IT and the British National Health Service

The British National Health Service is implementing an information technology program that is the largest civic project in the world according to the article below. The goal is to have digital records and systems for all aspects of patient care such as booking, prescriptions, and medical records. While expensive, the promised savings are even larger.

This is the type of project that has the potential to increase health care efficiency substantially and to hold down costs, but due to information technology system coordination and other issues, is difficult to bring about in the U.S. through the private sector alone. The U.S. has very advanced information systems in individual hospitals, but not between hospitals or between hospitals and other health care providers such as pharmacies. Hopefully, ideology will not get in the way of the U.S. government taking a leadership role and pushing beyond current roadblocks to its 10-year program to produce electronic patient records, and to broaden the effort to allow all segments of the health care provision network to communicate effectively:

World’s biggest civil technology project comes alive, by Nicholas Timmins, Public Policy Editor, Financial Times: Robin Kantor, a consultant radiologist at Hillingdon Hospital on the western outskirts of London, clicks on a mouse – and offers a glimpse into the future of healthcare across the country. Alongside him, on two costly flat screens, before-and-after scans of the head of a woman who has been treated for a brain tumour pop into view. Another mouse click and the two Pictures are locked together side by side. Dr Kantor scrolls them down in parallel. Even a layman can see how far the tumour has regressed. ...

In truth, there is nothing very special about what he is doing. Thousands of radiologists in some 1,500 hospitals around the world have digital systems ... although not all are as modern as the one just installed at Hillingdon. The significance lies in it being part of the British National Health Service’s £6.2bn ($11bn) information technology programme, which is the biggest civil IT project in the world.

The goal, over a decade, is to provide 50m patients in England with an electronic care record – along with the ability to book hospital appointments on the day and online, with electronic transfer of everything from prescriptions to digital images and entire medical records as well as, in time, allowing patients access via their own internet “health space”.

Taking full advantage of the potential that IT offers has finally – many would say belatedly – become the next big thing in health. In the US, President ... Bush has announced a 10-year programme to produce electronic patient records, although the most basic pre-condition – agreement on standards so that different systems can talk to each other, in a country where healthcare is fragmented – has yet to be met. ... The USA and Scandinavia have the most advanced systems in individual hospitals although they are rarely connected to one another. But in terms of sums committed to a national programme, England is in the lead.

According to its advocates, the potential gains are huge. It should provide quicker, safer and more cost-effective treatment. ... David Brailer, Mr Bush’s health IT co-ordinator, has estimated that it will cost between $100bn and $200bn to achieve electronic patient records across the entire US. But the potential gains have been put at $700bn a year.

Installing such systems, however, is a mighty challenge. And three years in, the NHS’s programme, like most big IT projects, has its troubles. ... But if at national level the programme remains a source of controversy, on the ground it is taking shape. The path it is following is that taken by many IT projects: beset by problems but getting better as it evolves. .... At the moment this is all small-scale and very partial. But the key infrastructure is being put in place. ... Further difficulties, some of them substantial, are guaranteed. Yet already a future is hoving into view. ... It is far from trouble-free. But, essentially, it works. ... Yet the three main issues – what goes on the electronic record, how secure it is and who has official access – remain clouded.

Richard Granger, the programme’s director, has been fervent about security. Access to the system comes via smart card and password. And there are different levels. Doctors can see more than nurses; nurses more than administrators. Access is on a “need to know” basis – with actions logged to show who viewed what. Mr Granger is equally adamant that patient records are anything but secure now. He has a favourite slide of a public corridor in a West Midlands hospital, with files on patients scattered across the floor, lined up against the walls and piled high in a laundry trolley. Anyone could get at them ...

[W]hat goes on the record? The National Health Service will insist patients have a minimal demographic record ... necessary for hospitals, general practitioners and pharmacists to be paid. Beyond that, there will be tiers. Patients will be given the right (beyond the basic data) not to have an electronic record at all. They will alternatively be able to exclude what they see as sensitive: past mental illness, an abortion or HIV status, for example. ... Plans also envisage a “sealed envelope” into which these details could be put, to be opened only in an emergency. ...