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Is the NHS ready for the NHS app?

Coalface tales

James Booth

Friday, 24 August 2018

AdobeStock_101748106_nhsapp.jpgMy experiences with NHS IT systems have, I think it is fair to say, been mixed. I still have bewildered memories of starting my first PRHO job in 2002 to be faced with a hospital that used dot matrix printers, green-scale CRT monitors and DOS prompts on the path system. Coincidentally, that was also the year that saw the beginnings of the huge project to modernise and integrate our computer systems across the entire health service. That same project that was binned nine years later, having had £12 billion chucked at it to minimal effect. Computer hiccups and glitches continue to be a regular feature of my working life, and whilst no one can deny that decent IT is essential to running a safe and effective practice nowadays, a significant portion of my at-desk headaches stem from my PC. 

Of course, it’s not just the design and architecture of the system that is critical; it’s the staff and patients who get to access it. I’m still bemused about that day when a combination of an admin error and huge numbers of people not using “reply all” properly generated half a billion emails and a crashing of the entire NHSMail system, and more locally to me, a few months ago a small error at the local lab led my practice to receiving – quite literally – thousands of duplicate path results in the course of a day. This can be brought right down to the level of the individual patient, of course – just this last Friday, an electronic script request simply listed the colours of pill concerned (“the three white ones and the beige one please.”)

With this in mind, it was the iciest of chills that crept down my spine when I read a detailed account of the forthcoming NHS app online this week. I normally flick through Gizmondo to covet pricy laptops, so it rather spoilt my lunch as the potential horrors to come unfolded. The whole thing is worth a read, but even if you just get to the third paragraph and skim over the flowcharts for the nerds amongst us, you’ll read phrases such as “byzantine structure,” “utterly insane,” and “utterly nightmarish.”

It turns out that our erstwhile Secretary of State laid down eight challenges that he wishes to see the mobile app handle:

  • Symptom checking and triage
  • Access to your medical records
  • GP appointment booking
  • Repeat prescription ordering
  • Changing data sharing preferences
  • Changing organ donation preferences
  • Changing end-of-life care choices
  • Promoting “approved apps” to patients

Now, some of this is clearly a good idea in principle. Organ donation preferences being the obvious one, and the promotion of other approved resources might be handy. Symptom checking and triage I have my doubts over. I’m of course aware that Babylon claim that their AI is now able to pass MRCGP and work on a par with me (although I’d like it to have a stab at the consultation I did last week that encompassed a patient miming the passage of a bowel motion onto my floor before we got anywhere).  I would also – and with the disclaimer that anecdote does not equal data, even when hilarious – direct you to @DrMurphy11 on Twitter who is asked by the app about his genitals despite presenting with a swollen elbow. You can make your own joke up with that one.

Appointment booking and prescription ordering is a bit of a cheat, really. The app won’t do this directly, it simply plugs into the systems we already have via our websites and passes the request in. Nothing against that in principle, but a system with millions of users interfacing with one app that then talks to thousands of different systems has an awful lot of scope for error, and it isn’t going to be NHS Digital who are getting the annoyed phone calls, is it?

The really ominous part for me, though, is the early indication that here we have an idea that is going to get much, much more complicated before we are done with it. The initial plan for the app involved downloading the NHS app, putting in your address, then being directed back to the App Store, downloading a second, CCG-specific app, and then going from there. There’s a reason that the Amazon app is a single entity, rather than “Amazon Essex”. Have a look at the flowcharts in the article for an idea of the complexity involved. Securely identifying users is going to be a challenge, and one that is currently with a solution that involves a “video selfie”.

There are data implications here aplenty, as well. The article is quite positive about the “big data” possibilities here but I’m not so sure. The NHS hasn’t got an immaculate copybook when it comes to data governance, and healthcare information is some of the most sensitive data there is. With my child safeguarding hat on, I have genuine fears about safety critical information being accessed on a phone. 

So: problems aplenty. In fairness, there are some robust-looking pilot plans for this, and I don’t doubt that those working on it are skilled and committed experts, who seem to be funded accordingly. I’m also sure that a generation ago, there were GP forbears of ours harrumphing about having a computer in the office, and the absence of these is unthinkable now. Perhaps the root of my concern is that we are working in such straitened circumstances these days, with funding for much of what I would consider of greater importance unavailable. There’s a precedent for projects of this ilk to over-run, to over-cost, and create as many difficulties as they solve. I just feel we have bigger challenges to solve at the moment.

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James Booth

James qualified from UCL in 2002 and has been a GP partner in Chelmsford since 2006. He is also the named GP for Safeguarding Children locally. All views expressed are his own.
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