Healthcare changed. Its software didn't.

A consultation used to be about one problem and one medicine more often than it is now. Today, the person in front of you is likely to bring several of each — and the decision you make has to account for all of them.

The way we practise has had to change to keep up. The software most of us use hasn’t.

The patient has changed

People are living longer, and living longer with long-term conditions: high blood pressure, diabetes, heart disease, kidney disease. In Ghana, as in much of the world, these conditions are rising — and they rarely arrive alone. Each one brings its own medicines, and every new medicine has to fit with everything already there.

So the question has changed too. It isn’t only what treats this? It’s what treats this in someone who is also on warfarin, whose kidneys are slowing, who is twelve weeks pregnant, or who reacted badly to penicillin as a child?

Whether you’re prescribing in a clinic, charting on a ward or handing a medicine over at a counter, the decision now depends on more things at once than it used to.

The software hasn’t

Most healthcare software was built for a different job: to record what happened. A prescription was written. A medicine was dispensed. A consultation was documented. A bill was raised.

That record matters. But a record looks backwards. It tells you what was done; it doesn’t help with what you’re about to do.

So the pieces of a decision live in different places. The medicines list is on one screen, the lab results on another, the allergy in a note from two years ago, and the clinical knowledge in a reference book or a browser tab. The professional is left to bring them together.

The context is the hard part

Mr Mensah is 71. He takes metformin, 1 g twice a day, along with five other regular medicines. Today he’s come in with burning when he passes urine.

Everything needed to treat him safely probably exists somewhere. His latest kidney result — an eGFR of 38, down from 52 in March — is in the lab system. His medicines are in the prescribing record. The fact that nitrofurantoin is usually avoided when eGFR is below 45, and that metformin shouldn’t go above 1 g a day at his level, is in the reference.

None of it is missing. It just isn’t together. Connecting it — for this patient, in the few minutes you have — is the real work. And right now, that work happens in someone’s head.

The gap lands on people

Healthcare didn’t only get more complex. It got more complex in a way that lands on the individual professional, one patient at a time, while the systems around them still treat every piece of information as separate.

Something has to fill that gap. Today, it’s filled by memory.

In the next note, we look at why that isn’t good enough.

Next: You were never meant to remember all of this →