The much-criticised National Programme for IT only covered England, as each of the four UK nations runs its own healthcare. This article looks at Scotland’s relative success in building its emergency care summary system, covering virtually the entire population.
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Few tears were shed when the chancellor, Alistair Darling, appeared to sound the death knell last month for the hugely costly NHS national programme for IT. Yet it turned out to be a premature obituary for the £12.7bn scheme, which, instead of being scrapped, will have £600m – less than 5% – cut from its costs.
The programme, one of the most ambitious IT projects in the world, is designed ultimately to provide staff in hospitals and GP surgeries with potentially life-saving electronic health records on everyone in England. But it has been beset by problems since its inception in 2002. As a result, parts of it – including the core patient record project – are years behind schedule, it is costing several billion pounds more to implement than initially forecast, and has become mired in controversy over privacy issues.
Parts of the programme are running successfully, notably the computerised Choose and Book appointment booking service, the NHS N3 broadband network, and the electronic picture archiving and communications service (Pacs), which allows medical staff to quickly call up scans on a computer. As of March 2009, £4.5bn had been spent on these projects and other work.
In Scotland, however, the country’s independent NHS has shown it is possible to set up electronic records for all patients. Almost all of its 5.2 million population now have emergency care summary (ECS) records, which provide basic demographic data and information on patients’ prescribed medication to A&E wards, out-of-hours medical providers, and NHS24, Scotland’s version of NHS Direct.
Libby Morris, a GP who chairs the ECS board, says the system has benefited from having high standards of privacy for patients. “Patients are asked for their explicit consent before any doctor looks at the record,” she told a recent conference. “It’s just a matter of politeness and good manners.” Staff cannot browse records, as they need several pieces of data to get access to each patient. “You can’t look up all the Gordon Browns in Scotland,” Morris said. Only 1,400 people have opted out on privacy grounds.
Morris cites cases where the electronic records have saved lives – such as a 62-year-old patient who had not mentioned on admission to hospital that she needed insulin, and an unconscious 17-year-old victim of an overdose, where staff found the drug he had used through his father’s record, after the father had given permission for access.
In England, not only do few patients have electronic records but few hospitals have the software to use them. While the great majority of GP surgeries are computerised, many hospitals continue to use paper and outdated computer programs.
Connecting for Health, the agency that has managed the scheme for the Department of Health (DH), handed the implementation work to a small number of giant IT companies, acting as “local service providers” for five areas of England. BT has had some success as the provider for London, where it has connected all but one of the capital’s primary care trusts to national programme software, but it still has very few hospital trusts connected. Elsewhere, Accenture and Fujitsu quit the programme, leaving Computer Sciences Corporation acting as provider to 60% of England in the north, Midlands and east, and no specific provider in the south. To date, fewer than 1 million people in England have an electronic health record that can be accessed nationally.
The Conservatives, if elected to government, have plans to give patients more control over their records, possibly allowing them to choose who maintains the data, rather than giving the NHS a monopoly. Launching the party’s draft NHS manifesto last week, Cameron promised online banking-style access to records. “It’s the patients who’ll have the power in our NHS,” he said. “You’ll be able to check your health records online in the same way you do your bank account.” However, no details on how this would work were forthcoming.
Significant changes
Hospitals and primary care providers would still need software to access and add to patients’ records. A change of government would therefore mean significant changes to the IT programme , but would still be likely to build on the work of the last few years, rather than scrapping it.
As part of its ongoing attempt to demonstrate the importance the programme places on medical professionals, the DH last week appointed Charles Gutteridge, formerly medical director of Bart’s and the London NHS trust, as its first national clinical director for informatics.
In Scotland, where 40,000 records are accessed each week, Morris has little doubt as to the worth of the nationwide ECS system, particularly for those treating elderly people in psychiatric care. ”People tend to be on long lists of medicines they can’t remember,” she says. “A major benefit is increasing the safety of medicine reconciliation, and making sure that clinicians have the most up-to-date record of medication.”
• SA Mathieson edits Guardian News & Media’s SmartHealthcare.com site,
which covers NHS computing and informatics
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