The software exists, the will to implement does not

I did 20 years as a computer salesman in my misspent youth, and have since thought that I was impervious to any computer demonstration. I was wrong. I have been completely blown over by a visit to Cerner's 'Collaboration Centre' in Paddington. Here, the firm has laid out several virtual care settings: an outpatients clinic, an A&E ward, a maternity room and an intensive care unit/theatre. In each area, there were screens and equipment relevant to the area, displaying tracking data of patients and alerting clinicians to adverse events. I was impressed by how many of the screens and equipment answered my wish-lists for the hospital systems I have encountered in the last year: - Electronic documentation at the bedside, with mobile clinical assistant (MCA) devices, cutting out all the dreaded paper in the ward. - Handwriting and voice recognition software to speed up clinician reports to GPs – and patients – to an acceptable timescale, ie one day rather than two weeks. - All this on MCAs, BlackBerry or iPhone-type devices. - Immediate access and display of care records, and "integration with the spine". - A read-only view for primary and community care staff to access hospital pathology tests. One thing I particularly liked was a bedside screen called myStation. It gives the patient all the TV channels he or she wants, but with added extras: a list of the people caring for him or her, info about his or her particular condition and a screen called mySchedule shows the treatments due during the day. myHealth shows the patient his or her health record, and – hooray, hooray – allows the patient to correct that record and communicate with the doctors. Better still, myOpinion allows patients to feedback what he or she feels about treatment. That's what I call patient-centric medicine. Everything, or nearly everything, is there and waiting to be implemented as part of the all-singing-and-dancing Cerner Millennium package. But I gathered that a lot of stuff that I fancied had so far only seldom been implemented. Will it ever become mainstream? There's the rub. For starters, I understand that NHS Connecting for Health chose a subset of the full package, which ended up as the lowest common denominator of what the dimmest hospital trusts could manage to implement. The more interesting modules, such as those with direct benefits for the patient, were left out. The trouble with this approach was that the brighter hospitals already had a few advanced clinical systems in specific areas, of which they were inordinately proud. The clinicians and administrators responsible were reluctant to start with a "release 1", which would be inferior in those areas, although it might benefit other departments. In the end, everybody became unhappy with the CfH lowest common denominator. Only in those hospitals which bought Millennium independently, rather than through CfH, could choose the bits which matched the level of expertise of the various departments of the hospital. These hospitals, I understand, implemented quickly and are delighted with the system. You have only to read the press to know what happened to the early CfH implementations. (I am glad to find that two of my local hospitals have recently gone live with no problems.) There seems to be another problem about getting my patient-oriented bits implemented. What is implemented, and what is not, all depends on the individual hospital's business plan. Who draws up the business plan? The administrators, and to some extent the IT crowd, and, if they are not too busy to turn their minds to such mundane matters, the consultants. Maybe, in some enlightened hospitals, the ward sisters. Clearly all these stakeholders will demand the bits of Millennium that help them in their very difficult tasks. I don't knock that. But I ask, as I monotonously do, that the patient should have a say. The patient-oriented bits are clearly already there in the software, but the will to implement them is not there yet. If I am wrong, I would like to hear about it.