British Armed Forces doctors are frustrated and concerned over the operational failings of the £80 million decade-old Defence Medical Information Capability Programme (DMICP) electronic health record system as well as the Ministry of Defence’s new £900 millionMoDNet network.
First reported (subscription) by The Times of London, and then by other British newspapers and tabloids, doctors are claiming that DMICP suffers from persistent “crashes, long ‘freezes’, [and] lost consultations” among other functional issues that are placing service personnel’s health at risk and severely undermining the morale of military health care providers.
One doctor went so far as to anonymously tell the The Times, “There is nothing that has happened [in my career], including deployments to Afghanistan, that has caused me as much stress as the IT issues that we have.”
Lieutenant General Martin Bricknell [PDF], the surgeon general of the British Armed Forces, responded to the original Times story by conceding that there may indeed be some IT problems, but insisted that their number and consequences were negligible. He stated, for instance, that over the past two years there were only 53 significant events related to IT (i.e., patient safety incidents, adverse incidents, adverse or positive events, and near misses where harm, or potential harm, has occurred) out of 4.8 million patient consultations. Further, no one was ever harmed by these events, and all told, they amounted to a Lilliputian complaint rate of only 0.001 percent.
However, that figure has been questioned by the British Medical Association’s chair of its armed forces committee, Colonel Glynn Evans, who served five tours of duty as a doctor in both Iraq and Afghanistan since 2002. One reason why he questions the figure is that since April, the BMA has kept a log of incidents its members have encountered, which include examples of the system being completely unavailable as well as wrong patient information appearing during consultations.
Other issues raised include patient information not able to be saved and therefore lost, or their information being sent to printers not only in wrong buildings, but wrong cities. The BMA has turned over the log to Lt. Gen. Bricknell.
Col. Evans stated that military and civilian doctors employed by the Ministry of Defence have been informing him about IT problems with the DMICP system for several years, and that the system has been recently getting worse.
Last year, in fact, the BMA passed a unanimous resolution registering the association’s concern that “persistent and increasing faults with the Defence Medical Information Capability Programme (DMICP)” were negatively affecting patient safety and undermining the work of military clinicians. Lt. Gen. Bricknell promised improvements to the electronic health record system after that resolution passed, but apparently whatever was done hasn’t made much of a difference in the eyes of the military doctors.
There are planned upgrades to the Ministry of Defence’s electronic health record system and supporting network, but these efforts have been delayed for various programmatic reasons. At best, they won’t become fully operational for several years yet.
Evans says that BMA’s member military and civilian doctors working for the Ministry of Defence are telling him that the problems with DMICP are “the biggest problem…they are facing at the moment. It’s the number one issue in my in-tray. If I can’t access the previous health record, I can’t see what drug to prescribe and, because prescriptions are issued electronically, it becomes very difficult to prescribe.”
Some doctors claim that dealing with the electronic health record system’s IT related problems are now causing them to have to cut back on patient consultation and care, Evans states.
Evans also asserts that doctors have stopped reporting IT-related errors not only because there are so many, but also because it is time-consuming. Other doctors believe that problems won’t get fixed even if reported, so they don’t bother. Col. Evans declared that if the same IT problems occurred in the country’s civilian National Health Service’s surgeries, they would be shut down.
British MPs were outraged by the allegations of service personnel being placed at risk by the military’s malfunctioning EHR, and the parliamentary Defence Select Committee will likely start an inquiry into the issue this autumn.
It will be interesting to see whether the committee investigates how many and what kinds of health IT issues are actually being reported beyond those rated as being significant events. Perhaps then a better assessment of how health IT issues are directly affecting the care of service personnel can be made.
A similar health IT-related controversy has surfaced recently involving the U.S. Department of Defense’s new $4.3 billion electronic health record system called MHS Genesis, which is currently under development. DoD’s director of operational test and evaluation has raised concerns over the system’s functionality and usability and their possible impact on health care. Not surprisingly, these have been played down by those in charge of implementing it, too.
Robert N. Charette is a Contributing Editor to IEEE Spectrum and an acknowledged international authority on information technology and systems risk management. A self-described “risk ecologist,” he is interested in the intersections of business, political, technological, and societal risks. Charette is an award-winning author of multiple books and numerous articles on the subjects of risk management, project and program management, innovation, and entrepreneurship. A Life Senior Member of the IEEE, Charette was a recipient of the IEEE Computer Society’s Golden Core Award in 2008.