With the National Health Service review of health care in the UK being one of the most talked about information technology issues in the public forum at the moment, many of the large computer companies are noisily moving in on the rapidly expanding medical informatics market, but do they really know what they’re doing? Professor Jackson of the Clinical Operational Research Unit at University College, London, thinks they could do with a bit more expert guidance from the medical professions. His impressions of the Health Computing ’89 conference and exhibition at Harrogate were that many of the systems being marketed as a contribution to medical aid and resource management are really little more than accounting packages with most clinical aspects omitted. While they offer algorithms to solve, for example, the allocation of nurse resources to patient requirements, the solutions are constructed out of past events and do not attempt to predict simple little things like schedules. Furthermore, medical workstations are not yet readily available and the quality of imaging on medical systems is, in Professor Jackson’s opinion, of a poor quality and not geared up to getting X-rays on the clinician’s micro. Also noteworthy is the fact that most, if not all, of the statistical packages being offered to the National Health Service are standard SPSS packages which are not specific to the medical environment. It just so happens that Professor Jackson has a medical-specific statistical package to offer. Called Sureal, it is a survival and event analysis package developed over 15 years with 30 clinicians in the cancer field. The program is, according to its maker, able to plot and analyse data from the largest clinical trials imaginable with output to either CGA or text-only screens, or direct to Hewlett-Packard compatible plotters. It is soon to be marketed by Claymore Services, the company that launched the DHSS Mapping System on an unsuspecting world. Jackson’s overall conclusion, drawn from Harrogate, is that doctors are very negative about the National Health Service review, and that there are no major initiatives coming from the government. State of anomie This lack of direction could well stem from the state of anomie which seems to exist between the medical profession and the computer industry – something that Jackson is hoping to alleviate by setting up a number of companies. For example, Medical Advisers Ltd, based in London SW1, already offers an independent review service of the clinical environment for the Department of Health, Regional and District Health Authorities, international consultancies such as Coopers & Lybrand, and computer companies like ICL and Bull. Jackson is also the chairman of Healthcare Informatics Ltd which has recently been launched from University College, London. The Foundation operates on a subscription basis with subscribers partaking in an annual study tour and conference, as well as in report research and review by selecting research topics and subject boundaries. The Foundation’s first report, due to be published in June, is a European survey of Expert Systems, which, among other things, will be assessing the requirements for a general architecture. Jackson is also about to establish an Institute for Medical Informatics at University College, and would welcome further sponsorship from interested computer companies. Whether these ventures will solve the problems posed by the National Health Service review is doubtful, but at least someone is independently assessing the fundamental issues such as, what is a clinical information system, and, exactly where are the thousands of systems with the necessary back-up and hardware to come from over the next two years? Katy Ring
