Sunday, 21 January 2007

The NHS Programme for I.T. (Part 3)

The first of the remaining parts of the NPfIT I'm going to cover is the new communications service, NHSmail. According to the Connecting for Health website, the new service (which replaces the existing Microsoft Exchange setup) is:
  • A national directory of people in the NHS, containing the name, email addresses, telephone numbers, name and address of their NHS organisation, and information about departments, job roles and specialities.
  • Accessibility from anywhere on NHSnet or the Internet, particularly useful for staff who work from more than one location.
  • An email address that stays with you as you move around the NHS.
  • Calendars and folders that can be shared with other users across the NHS.
  • Automatic encryption during sending of emails.
The theory behind this is great. I'm a big fan of replacing paper systems because with IT, you can create instant and multiple backups, but it would take much longer to make copies on paper. I wonder about the value for money though. I'm glad they took into account encryption, but quality encryption packages can be bought relatively cheaply. Sharing of calendars can be done with Exchange, so in that respect there was no need to replace the old system - that point is not a benefit. Having a unique email address is good, but fairly easy to organise. I think the first point in the list of features is the big selling point, although it doesn't state whether it will be everybody and how regularly it is updated (people can leave the NHS and other will join - it's not just about having unique email addresses). I would still be interested in finding out how much it cost. The features are fairly inexpensive, but as the organisation is huge that might change things.

Now onto PACS:
"Picture Archiving and Communications System, more commonly known as PACS, enables images such as x-rays and scans to be stored electronically and viewed on computer screens, so that doctors and other health professionals can access the information and compare it with previous images at the touch of a button.

By delivering more efficient imaging processes, PACS will contribute to the delivery of a maximum 18 week patient journey by 2008."
That 18 week goal could be considered ambitious, but there are signs of improvement already (86.9% of outpatients waiting under 8 weeks and more than three quarters of inpatients waiting under 13 weeks). This is something that I think will really struggle. X-rays need to be really high quality, therefore the file sizes will be huge. You would need an absolutely vast amount of storage and a massive backup facility. I'm sorry, but it just seems too problematic.

Choose and Book is another interesting idea. Like other aspects of the NPfIT system, there's been an earlier adopter program, so there is opinions available already. An online/phone system for booking (as well as the possibility of picking from multiple hospitals) sounds great. However, there are reports of problems with the implementation already:
"Half of the GPs said the choose and book online booking system was poor or fairly poor. The poll was completed by 447 hospital doctors and 340 GPs.

And in a further blow, ministers said other parts of the project were behind schedule, pushing it over budget.

The Financial Times reported that the government had admitted the electronic records system - a database which could be accessed by health professionals anywhere in the country - was more than two years behind schedule."
Sure, many big projects fall behind schedule - but two years! Also, for 50% to say it's poor or worse is worrying. The problem is that as it's been in place long enough to see 400000 bookings, it could be difficult to make any changes if they are needed.

There's also ETP. This is a great idea, as long as there is proper security in place. It would be a major disaster if prescriptions were changed en route. Apart from that, I don't really have any worries about it. I couldn't find negative news articles either.

I have highlighted some good points in these three parts, but there are some clear worries/problems with NPfIT. Also, there was little consultation with the people who'll be using the setup - the doctors, GPs, etc. The people on the 'shop floor' will see problems with things and they are capable of coming up with ideas about how to fix them. Also, why not provide doctors and surgeons with tablet PCs and PDAs? That way they could access patient notes and records that are perfectly readable and if the person is from another country, they could change the language instantly. That must beat patient notes written on paper and made available on clipboards at the front of beds. Notes at the front of beds aren't the most portable either and they could be damaged. Of course, to make PDA and tablet PCs work in that environment, WiFi would need to be freely available. Why not focus on those things too?

I'd like to know what you think about what I've posted in any or all of these three parts.

Technorati tags: NPfIT, Connecting for Health, Government, IT, NHS