IT on the NHS

IT on the NHSFrank Burns was appointed by the minister for health to come up with a clinical strategy for the NHS. Adrian Morant reports Information technology in the National Health Service is just about to get a boost with the imminent publication of a new strategy – or so Britain’s beleaguered healthcare computing suppliers hope. The last five years have been pretty desperate for them, even though the NHS has been working to a long-term IT strategy since 1992. Unfortunately that plan was focussed on building an IT infrastructure to implement and support the internal market. Computer systems to support clinical care were never at its core. That made it pretty unpopular with the medical professionals – and without their help, the NHS computing bandwagon was sure to hit the buffers. So now it is being switched to a new track – a track essentially built by one man. Frank Burns, chief executive of the big Wirral Hospital near Liverpool, was appointed by the new health minister Frank Dobson in June 1997 to develop the new, clinically-oriented strategy. Burns can’t publish until after the comprehensive spending review in July, but he has already told the NHS the essence of what he wants: Electronic Patient Records. Getting such a project going is no picnic, though Burns’ own hospital, Wirral, has for some years been a pioneer of EPRs. In their simplest form – patient administration combined with order communications – they are beginning to spread through US hospitals – supplied by healthcare computing companies like HBO, SMS, and EDS as well as specialised divisions of big companies like IBM and Microsoft. And Burns’ forthcoming programme will at least have a good jumping-off point in that the previous strategy bequeathed him some essential infrastructure. There is already a national private intranet available to the whole NHS, including GPs. Standard data formats have been developed for lab results and other common medical messages. Virtually all citizens have now been allocated a unique number that will identify all their medical encounters. A whole vocabulary of “clinical terms”, the Read codes, has been developed to enable doctors to encode medical descriptions such as diagnoses. Burns may choose to mandate all hospitals to install the sophisticated software necessary to deliver a pan-NHS EPR. Over the more than 400 trusts, that means megabucks, because such systems have a typical lifetime cost of over a million pounds. GPs are due to have all their computer systems replaced or up-graded over the next 18 months too, to enable them to exchange electronic messages with hospital EPR systems. That would add up to real money – albeit spread over a five to ten year period – so if this is the strategy, it’s not surprising that the Treasury is sitting on it. And the delay is making the industry uneasy -it has been promised “jam tomorrow” so many times. Bryan Wrighton, managing director of HBO, the largest UK supplier, commented: “We are going to see a lot more clinical care systems over the next decade. But my real concern is, will the money be there?” In common with other IT suppliers to the health service, Wrighton fears that the Treasury will not allow NHS trusts to discard the grotesquely complex hoops through which they have to jump whenever they plan even a moderately sophisticated IT project. Because of long-past scandals such as the Wessex affair, hospitals are obliged to follow various rigid procurement procedures for IT systems – seemingly designed to ensure that the projects are out of date before they are even specified. Worse, any capital expenditure larger than ?250,000 has to be funded by the Private Finance Initiative – of which health IT suppliers are very wary, because it offers no short-term financial benefit to the suppliers. Via the Computing Software and Services Association, the industry has asked for the PFI threshold to be pushed up to ?1m, and for the procurement regime to be relaxed generally. “Burns believes he has convinced the Treasury to accept these changes, but I’m concerned that they will beat him down”, says Wrighton.
The other factor that might yet scupper Burns’ plans is the millennium.The NHS Executive has already declared busting the Year 2000 bug to be the service’s highest non-clinical priority. And a recent National Audit Office report estimated the NHS bug-busting programme would cost over ?320 million in England alone – and that doesn’t include the cost of new systems for GPs. That’s considerably more than one year’s total IT spend throughout the whole NHS. No wonder the Treasury is being cautious. Electronic Patient Records
The EPR is such a simple idea that you can’t understand why isn’t already being done. What it means is that each NHS body – say, a hospital or a GP – will generate and store all its documents on you in computer-readable form, and transmit them electronically where possible. Each of these documents will be tagged with a unique identification number, so that anyone in the NHS can – if they have the authority – trace every clinical and administrative datum about every encounter you ever had with the service, and retrieve it from the institution that owns it.
Simple in principle, yes; but not in practice. The variety of document and data types – GP notes, prescriptions, referrals, discharges, hospital episode summaries, diagnoses, treatment plans, pathology lab results, x-ray images etc – make it a lot harder than, say, counting money or tins of beans. Add to that the sheer Byzantine complexity of the NHS itself – the types of organisations, the funding, the professional hierarchies, the confidentiality issues, the cradle-to-grave nature of healthcare, the connections with external bodies such as social services – and it is a can of worms.

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