[This week's blog is from a surgeon working in the NHS who has kindly agreed to share (vent?) his technology frustrations.]
A little bit of back ground first. I am a 32 year old, born in the era before the internet, very much before Twitter and Facebook, when a modem was analogue and for hacking in to the Pentagon in movies! My first piece of proper computer technology was an old Compaq 386 desktop with a VGA monitor that could display 256 colours. How everything has changed! We take it all for granted: I am typing this on a tablet with a Bluetooth keyboard.
I am a self confessed technology lover, the more complex it is and the more I can tinker, the more I want it. My current obsessions are (even if I don’t understand them!) Android everything, XBOX Kinect, arduino and 3D printing. Now you probably think I’m some IT geek or something like that, but alas no… I am a doctor.
Medicine and the NHS are a bit like an old National Trust house: something to be proud of, with people who love it and work hard to keep it going. Unfortunately just like an old house, it often costs us more to keep it up to date than we can afford.
This is where the juxtaposition of cutting edge technology and the NHS collide. I am an orthopaedic surgeon, and as far as medical specialties go, we love our gadgets. It’s all power tools and mechano sets! A great place for innovation and new technology. But this is where I get frustrated. Like any huge expansive organisation with too many people ‘in charge’, red tape is everywhere. Let me give you a recent example.
I had an idea after much internet trawling and research to take a Microsoft XBOX Kinect and use it to control our computer in theatre to manipulate digital X-rays hands-free whilst sterile. I bought all the bits myself and trialed it at home to make sure I could do what I wanted to do. Bingo! It worked. All in it only cost me £100. The next day I stepped in to the operating theatre and proceeded to plug in the Kinect to the rather ancient looking Dell Pentium D desktop with a 17inch LCD monitor (bear in mind this is a brand new hospital open just 6 months). Security policies reject the USB connection to the Kinect. My USB memory stick is not encrypted and therefore rejected.
First hurdle and I’m on my face! Next I get a word in my ear that even if it had worked I would not physically be allowed to plug in the Kinect power-supply in to the wall socket. A commercial product made by one of the biggest companies in the world and I need to get it safety tested first. It’s a wonder I have not burnt my own house down thus far without getting every product I own safety tested!
Not wanting to give up I went ahead and attempted to jump through the hoops put before me. First stop IT. To my shock they were very helpful and found a fellow geek who agreed to set everything up and circumvent the security policies and install my drivers.
[Ridiculously, he also highlighted that security in the hospital network was 'perceived security': pointless barriers to those who are the least computer savvy. Anyone really wanting to do bad things to the network with an ounce of tech knowledge could have the run of the system, as he highlighted by plugging his own Macbook in to an ethernet port in the wall. Completely unrestricted, unproxied, non MAC filtered internet from an NHS connection. You didn’t need to even get at technical as that. Simply un-clicking the “Use proxy” in Internet Explorer settings turns off the filtering!]
Back to my story. Drivers now installed and USB ports unblocked, I still had to make sure the Kinect would not somehow short circuit the hospital and tried to get it safety tested. Easy? NO. The hospital had no obligation to safety test as it was not a device owned by the hospital. So the fact I had not asked for funds from the NHS to buy this device for research, actually hindered me using it. Eventually I convinced someone to look at it: this involved the case going in front of a group of managers to decide if it needed to be safety tested. After this meeting, I was given the all clear and the device was then adorned with a little green sticker with TESTED on it! Whoop!
The research has gone on to be a success and works well. It was just a very convoluted and overly complicated process to have to navigate through. I understand the NHS, when dealing with patient information, has to be very careful, but I don’t believe it really is. It looks like it is, but as my example of the network restrictions above shows, it’s all a bit superficial, blocking things that don’t need to blocked and not those that do. Here are a few more examples:
- No USB sticks that are unencrypted can be plugged in to a computer in the NHS. I think this is a pretty standard circumstance across most of the country – it stops data being taken off the network and lost or left on trains. I would be happy to comply with this if I really thought it made things secure. BUT, guess what? This preventative technology doesn’t work on NHS Pentium Ds running Windows XP…
- Cloud storage anyone? You can happily upload on to Dropbox, Google Docs etc. – IT know you can, but as long as it seems secure, it’s ok…
- It’s not permitted to make digital copies of clinical images and send these to another hospital over the NHS network. But you can put a printed photo in the post instead! Where did I put my carrier pigeon…
It has now got to the point with security in the NHS that there is an assumption that we are all evil doers just lurking to send patient information out of the system! It’s ironic that I am trusted to cut someone open and listen to all their most intimate problems, but not allowed to put a USB stick in to a computer just in case I feel the need to upload the X-ray archive to Facebook. The world is moving on: smartphones are everywhere and we need to embrace this technology and use it.
The rest of the world is as I observed at the eHealth Live show in 2011. To be able to have a tablet on a ward round with access to the patients GP records, their medications, X-rays and blood results would be such an advantage. Why don’t we? Because of money.
I think an “integrate your own technology at work” scheme should be born. Now with open web standards, platform independent applications and VNC we should be allowed to utilize our own technology for the patients benefit. Almost every orthopaedic surgeon I know has an iPhone or Android phone. We have more technology in our pockets every day than that dusty Dell PC in the corner.
Now where’s that National Trust sticker, I might just put it on the entrance to the hospital…