on how we spend money on administration and
development, which for instance hand us a job to do by next April, and
tell us we may not yet sped any money on IT elements of it, but may buy
photocopiers and fax machines (latest NHSE guidance) or prevent us from
using the money saved by introducing efficient means of doing a job
which therefore becomes redundant to pay for introducing those means -
IS.


%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%