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

The NHS Programme for I.T. (Part 2)

This part covers the Patient Care Records System (CRS) because I believe it's one of the most important parts of the whole setup. Without accurate records it's makes everything so much harder. They also have to be retrievable quickly. It's possible that it could make things much better if done properly though.

The terms of reference for the 'taskforce' who introduced the system was:

• To identify and analyse the problems perceived by different stakeholders.
• To resolve identified problems in ways that are practicable and for the benefit of patients and the NHS.
• To resolve identified problems in ways that are practicable and for the benefit of patients and the NHS.
• To take account of the legal basis for storing, sharing and using records and Department of Health policy.
• To take account of the technical and practical barriers to implementation.
• To draw up an agreed plan for implementation of the shared summary record.
• To make recommendations to ministers.
• In doing this to take account of the implementation and use of shared records by the Veterans’ Administration in the US.

As you can see, a lot of those points are fairly generic, but the important ones concern technical barriers and legal difficulties. As it is an electronic system, where people details will be communicated over internal networks and the internet, security is essential. Without adequate procedures in place, it will fail straight away. The legal issues will be about things such as sharing information, so it's about the Data Protection Act and Computer Misuse Act. It's good to see that they also took notice of the implementation of similar systems (see last point).

Back in November, there was an article on the GuardianUnlimited website about the new records service and the opening paragraph was:

"Millions of personal medical records are to be uploaded regardless of patients' wishes to a central national database from where information can be made available to police and security services.."

It went on by raising concerns about details of things such as alcoholism and the staus of HIV patients being available and potentially vulnerable as the system could be 'hacked into'. There were a number of responses to this, one of which was from Ian Hayes, who is a trustee of the Terrence Higgins Trust:

"I am writing to express my concern about the lack of balance in your coverage of the Electronic Care Record. The articles seemed calculated to raise concerns, especially in vulnerable groups with most to fear, without attempting to look at the safeguards that will surround the system and potential advantages of a national patient information database."

He also said:

"The Care Records Guarantee, which you only mention in passing in your coverage, represents a significant attempt to give people rights in over their medical records. It is based on a clear view that my medical records are my property over which I have control and includes a right to opt out."

Ian Hayes makes a good point in the second quote - people have the opportunity to opt out with certain pieces of information. That almost completely takes the worry about make data more available to other services out of the equation.

Ok, so sharing data is less of a worry, but what about security. It is an almost worry now. What measures does the project have to protect records from things such as 'hacking' and viruses? We're talking about more than 50m patient files here.

On the Connecting for Health website, there are two technical pages. One is about the Central Design Authority and Technology Office. The other is for NHS Data Standards and Products. Unfortunately, they don't cover anything in any great depth. Those pages don't tell you about the safeguards to protect the records. None of the other projects covered in my previous post tell you anything either. I checked the factsheet for N3, which gives you basic details about infrastructure, but nothing about security. I'm sure there will be some measures in place, but unless they are publicly available and clearly explained, the worries will still remain.

The next part will cover the other parts of the programme and will also have my ideas for how it could have been done better. I'll also mention how the new setup will affect GPs.

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

The NHS Programme for I.T. (Part 1)

Oh dear, oh dear, oh dear - where shall I start? It seems like such a good thing in theory - getting all the technology up to date is excellent - theoretically reducing failures and improving efficiency - the latter happening with appropriate staff training. However, it is something that has had problems from the start.

This topic will be split over multiple posts because it is so huge. I'll be covering it's faults, it's positives, why it was developed and also what I think should be done. It's a subject that I've been talking about for ages, but now I'm posting about it here.

I think one of the first things that needs to be covered though is the description of the programme. NPfIT is delivered by the government agency Connecting for Health. The parts of it are:

• NHS CRS - A new patient records system.


• Choose and Book - A new service for booking appointments and choosing hospitals.


• ETP - This is the Electronic Transmission of Prescriptions, which has been introduced as something which will be faster and more convenient.


• N3 - the broadband network.


• NHSmail - A new central email service.


• PACS - This is the Picture Archiving & Communication System, which will store things such as x-rays.


• QMAS - For those of you who are old enough to remember the Quatermass Experiment, it's nothing to do with that. It's the Quality Management & Analysis System.

The next part in the series will be covering the new patient records system.

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