>Does the odd occasion justify the enormous expense?   
The cost of adding a service to a network or computer system is low
compared to the cost of setting it up in the first place.  Much of the
cost of setting up the systems has been met, largely of course by
society as a whole, but there is still a lot to go.

So, having set up for instance a national network for the health
service, and connected everyone to it, it becomes fairly cheap to add a
service allowing a computer running Adastra in the OoH centre to
identify itself to the computer in a practice, report that it has a
particular doctor deputising for the practice and about to see or
advise a particular patient of the practice, and ask for summary,
allergies and recent treatments.
It would even be possible to only allow this to proceed if the patient
had given their PIN, and to arrange to bypass this in individual cases,
on the responsibility of a named and logged doctor, who certified the
patient to be unable to give consent to such disclosures through for
instance hypoglycaemia or suspected poisoning.

DO patients want it?
Many of them assume we already have it running, and one task fro GMSC
is to say to the public that this is something which they could have,
and how much it would cost - and by all means allow them to consider
other things the money might be spent on.
If we are asked to do these things, and we are, then GMSC should secure
for us the funding, and a way of doing them which does not remove
control of medical records from the patients and doctors to whom they
relate.  

Parts of this argument are of course running along the lines of "We
should not build a hospital, we should spend the money on treating
patients" or even "money paid to doctors would better be spent on
treating patients" - one does need some infrastructure to deliver the
care, and computers seem to be widely thought of as useful in running
medium to large organisations, and small orgs with lots of information
to handle.

Keeping detailed morbidity records is expensive, and the benefits other
than in supporting the infernal market in fundholding are not I think
proved, however if anyone wants to reverse such a trend they need to
take proof of damage to the government and to the public, rather than
sabotage or try to resist such processes.

If such records are to be kept and used, keeping them on computers is
cheaper than on paper.  Like is rarely compared with like.

Is there justification for a screen on every GPs' desk?  I think there
is, and I would put it in communication, in general and for specific GP
political purposes, and in the acquisition of knowledge or information.
Intranets have payback times on the order of weeks in many
organisations, and there is little reason to expect the NHS to be
different.

There are some alarming thoughts around, one of which is exemplified by
the FHS CU website, remarking that centralising data is a prerequisite
to making an Intranet work, this is quite clearly not the case, as the
point of the Web is its weblike structure, but they probably mean well
and just have more experience dealing with hospitals and HAs.  A poor
state of affairs, that.



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