Choose and Book

Choose and Book

One of the largest ICT projects ever funded by the UK government is attempting to revolutionise the way patients and healthcare professionals keep tabs on each other. The project is centred around an Electronic Patient Record (EPR) System but includes a number of discrete functional parts. One of these, ‘Choose and Book’ is designed to allow General Practitioners (at the coalface of routine healthcare) to choose which hospital and medical team they refer their patients to. Currently there are 9.4m such referrals each year, representing about half of most hospital’s workload. That’s a lot of booking and a not inconsiderable amount of choosing to do! More than 200,000 ‘choosings and bookings’ should have been made by the end of last year but only 63 were actually made according to the National Audit Office.

Apart from the usual technical problems and some issues over patient confidentiality there appears to be serious issues with the ‘process’ that GPs need to follow to use the system. A GP interviewed on BBC1 this morning (19 Jan) said that it took nearly 45 minutes to go through the process on-screen – and even GPs with good ICT skills found the system hard work.

In my experience this is the key reason ICT systems fail – the user behaviour and process are never fully modelled. According to the BMA, GPs were involved in the design, but only very early on, and it appears that by the time they were able to really test the system out it was too late to make major changes to the underlying functionality. On so many projects I have seen a token involvement by so-called ‘user representatives’ count as fully fledged user-centred design. In my book this doesn’t count – if you want to develop system that will actually be used you need to embed real users and user advocates (that’s one of my roles) right from the start – and keep them with you right until the end.

I’m currently working on some outline ideas for a ‘Technology Integration Model’ (TIM) which can be used during technology projects to assess the balance of resources between PEOPLE, PROCESS and TECHNOLOGY. Codename is ‘Tripod’ – watch this space.

If you have experience in this area I’d love to hear from you. Possibly collaborate in some way?

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