On Sun, 2 Aug 1998 11:41:26 +0100, Adrian Midgley wrote:

>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.

But we live in a GP world that dictates keeping both in parallel.  I
find thta not only irritating but also retrograde.

Hence my dislike for the word 'paperless'.  I bet you still have meters
of shelves with paper notes stored on them!

>THis does of course depend to a degree on the competence of design

All the designs we currently have are crap and you know it!

None of these systems were conceived with *my* wellbeing as their
Priamry Directive.

>but this is best approached by such items of
>conversation as TextBase, XML, and the freely movable patient record -

Hard work needs to be done before we are anywhere near!

This hard work had better be (a) focused, (b) aimed at the right
audience,  and,  (c) well versed in the way humans work and think.

In a one-liner:  start with the human then ask: what do I need to do to
make her life better?

>The imagined rigidity of electronic records is in fact the rigidity of
>the card index system, carried into electronic format in simple
>databases.

Then the rigidity is not "imagined".  It is real because these are the
systems that we have to subvert in order to make them work.

A good system does what it says on the box and works straight out of
that box.

>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.  

So,  what are your practical proposals to overturn all that?

1. .....
2.......
3. .....

I am so ground down with the endless diagnoses and analyses of the
past.  I wish to see concrete and practical proposals to achieve
progress.

>Underfunding is not part of it!

That may be so,  but 'funding' is :-)

>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.

I refer you to the question I pose above:  yeah,  right,  we know all
that and we have known it for yonks.  What NEXT?

Ahmad

________________________________________

Dr Ahmad Risk
http://mednetics.org
home: +44 1273 748198
work: +44 1737 240022
fax:  +44 1737 244660




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