Change the Record

© Hurricanehank

Earlier this week Health Secretary Andrew Lansley published the Department of Health’s long awaited Information Strategy whitepaper “The Power of Information”. It details plans to take all patient records online by 2015…but haven’t we heard all this before?

Back in 2002/3 the National Programme for IT (NPfIT) was born. It promised to do much the same thing, as part of the overall revolutionary plan for NHS interoperability. We all know what happened next – at the last count the Programme had spiralled to £12.4 billion and was officially ‘axed’ in September 2011 with us being years older and no wiser.  I accept that we are a little closer than before to the goal of a standardised, electronic system for patient records across the NHS…but what needs to change to make Mr Lansley’s vision a reality this time around? Here are some pointers:

  1. Break down barriers to change – the NHS Spine has been in existence for many years…it’s not the technology that’s holding us back but the attitudes. However, things are moving and nearly 15m Summary Care Records have been created. It is interesting to note that a patient’s ability to “opt out” was a huge sticking point…to date only 1.29% have chosen to do so.
  2. Identify patients by one unique number – incredible as it may sound, a patient’s NHS Number is not always the primary identifier for an individual across all sections of the NHS. This needs to change so we move to a one patient, one record system.  This is a key message from the Information Strategy.
  3. Clean up ‘dirty’ data –in the last couple of months we’ve had news that 20,000 pregnant men and 95,000 ‘ghost patients’ remain on the NHS books. This needs sorting and much of this process can be automated.  As an example, Quicksilva’s orQestra® system is helping our customers to verify NHS Numbers…in one case resulting in a 1.1% improvement in verified records in the first month…when you’re talking about 1.3m records, that’s getting us there.
  4. Pharmacies need to be encouraged to provide electronic transmission of prescriptions using barcodes – the Electronic Prescriptions Service (EPS) shows promise, but is far from the universal standard. Greater take-up will improve the quality of the data online and remove the need for routine appointments, a significant overhead for GPs.

No one can pretend that any of this will be happening quickly. One of my main concerns is that there is no optional central guidance as to what solutions can be used to deliver on the Strategy. Mr Lansley has instead called on GP surgeries and hospitals to use “imaginative solutions”. It’s true that the top down approach of NPfIT did not work but I think more guidance is needed for those healthcare providers who cut their IT budgets leaving them with no-one to help them make important decisions which will affect their future in competition with the private sector.

3 thoughts on “Change the Record

  1. Only when there are proper standards in place for validation and verification of data will things improve. There are no requirements for checks on clinical information, only on data items that are linked with payments in the NHS. There is no requirement for those entering data onto clinical systems to be trained, for provision of help with data entry if locum or bank staff are brought in who do not know about the data management systems. There is little audit of clinical information. I have gone through the documentation for a number of Trusts and found nothing that covers these issues.
    It would help if those who were managing IT in NHS understood how the inside of a computer worked – that is not always the case. There should be a requirement that someone with “IT” in their job title knows how to write a programme in some computer language. There’s been discussion in the media about the lack of programmimg skills amongst school students – well there’s a black hole in the knowledge of many NHS IT depts where there seems to be a belief that one can manage an IT project without understanding how the software will work.
    Also there needs to be proper User Acceptance Testing of all new software. In a meeting last week it became very clear that I was the only person who understood what this entails. It’s not the supplier making sure it does what they designed it to do, it’s the users testing that it does what they think it should do.
    Also, there’s some useful information in “The plot against the NHS” by Player and Leys about IT projects in the NHS.

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