ABC of health informatics:Communication and navigation around the healthcare system

Directory information is vital for people to navigate healthcare services and to allow clinicians to do their work, but in many healthcare organisations directory information is under-rated, or even non-existent. Directory information changes quickly, and originates locally. It also needs to be accurate, up to date, and available nationally to support greater use of eHealth. Some of the information can be distilled from local sources of data, and one approach might be to expect it to be everyone's business to ensure that these sources are kept up to date-just as clinicians maintain a patient's record. Unfortunately, this idea leads to a "collusion of anonymity" where "everyone agreed that someone should do it, but no one did." A solution might be to have a designated person for each organisation-for example, a laboratory or primary care centre-whose job it is to maintain this information. Maintaining directory information can be seen as "organisational governance." It is an intrinsic part of being a team member and central to being a responsible employee. It seems ironic that when accurate, comprehensive, up to date contact information is needed by NHS organisations, they pay for directories and databases published by external organisations-for example, Binleys directory, NHS Confederation, and Medical Directory. Perhaps the NHS should outsource this activity and set up central service level agreements with these organisations for less money than NHS Trusts currently spend on paper directories. Pressure from an external contracted organisation might persuade organisations that are funded by the state to provide the necessary data in a timely way, which has often defeated internal efforts to capture these data in the past. In future, pre-referral investigation protocols for each consultant might be readily available and potential Mrs Smiths need not be so disappointed.