MEDICAL MATTERS: We have got used to booking flights on the internet and soon checking in online. But when it comes to the health systems and information technology we are in a muddle.
The controversial PPARS human resource payroll system eventually cost more than €200 million or 25 times the original estimate.
About €57 million went to consultants charged with sorting it out.
The NHS is now following Ireland with its own computer war story. It wants a "Choose and Book" system whereby a patient can book themselves in to see a doctor or hospital clinic.
The cost has gone from over £6 billion to £20 billion sterling with very few being able to book satisfactorily.
Interestingly, Accenture, one of the consultants to the project, has written off £260 million because it agreed a contract on payment on successful delivery of the new system.
Getting consultants to share risk is new to the public service and we are likely to see more of it.
As a GP, I can refer a patient for the most sophisticated computerised scan available which can outline the patient's anatomy and pathology in very fine detail. The result is printed out, put in the post for a man on a bike to deliver to my surgery.
A recent study of Irish general practice has shown that the majority of GPs are computerised with internet access. Many record all their consultations on to the system and print out their prescriptions leaving a reliable record behind.
Increasingly, hospital letters and reports are being scanned in and doctors can look up diagnoses online and print off relevant information for the patient.
We can now look up patients' blood results the next day which is a marvellous boon to clinical practice.
However, we have to wait for the paper record to scan it in to the patient's file because the hospital system and practice system don't talk to each other - as the computer language has it.
If I want to know how many patients I have seen this week or last month, my expensive system cannot do it.
If I want to search for all my diabetic or asthmatic patients because I want to review their care, I cannot do it on my system. I have to do it from memory while my computer blinks at me.
Staff turnover in the IT industry is a fact of life but it interferes with the delivery of sustainable intelligible systems that make sense of patient data.
The Government is setting up a Health Information and Quality Authority (HIQUA) which will be an agency that is charged with standardising and streamlining informatics in our health services.
It is being linked to quality because we cannot measure the ups and downs of what we do without data.
HIQUA is a long time coming and most of us don't know what it is planning to do. It has appointed a chief executive and hopefully things will begin to move soon.
It is odd that the criticisms of the Harding Price report on the Lourdes hospital have not provided an impetus for measurement of what is going on in the health services.
Some say it is because we are afraid of what we will find.
We will also find that some bits of our services work extremely well and could provide a blueprint for other similar services that are struggling.
As we do not have a national system of healthcare we cannot aspire to a national information system which is probably just as well. Nonetheless, we do need guidance on minimum standards such as the need for local hospitals to take into account the need to "talk to" local general practices in IT terms. Currently, the GP systems are sitting pretty and the hospital systems are inaccessible to all but the staff who work inside. The patients flow between the two systems having blood and X-ray tests duplicated unnecessarily.
Following the costly PPARS and "Choose and Book" difficulties, we know for sure that big IT projects are proving impossible to deliver.
However, it should not be difficult for local hospitals and their referring GPs to streamline their systems that would enable exchange of e-mail addresses, access to laboratory, X-ray and outpatient waiting times.
Anything grander seems a bit too much.
Who knows if the technology is up to it - too few of us understand the computer experts in full flight. Let us hope HIQUA will think in terms of competence, reliability and patients rather than guff about having "a world class" information system.
Dr Tom O'Dowd is professor of general practice at Trinity College Dublin and a practising GP.
Dr Muiris Houston is on leave.