Is there hope for clinicians in the digital age?

Getting the majority of doctors to go beyond spreadsheets is a daunting task, says the patient from hell
Most clinicians have some keyboard skills and can write emails and manipulate spreadsheets, but that doesn’t mean they have a real understanding of IT. Photograph: Martin Rogers/Workbook Stock/Getty

At the beginning of this year I bemoaned that GPs no longer understood IT. Five months later, however, I cheered because the NHS Hackday showed that a lot of clinicians do in fact want clunky NHS IT systems to be improved and are prepared, if only for a weekend, to get down in the mud with loads of geeks and get their hands dirty writing innovative medical Apps (and I am delighted to hear that one of these Apps, Patient List, is to be released as open source).

But, sadly, in an increasingly digitalised NHS, geeky clinicians are a rare breed. What about the majority of doctors – how much do they understand? And, more importantly, what are they taught about IT in medical school?

Not a lot from what I've seen in Learning to manage health information, a 56-page document produced by the Department of Health's embedding informatics in clinical education (eICE) team. It sums this up by admitting that "many healthcare professionals continue to have limited or no education in informatics and yet the expectations of them to manage information effectively is a current and increasing requirement."

I get the impression that although the eICE team was set up in 1999 and has been bashing away relentlessly, it has not made much progress in educating the lumpen mass of clinicians to make them ready for the digital age.

Many of them still seem not to have got their heads around relatively simple national stand-alone systems, some of which have been around for years, like Choose and Book, e-prescribing and Summary Care records. My GP surgery seems to have had no difficulty with implementing these systems so it can be done.

Assuming that most clinicians have achieved some keyboard skills over the years and can write emails and manipulate spreadsheets, doesn't mean they have a real understanding of what they ought to know about IT or how it can improve the care they provide to patients and make their own lives easier. What is scary is how much there is for them to learn.

Just look at what they have to get their heads around right now; electronic health records, for a start, are changing the relationships between clinicians and healthcare teams, but security problems need solving by clinicians as well as by IT experts.

Telehealth and telecare require them to master all types of physical and psychological measurements and remote monitoring, and throw away the conventional way of treating patients. Public health education and information requires them to use different media channels to inform citizens, both healthy individuals and patients, about medical and health topics and to increase self-help. They also have to deal with patients, who diagnose themselves on the internet and just visit the doctor for confirmation of the research they have done.

Then they need to get a grasp of what is involved in giving patients access to their records – and even make changes. Medical Research Using eHealth Grids means learning to control powerful computing and data management capabilities to handle large amounts of heterogeneous data.

The mind boggles. There are also clinical coding systems, like Read Codes and Snomed, and more generally, they need to understand the need to standardise procedures and data, and the importance and limitations of interoperability.

Now there is also the new mobile world, which will revolutionise the life of doctors on the wards. And social networking, useful for campaigns and for patients to communicate with each other, but can have pitfalls for healthcare professionals. And who knows, they may get around some day to using email as a bog-standard way of contacting their patients.

And finally, there is the ability to suss out technological snake-oil salesmen.

Will they catch up? I doubt it. The eICE report ends by saying: "It is recommended that commissioners and providers consider the need for catch up or consolidation programmes, based on the guidance in this framework." So we are back in the hands of the GP commissioners, who have too much on their plate already, and who have not shown much inclination in the past to improve their IT knowledge, or initiate IT systems for the benefit of their patients.

To suddenly realise the importance of the digital revolution and be ready to commit resources to educating their clinical colleagues would be out of character. I don't hold out much hope.

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