So which is IT: the solution or the problem?

There is an assumption that health care computer systems brings only benefits, but there is a growing body of evidence to suggest that there are a number of ways technology can cause harm to patients as well as potentially expose nurses and others to professional misconduct, disciplinary or even legal action.

Inadequate training

For some time there has been concern about both the computer literacy of clinical staff, and the training and competence of information technology (IT) staff in NHS organisations. This has led to various initiatives including the development of a specific NHS element to the European Computer Driving Licence.

In my experience nurses have little or no understanding of important legislation such as the Data Protection Act (1998) or the impact of such legislation on clinical practice and how it might leave nurses professionally and personally vulnerable.

An example of this was reported in a local newspaper in 2006, when a large number of nurses with no legitimate clinical reason were found to have accessed the record of a famous footballer. The NHS trust quickly acted to make staff aware of their responsibilities.

Issues with the training and competence of IT staff have also been reported. These include a primary care trust which issued all staff with identical pin numbers for smartcards to access clinical systems.

In another incident, an IT trainer trained a consultant physician to order tests and investigations in a live clinical system rather than in the test system. Subsequently the changes made and tests ordered during the training session were not reversed so the system sent out an automated letter and a 14 year old boy attended the hospital with his parents for a colonoscopy. This basic error highlighted the lack of training and experience of a number of IT staff.

System problems

Over the last couple of years there has been an increase in the number of reports in the computer press relating to clinical system software and hardware issues that have led to problems. These include lost or corrupted patient records and systems becoming unavailable for extended periods.

Examples of software problems include a hospital foundation trust which was creating hundreds of duplicate records each day until a problem with a software upgrade was spotted. During 2006 another trust had a problem where under certain circumstances their patient administration system incorrectly displayed patient referral data and recorded a patient’s referral data against the wrong electronic patient record.

What next?

The incidents highlighted here are the tip of the iceberg. Work urgently needs to be done to find out the true extent of the problems and address the issues that are being raised, particularly around the competency of IT and informatics staff as well as the testing and evaluation procedures used by system suppliers.

As nurses we need to understand the potential consequences of our interactions with clinical systems. We must guard against clinical incidents and becoming vulnerable professionally. To do this we may need to take responsibility for being aware of our responsibilities under the Computer Misuse Act1 (1990), Data Protection Act2 (1998) and the Caldicott Report3 (1997) as well as making sure we have adequate computer skills.

For more information see the following useful publications: