A few niggles with electronic documents come from the consulting room

Our GP columnist, Neil Paul, is a big fan of technology. Sometimes, however, he’s tempted to go back to paper. Then, he’d like to know when software companies are planning to improve their IT.  

As a student, I worked as an IT support person. As a result, I have a host of funny stories of a kind that will be familiar to many readers of this website.

For instance, I remember being called to a secretary who claimed her printer had just stopped working. When I got there, I found it sitting on her desk, unplugged, and with the cables in a drawer in their packets.

I have never been a software developer, but I expect similar things happen to them all the time. It must be a nightmare having hundreds of people requesting features; and more bugs appearing every time you change the code.

There are some problems so basic, however, that as a user you just want them fixed ahead of getting new features you might never use.

Back to basics?

Let me use my practice’s document management system as an example. I like it; I have reviewed it favourably; it works well and as a primary care trust we are rolling it out to all our practices for an electronic clinical correspondence project.

The developer’s website is particularly informative about bug fixes and new features. However, like many companies, it doesn’t tell me about known limitations and how, when and if they are going to be fixed.

There are several things about the software that drives me mad. In fact, I have sometimes been heard to say that I’d like all my letters on paper again. “I don’t have to plug Microsoft, but the company does appear to have invested a lot of time and trouble into making its software useable.”

For example, when I return from holiday I often have 200 or more letters in my system inbox. The first patient of the day turns up to discuss a letter that came in while I was away, and I call up their letter. This is great – I don’t have to search through a tray trying to find it or dig out the notes.

The patient and I discuss the letter, and then I want to file it. This means taking it out of my inbox; but I can’t because I’m in the letter viewer rather than an action window. To action it, I have to open the inbox menu and then all 200 letters, as they don’t have names on. This is not so great - if the letter was on paper I could action it and drop it wherever it needed to go.

Also, I can’t filter my inbox using categories? If I could, to get rid of my 200 letters, I might bring up all the A&E ones and go though them quickly, as they rarely need detailed reading.

Or I might bring up all the oncology ones to see what has happened to my palliative care patients or I might scan down the list and pick out letters on particular patients that catch my eye. All of which would be an improvement on paper.

Ironing out the wrinkles for improved efficiency

My brief for this column says I don’t have to plug Microsoft, but the company does appear to have invested a lot of time and trouble into making its software useable. Office 2007 has context sensitive menus that change and bring up the things you are most likely to want to do next.

I believe Microsoft also has labs where they watch people trying to do things so it can work out how to help them do things easier and quicker. So I am very annoyed that for five years I have been asking my document management system’s vendor why I can’t have some changes to its product.

I wonder if any of its developers have actually tried to use it. Of perhaps they have only tested it with a few letters. With 200 it can be very inefficient.

Why doesn’t it allow me to file a normal document with one click? I have to click on comment, then on normal, then on save every single time. Also, I’ve lost count of how many times I have clicked ok, just to regret it. Why isn’t there an undo function?

Everybody I have spoken to agrees with me on these points. I would like them to be acknowledged and to get a regularly updated, realistic timetable of when they will be fixed - if ever.

About the author: Dr Neil Paul is a full time GP working at the Ashfields primary care centre in Sandbach. He has just been appointed to his primary care trust’s professional executive committee and has a lead role for IM&T and Payment by Results.