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The era of the controlling “Too Big to Change” Health IT providers needs to end

Mike David Smith
3 min readAug 31, 2018

Every day, our GP practice is sent hundreds of documents from our local hospital. These vital discharge letters and clinic letters were until recently sent to us in the post, when it was quite belatedly realised using e-mail would be a lot cheaper and faster. So now they come by e-mail. As a PDF. This is progress, of a sort.

You see, the problem is, our clinical IT system cannot import PDFs. Therefore, every day, each letter is then printed out, scanned into the IT system, then shredded. In the process, our dedicated secretarial team have to then ensure the document is linked to the correct patient record and manually label the document. A process so wasteful and tedious it is astonishing.

On learning of this process, I contacted our IT provider to see if they could allow PDF imports — alas, effectively, no. They already provide a system for hospitals to send documents electronically to the system, so the scanning system we rely on is a “legacy” system that isn’t a priority. So I contacted the hospital trust, could their system utilise the electronic transfer mechanism? Alas, again, no. They are procuring a new system that will go live in 3 years time, and their current provider is unwilling to make changes.

So for the next 3 years, our practice, along with tens of others in our area, and I expect hundreds across the country, are left plodding on with this hopelessly wasteful process.

Too Big to Change?

The problem we face is created by the oligopoly of large IT system providers. These providers hold all patient data within their control. Any changes to processes within the health service need their support; and that support will cost money and time. They cling to their contracts and state they provide exactly what was once procured from them, and any changes will require them to be willing to make them, at a cost they dictate. There is no scope for competition without throwing the baby out with the bathwater and changing the entire system.

Open up the system

The NHS needs to break the stranglehold the IT providers have on the data contained within their systems. It isn’t their data. The data belongs to the NHS and it’s patients. The only way to get the data out, is by exporting the whole lot into a new system; a process that is painful and expensive for all involved, so rarely happens. This needs to change.

Technologies have existed for many years creating secure mechanisms that allow many systems to access the same central dataset: Application Programming Interfaces (APIs). Using these APIs, faced with a situation such as the one our practice is suffering though, a small IT provider could develop a simple add on module to existing systems allowing discharge and clinic letters to be appended to a clinical record direct from the e-mails we receive. Even better, it might be able to cut e-mail out the equation entirely and have the data move directly from the hospital system to the GP system.

Small modules like these have the potential to revolutionise the NHS overnight. Suddenly, the thousands of small inefficiencies in the NHS that the large IT providers deem too small to be worth solving, can be resolved by local innovators.

Change is Afoot

Thankfully, judging by the terms of a NHS Digital procurement document released recently for GP IT Futures, such a modular system might well be in the works — for General Practice at least.

I’d like to make a personal plea to the NHS Digital team — please ensure the eventual GP IT Futures contract has openness at it’s core. Ask the questions: Who is holding the data and could they ever be obstructive with it? Could a small company innovate without having to reinvent the entire system?

The future is looking brighter, for now though, it’s back to the scanning pile.



Mike David Smith

Doctor working in North East England with a keen interest in technology