Concerns raised over security and interoperability as DH unveils long-awaited NHS IT plan
The Department of Health’s long-awaited Information Strategy has been met with widespread derision amid fears it does not go far enough to drive the changes needed to improve the use of technology by health and social care services. <,p>
The 100-page document, entitled The Power of Information, sets out the Government’s plan to provide all NHS patients with secure online access to their personal GP records by 2015.
But this timescale of less than two years has been widely criticised, with objectors citing a lack of interoperability and suggesting that, after the spectacular failure of the NHS National Programme for IT, yet more money could be wasted for little gain.
This strategy is 80 pages too long and reads as if written by an old geezer just given a hand-me-down laptop who has realised there is a whole new world outside the day centre
In a scathing attack, NHS commentator and broadcaster, Roy Lilley, said: “This strategy is 80 pages too long and reads as if written by an old geezer just given a hand-me-down laptop who has realised there is a whole new world outside the day centre.
“It offers such gems as ‘information can bring enormous benefits’. Really? And ‘paper records get lost’. Surely not! And what about ‘advancing information technologies have revolutionised the way we interact’. Gosh, I hadn’t noticed!
“The report meanders through the views of the user, carer, citizen, healthcare professional, provider and information intermediary. It’s tedious. We all know what we know; that NHS IT has been a horrible misadventure. Will this report fix it?
“GP records are held on paper and a variety of proprietary software. Not all are web or cloud based, not all have firewalls to cope with external access, and not all have servers big enough to cope. There are serious technical, funding, contractual and security issues to fix – in about 36 months.
We all know what we know; that NHS IT has been a horrible misadventure. Will this report fix it?
“This report reflects the times we are in and is a harbinger for a denationalised NHS to come. There’s no new money; funding will come from savings from kyboshed IT contracts, plus the £20billion efficiency savings. Can you hear any cash rattling in the tin? I can’t. My bet is, in another three years there will be another report.”
The report does fill in some of the blanks and answer a few questions relating to the deployment of IT following the death of the national programme.
It shows a shift from the old top-down approach where national solutions were forced on providers to a more local system whereby trusts will be able to procure their own technology. However, this has led to concern that the disparate systems will fail to link up and the aim of being able to access patient notes wherever a person happens to be will be scuppered. It has also raised fresh questions over how patients’ personal details will be protected.
In addition, the promise of a capital fund to help trusts pay for the necessary technology is lacking in detail, with no firm figures or distribution arrangements given.
Lilley said: “Mums will be able to look at their kids’ records and later be able to see if their daughters are on the pill or if their son has been to the sexual health clinic.”
With some way to go on the efficiency savings required in the NHS, we have reached the point where the focus must now shift from doing more with less to a fundamental transformation in the way we deliver the actual processes of care. Information is central to this
Dr Laurence Buckman, chairman of the British Medical Association’s GP committee, added: “We believe patients should have access to their health records, but we'd want to be satisfied that their records would remain secure before this was implemented. For example, it would be important to be certain that it couldn't be an abusive partner or a parent trying to access their teenager's records."
And Marc Lee, EMEA sales director at access risk management company, Courion, told BBH : “Quite clearly, this project will require the NHS to embrace risk management solutions that help authorities to prioritise and plan for risks and give them the real time tools to spot and stop abnormal activities.”
On the issue of driving interoperability and joining up individual systems, it is thought many of the problems could be solved by implementing US-style incentives, which reward trusts for taking swift action to implement the necessary improvements while penalising those that lag behind.
Dr Paul Altmann, the chief information officer at the Oxford University Hospitals NHS Trust, told the Guardian : “In America one of the things that Obama has done very well is to develop a concept of meaningful use, so all healthcare organisations are told that they need to work towards electronic-centred information over three to four years.
"If they do so much in year one, then they get a significant amount of money. In year two they get a little bit less, and in year three they get less. If they haven't achieved it in year four, then they start being penalised. Perhaps we need to develop similar incentive processes here.”
So-called ‘disruptive technologies are already playing a pivotal role in improving service delivery and driving innovation across the NHS. Sadly, all too often, these are only islands of innovation and this cannot remain the case indefinitely
While this is not covered in detail within the strategy, Dr Charles Gutteridge, the Department of Health’s national clinical director for informatics, revealed that in 2013 the NHS Commissioning Board will publish standards on the issue and outline a process that will ‘both reward people who use the standards and apply sanctions to those who do not’.
Also planned for next year is the launch of a single portal bringing together services currently provided by NHS Choices, NHS Direct online and Healthspace, plus a 111 ‘routine’ phone number. For 111 this deadline is seen as ambitious because of issues with potential suppliers. Serco has decided not to bid and Capita has expressed concerns about the tendering process.
And, the strategy says that, by 2015 GP surgeries across the country will be expected to have in place systems that enable patients to book and cancel appointments, order repeat prescriptions and access their records on line.
Responding to the report, Dr Justin Whatling, vice chairman of strategy at BCS Health, the chartered institute for IT, said: “With some way to go on the efficiency savings required in the NHS, we have reached the point where the focus must now shift from doing more with less to a fundamental transformation in the way we deliver the actual processes of care. Information is central to this and the NHS Information Strategy sets the vision for what is required to be achieved. “
The institute has particularly welcomed the strategy’s adoption of its recommendation that every health and social care organisation appoints a chief clinical information officer (CCIO) to drive adoption of innovative technologies.
However, Dr Whatling added: “We would like to see more emphasis on commissioners encouraging the sharing and adoption of best practice in partnership with industry and the third sector and would like to have seen the strategy place clear obligations on hospitals to digitise their patient records and open these to scrutiny by patients.
BCS Health believes the document should have gone much further in setting out the strategy for interoperability standards, emphasising the re-use of globally-utilised, supplier-driven standards and establishing a vision and strategy around accreditation and certification of systems to those standards
“BCS Health also believes the document should have gone much further in setting out the strategy for interoperability standards, emphasising the re-use of globally-utilised, supplier-driven standards and establishing a vision and strategy around accreditation and certification of systems to those standards.”
While welcoming the acknowledgement of the importance of embracing technology moving forward, technology suppliers are also harbouring some doubts that the strategy will result in the joined-up systems the Government wants.
Professor Michael Thick, vice president of clinical strategy and governance at McKesson, told BBH : “In the new world of a patient-centric NHS, the old silo approach is no longer sustainable. Information is everywhere, but for it to be of value, it must be shared across the system.
“There is little doubt new technological developments continue to offer unprecedented opportunities to interact with the health and social care system in ways that are convenient, cost-effective and which drive quality. So-called ‘disruptive technologies are already playing a pivotal role in improving service delivery and driving innovation across the NHS. Sadly, all too often, these are only islands of innovation and this cannot remain the case indefinitely.”
To read the full report, click here