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HEALTH AND THE COMPUTER

INTRODUCTION

I decided to write about the impact of computers on the health sector and in particular about the difference the computer has made to working practices of the professional at local level.

The implications concerning confidentiality of individual patients' information held on computers will be addressed to some extent although this would make an essay subject in its own right.

The topic which interests me most is the difference the computer has made to the empowerment of the patient. There is a fund of knowledge available on the internet and this has had a profound effect on the information available to the patient and his participation in his own care.

Technical advances in medicine itself such as laser surgery techniques, gene therapy and various ways of scanning are fascinating and glamorous but are outside the scope of this essay.

THE EFFECT ON THE PROFESSIONAL

INFORMATION STORAGE

The most obvious change to the working practice in the surgery of the average GP is that patients records are now mainly computerised. The terminal on the doctor's desk has an instantly available readout of all the treatment given, drugs prescribed, referrals to other parts of the NHS etc. This record gives an immediate warning of any known allergies (if the patient is allergic to penicillin for example, it is vital that the prescribing doctor has the information at the time of prescription).

INFORMATION ACCESS

There is a vast body of information available to the doctor and the computer makes it manageable. Instead of the doctor or nurse having to read through reams of paperwork, the latest findings can be downloaded by an admin worker so that the doctor can be made aware instantly of any newly-discovered drug side-effects or contra-indications (for example).

As an aid to diagnosis the computer is invaluable, although doctors' attitudes vary. When confronted with a number of seemingly unrelated symptoms, the doctor cannot be expected to remember whether these combine to form an obscure syndrome - the computer provides possible answers at the touch of a key.

There are certain legal implications here. If a wrong diagnosis is made or the wrong treatment is given, whose is the responsibility, the doctor who used the software or the programmer who wrote it?

INFORMATION SHARING

The computers within a local clinic or GPs surgery will be linked in a small network so that everyone who works in the practice has access to the appropriate part of the information. This avoids duplication of records and also means that at any one time several people can have several people can have access to the system - while one patient is being seen by the doctor, the admin worker can be adding the test results which have just arrived for another patient.

ROUTINE TASKS

Many surgeries have changed the prescription of drugs to a computerised system.  A repeat prescription can be printed out by a member of the administration staff as long as the doctor has given the initial authorisation. This is a time-saving measure for the doctor (but probably not for the patient who may still have to wait 48 hours for the prescription).

POSSIBLE DISADVANTAGES

  • While the computer is a boon in that there is more information instantly to hand, the actual use of the equipment can be a barrier between the doctor and her patient. Not all medical personnel are comfortable with IT and the patient may feel that the doctor is preoccupied with the monitor so that she is paying less concentrated attention to him.

  • Insurance companies and employers may consider that they should have the right to know about certain illnesses or genetic predispositions for their own commercial reasons (although it may be disguised as "offering a service"). It will be a challenge to make records readily available to the professional who needs to know while restricting access by those who merely want to know. Any information specific to a patient which is stored on computer (whether at GP or hospital level) is covered by the Data Protection Act and is also being considered at a European level. National and continental boundaries are no real barrier now in the age of the internet.

THE EFFECT ON THE PATIENT

The amount of information available to the patient since the advent of computers has increased enormously. Even if the patient has no home computer, there is access through the local library to publications and resources on the internet which a short time ago would have satisfied the professional health worker.

There are large portal sites for example, which act an online encyclopaedias of health topics. Here the visitor can gradually work his way through the system until he finds the exact piece of information he needs.

The patient can also track down information simply by typing in the name of the illness or drug into a search engine and then taking his pick of the search results he is offered.

It is possible to double-check on the side-effects of drugs which have been prescribed, in addition to the leaflet published by the drug company (which is not disinterested). Similarly, anyone who has been diagnosed as suffering from an illness can now access information about the disease for himself.  As it is now possible for patients to obtain unsuitable prescription drugs by ordering from a website, this is a possible area for regulation.

The amount of information which is available makes it very important that care should be taken when evaluating its reliability. There is no regulation and there are plenty of sites which are misleading (and in some cases downright dangerous). Fortunately there are sites like Quackwatch to help weed out some of the worst.

SELF-HELP GROUPS

Since the growth of the Web, the patient or carer has had more access to support from fellow-sufferers as it is easy to make contact with or even to set up a self-help group. Self-help groups can operate databases, they can run supportive email groups and they can also act as centres giving links to other sites or networks.

NHS DIRECT

I have given NHS Direct a separate paragraph as I believe it is one of the most important developments in the organisation of the NHS in recent years. It is only because of the advent of the computer and accompanying software that it has been possible to provide a service like this. The patient has access to a professional who can give advice and direct the patient to the next step in obtaining treatment for anything which needs further help. This can help the doctor by cutting down on out-of-hours calls, the paramedic by cutting down on non-emergency work and most of all the patient. I have reason to be personally grateful for the existence of the service.

FUTURE DIRECTIONS

  • It is probable that the expansion of the computer into the health sector will continue to affect the patient's access to services - he may be able to email for repeat prescriptions, chiropody appointments or to retrieve routine test results. His doctor may use email to remind him about his checkup.
  • There have been attempts to create a much wider information network within the NHS but so far this has had limited success. Until there is standardisation of software, there cannot be a completely open sharing of information throughout a health authority or on an even wider scale. The independence of the health authorities is an obvious limiting factor here as is the cost of installing the system.

  • The government has stated its intention of increasing the availability of "drop-in" health care clinics on the high street or shopping mall. The patient's information will be available to the professional at the centre and she in turn will be able to feedback to the patient's own GP giving details of treatment administered.

  • A patient could have the facility to use his PC or WAP device as a health service terminal with two-way access using the built in microphone and digital camera. As technology advances, science fiction becomes science fact.

SUMMARY

We have seen how the ability of the computer to manage information affects both the health professional and the patient.   Anyone who has health concerns now has access to knowledge which used to be the territory of the professional health worker.  This can be either reassuring or the opposite but in any case the access is the important thing, as long as care is taken to discriminate between the genuine and the bogus. It could be said that the best prescription is a healthy dose of scepticism!

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