No tweets please, we're British health workers

For the last couple of months I've been discovering twitter, more so especially since starting a new job in the world of health research informatics. As well as encountering some rather odd yet friendly individuals (Hi Becky), and getting into political debates with some of my favourite actors (Hi Adam), I have found it incredibly useful.

As an almost random sample, here are ten of the twitter feeds I've been following, from which I've gained ideas, learned news or generally found out stuff I wouldn't otherwise have had access to, and which have therefore made me a much better value employee for the UHL and the Leicester Cardiovascular BRU.

@EHealthInsider, from whom I've learned about the state of play with NHS CfH funding, and the reality behind the disaster-laden headlines of the NHS National Programme for IT.

@23andMe, from whom I've learned more about the human genome than I thought I'd ever understand.

@sangerinstitute, from whom I've learned health history and also state of the art science.

@medpedia, from whom I've learned that it's possible to build an encyclopedia of health as a collaborative effort.

@wellcometrust, from whom I've learned about grant applications, research that's already underway and also fun and interesting public events concerning health and science research.

@IMIAtweets, from whom I've learned that there are many other people, far cleverer than me, battling with the same issues in health and research institutions worldwide.

@HL7_Inc, from whom I've learned more about ontologies and dictionaries than I could write in a... well... dictionary.

@CDISC, from whom I've learned about efforts to standardise health and research datasets, and then to further standardise them so that they can be shared and merged with each other.

@glynmoody, from whom I've learned that the right way to do something in the field of health informatics is often not the one which is most readily publicised.

And @Richard_Dawkins, from whom I've learned so many things as to make listing them an impossible task.

That's just ten pretty much at random from the 170 different feeds which twitter is helpfully collating and delivering to my mobile phone (thanks, UberTwitter) and to this PC. I can also catch up with them while I'm working, provided I do so using the computer on my desk provided by the University of Leicester. If I switch on the PC next to it, provided to me by the UHL NHS Trust, twitter, along with many social network and blogging sites, is blocked.

The UHL used to allow access to social networking sites. Indeed, as a UNISON representative I've previously spent many hours in a disciplinary hearing on behalf of a member of staff accused of spending too much time on virtual networking and not enough on real-world networking (it's called management, but it's basically the same - making links, learning stuff, teaching stuff, and building networks and systems out of people and things). Inevitably, after a few cases like that, the UHL deployed their nut-cracking sledgehammer, banned everyone from using social media sites at work and blocked access to them.

The irony in all of this is that the NHS seems pathologically incapable of seeing the value in social networking, for all of the Government's claims to (a) a commitment to Digital Britain and (b) joined-up thinking. All over the world there are fascinating stories of clinical teams using facebook, twitter or other social media sites to communicate with each other, or with patients or communities. But precious few examples from the UK.

And is it any wonder, when this is the standard of advice that NHS organisations are given about how they should frame their relationship to social media? You know it isn't going to go well when the advice, issued last month from the Department of Health Informatics Directorate, is posed in terms of "Information Governance: Information Risk Management". Oh yeah, communicating with people is a risk. Maybe we should all just stop doing it then?

The guidance says absolutely nothing positive about either blogging or social networking, despite there being significant evidence that healthcare organisations can secure both internal and external benefits from the use by staff of such tools, and instead presents social media purely in terms of risks and dangers:

Why are Blogging and Social networking an Information Governance issue?
The use of blogging and social networking websites by an NHS organisation’s employees can expose that organisation to information risks, even where these sites are not accessed directly from work.

So the NHS isn't just concerned to stop us using social networking while we're at work - it thinks we should be policed even when we're doing so from home. Delightful.

The 'advice' continues...

A range of potential threats exist that organisations should be aware of:

Unauthorised disclosure of business information and potential confidentiality breach

Malicious attack associated with identity theft

Legal liabilities from defamatory postings by employees

Reputational damage

Malicious code targeting social networking users causing virus infections and consequential damage

Systems overload from heavy use of sites with implications of degraded services and non-productive activities

Intimidation of employees from inappropriate use of sites leading to investigations

I particularly like that last one, which isn't explained at all in the document, and which sounds suspicously similar to the justification used in a previous era for the security services' classification of homosexuals in public office as a security risk: they are a risk because they might get blackmailed, which is possible only because they're desperate to keep their sexuality a secret, which is in turn only because it would classify them as a security risk, and so on. Likewise, users of social networking in the NHS might be "intimidated" as a result of using these sites "inappropriately", and face "investigations".Isn't it obvious that the way to deal with this is not to further intimidate those staff who do want to have at least one foot in the twenty-first century, but instead to welcome the development of new media and new mechanisms to communicate with our colleagues and our patients, and to support staff in finding ways to appropriately embrace and use the technology to the advantage of the NHS?

Apparently not. Instead,

Actions that may be considered by NHS organisations include: Deploying technical controls to block or control permitted website usage; Educating users about the potential business risks and impacts associated with blogging and social networking.

While the document does at least acknowledge that NHS organisations might want to revise policies to include "acceptable use of blogging and social networking sites", there is nothing in the entire document to indicate why any NHS organisation would want to do any such thing. Since the Department of Health Informatics Directorate clearly consider social networking to be the work of the devil, designed purely to entrap foolish healthworkers into incurring incalculable risk for their employer, the idea of any hospital manager reading this document and thinking an acceptable use policy is a good idea is truly surreal. They will more likely set off round their hospital with an axe to smash all the computers and cut the N3 connection without delay, before any more risks get into the building.

It is truly pitiful that this is the 'best practice' being advocated by the very people charged with developing informatics policy for the National Health Service, and perhaps gives a clue as to why so many IT projects in the NHS are monolithic, ill-judged and ultimately doomed to failure. If I were drawn to making random predictions about the future of healthcare and information technology as some of the smart people I follow on twitter are able to do, I might say that the widespread use of social networking, microblogging and the like in health care institutions will continue to blossom worldwide, and, yea, even within the NHS itself, and that collaboration, science and ultimately patient care will all benefit greatly as a result, and that the King Canutes of the DH Informatics Directorate will be forced to recognise that their nineteenth century attitudes to a twentyfirst century technology are counterproductive and damaging to the NHS. But making such a prediction on the blog of an NHS employee would probably be considered risky. So I won't. You'll just have to draw your own conclusions.