Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Wednesday, September 19, 2007

UK NHS – A Summary of Commentary and Discussion over the Last Week.

While seldom out of the Health IT news world wide – the following series of articles provide a major update on what is going on and how successful the project is at present. It is fair to say the report card is ‘mixed’ at best. Could do better seems to be a useful summary.

The following offer a useful summary.


UK Report Reflects Success, Doubts Over e-Health

September 14, 2007

Recent stories here in the US have talked about how the push for adoption of electronic health records has slowed, at least temporarily, while doctors and patients evaluate their worth. The general consensus seems to be that, long term at least, there's no doubt about their value but that users need to be convinced again why they should invest in them now.

That's not an uncommon scenario. Look at the adoption curve of most new technology products that aren't called iPod or iPhone and you'll see a flattening or even a dip after the early adopter phase. The expectation is that people will start putting money into EHRs again once the returns on that investment become clearer.

The experience that the UK has been having in building an electronic patient record infrastructure is instructive in that regard. While in many ways the centralized, government-led health system in the UK is completely different from the market-led system in the US, nevertheless the influences at the local level and on the individual for adoption of EHRs and EPRs are similar.

A report this week from a UK parliamentary committee flatly states that there's no longer any doubt that EPRs have huge potential in terms of the benefits they can provide for patients and health systems overall, but that how and when they will be delivered in the UK is still very much in doubt.

….. (see URL above for full article)

The report cited above is an important read – as is the report cited below.


Wanless warns NPfIT risking NHS modernisation

11 Sep 2007

In a review of NHS modernisation efforts Sir Derek Wanless has criticised the slow progress of the National Programme for IT (NPfIT) and called for an audit of the programme to ensure it supports wider health service modernisation.

The report warns that considerable challenges lie ahead in modernising NHS IT systems and says there is "continuing debate over the feasibility of some current NPfIT plans".

With limited progress on its core objectives, and the lack of a clear measurable business case against which savings can be measured it says that Connecting for Health, the agency responsible for NPfIT, appears to be being allowed to follow "a high-cost, high-risk strategy that cannot be supported by a business case". Concerns are also expressed about the future impact of the monopolistic contracts awarded by the agency.

The report analyses the progress of NPfIT within the wider context of NHS modernisation and investments made and finds the programme wanting in key areas, particularly enabling productivity gains within the service. It observes that NPfIT has largely occurred in the absence of any published or measurable business case.

Despite receiving very significant investment since 2002 Wanless says the programme has so far largely failed to deliver. "The extent to which the NHS will benefit from these investments remains unclear."

….. (see URL above for full article)


King's Fund: Our Future Health Secured? (.pdf)


NHS ICT spend set to hit £2.9bn

12 Sep 2007

The total spend on Information and Communications Technology in the NHS is set to hit £2.9bn in 2007/8 according to figures contained in a new report on NHS investment for the King's Fund.

Our Future Health Secured, authored by ex-NatWest boss Sir Derek Wanless, states that ICT spending in the NHS, combining both local and central spend, is set to almost triple from an estimated figure of £1bn in 2002 to £2.9bn by the end of 2007/8.

"Actual ICT spending in England is estimated to have increased from £1bn in 2002/3 to £2.3bn in 2005/6. In 2006/7, the planned increase in ICT spending is set to rise by 25 per cent to just under £2.9bn," says the report quoting figures supplied by NHS Connecting for Health.

The King's Fund report, which comes five years after Sir Derek published a review into future long term funding of the NHS, says that actual spending on ICT in the NHS was slower to pick up than originally envisaged, but has since exceeded the recommendations he made five years ago.

….. (see URL above for full article)

Following are three further perspectives on the Parliamentary Report mentioned above.


MPs criticise e-health record progress

By Kablenet

Published Thursday 13th September 2007 15:36 GMT

The Electronic Patient Record project needs better planning, more consultation and a new timetable, say MPs.

A report from the Commons Health Select Committee on the e-patient record - a key project in the 10-year NHS national programme for IT - highlights a series of problems with the management, security and timescale of the scheme.

The role of Connecting for Health (CfH), the agency responsible for the national IT programme, needs to be increasingly modified. It needs more focus on setting and monitoring national technical standards, if the development of the e-patient record is to be successful, claims the report, published on 13 September 2007.

"Professionally developed datasets and agreed approaches to the structure and content of detailed records are urgently needed for each of the main clinical specialties and for use in a range of different care settings," the report says.

The MPs called on CfH to work with the royal colleges and other professional groups to identify the information standards that will be required within their specialty area to develop consensus-based clinical information standards.

The e-patient record scheme will have two separate systems: a national summary care record (SCR), containing basic information; and a detailed care record (DCR) of more comprehensive information.

….. (see URL above for full article)

This article was originally published at Kablenet (http://www.kablenet.com/kd.nsf/FrontpageRSS/AB08D8052D588E35802573550038ECDC!OpenDocument).


NHS IT system 'maximises' security risk

The current architecture of a showpiece NHS IT system “maximises” the risk of patients’ confidential details being leaked, stolen or breached.

Rather than minimising the security risk, the Spine provides “both a bigger target and a larger number points of attack” than if the NHS used a group of smaller systems.

Plans for the future of the Summary Care Records, a single database of patient data accessible by all NHS staff nationwide, will also make the system “more difficult to use.”

Delivering these damning verdicts on the system, due to store the data of 50m patients, the Commons Health Select Committee called for all staff with access to be security trained.

Security applications for healthcare systems provided by IT contractors, such as BT, should be independently evaluated, with the results to be made public.

The committee said such measures would install confidence in the £12bn computerisation of the NHS, and reduce the risk of security breaches, which are “problematic” and “challenging”.

….. (see URL above for full article)


Confusion surrounds Summary Care Record

14 Sep 2007

Indecision about the Summary Care Record has led to confusion about its content and purpose, according to a report from MPs.

The Health Committee has heavily criticised both the Department of Health and Connecting for Health for confusion about what will be included in the SCR and what the record will be used for.

In their enquiry into the NHS Care Records Service the Committee took evidence from a variety of Connecting for Health representatives on the SCR but claimed that officials gave different answers on different occasions to questions.

The report said the Committee supported the aim of introducing a nationally available summary record but deplored the “delays and continuing indecision about its content."

The report added: “The Committee was told at various times that the SCR will be used for the delivery of unscheduled care, for the care of patients with long-term conditions, and to exchange information between primary and secondary care. It is little wonder that patient groups expressed confusion about the purpose and content of the SCR.”

….. (see URL above for full article)

All in all a useful collection of reading about the progress of the largest public health IT project in the world.


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