The Holy Grail of Integrated IT – By Partha Kar
Working together to improve diabetes care is a common refrain nowadays and indeed there are hosts of initiatives to try and make that happen. When people talk about obstacles, one fundamental issue always pops out- the lack of an integrated IT system. It is mostly seen as the Holy Grail and while some areas have indeed shown the chutzpah to achieve this, in many areas, it continues to be bogged down in discussion forums or await its turn in the “Pending Projects” box.
However, the critical question has to be whether that is indeed as a big a block as perceived or whether that’s a cog of the whole process which needs rectifying and isn’t quite the end-all and be-all which prevents integration from happening. Or more controversially, whether for some, it’s a convenient shield to sit behind and enjoy the stupor of status quo, share in the “washing hands of Pontius Pilate” and sit back and say….”Only if IT was sorted..”
There can be categorically no debate that an integrated IT system would go a long way to improving care in diabetes- perhaps most importantly by joining up different providers in the fractured NHS we all belong to nowadays but let me also say that it isn’t what should prevent “working together” happening. Lets be devils advocate for a second and look at systems where health care professionals do have access to diabetes records- for example within hospitals. Any inpatient audit would show lack of consistency not only in data but also HCPs shying away from using data which could help smooth the pathway of PWD. So what hope is there when the IT data expands to include say ambulance data, primary care? The issue is not with data but the education and knowledge of all. Data and information is worthless, however integrated, if you aren’t aware what you are looking for.
The basic premise behind all of that hinges on one thing – relationships. I can only speak from a specialist point of view and from our experience, if you improve relationships with primary care, if you try to understand the unrealistic pressure they have been put under to deliver diabetes care, then perhaps, just perhaps- a two way street develops where the specialists role as an educator is seen for what its worth, ergo as a support for primary care at all points of time- rather than a lecture from someone who deems to “know it all”. Locally, the bedrock of our model is not based on any swanky IT system but the relationships built over years across 83 GP surgeries, paramedics etc. Let’s not forget that simple things in existence like nhs.net emails provide some level of information governance which can, if used appropriately, cut across many a non-integrated IT issue. Another simple example? Locally GPs and practice nurses like using the phone hot line as advice and assurance is instantaneous- cuts across IT issues as information is shared but that level of trust doesn’t happen overnight. It once again goes back to one basic essence- relationships.
To conclude thus, we would like to exhort clinicians to begin thinking of the basics first, the basics of mutual respect and relationships- without that, the best integrated IT system will achieve little bar perhaps ticking some boxes even better. Will it improve care across the board? Our experience over the last 3-4 years would suggest that it’s not the one and only thing to stop care from happening- rather an adjunct in a big wheel- the essence of which is? Yes you guessed it….relationships.