VSJ – July 2002 – Work in Progress

Council member John Ellis, FIAP is a representative of the IAP to the Parliamentary Information Technology Committee (PITCOM). Here, he reports on a meeting he attended at the end of April.
It can be quite amusing to see Government at work and to observe the similarities with the ‘Real World’. At a recent meeting in the committee rooms in the Houses of Parliament the subject for discussion was the Health Service and its requirement to have implemented integrated IT systems by 2005.
The three speakers all gave interesting presentations. As with any corporate project, they all wanted the same thing – here, integrated systems allowing current information on patients to be seamlessly available at all levels within the NHS. Of course, they had different views on how this should or could be achieved and whether the 2005 deadline could be met.
As in any organisation, the people at the coal face have already done some of the work. In this case that’s General Practitioners. Many practices have purchased some software to do the tasks required in managing patient records and have even got 80% of the historical records inputted as well. They may also have data links to local pathology laboratories so that the information can be exchanged electronically. Systems are able not just to manage individual patients. They may also be used for proactive tasks like inviting for review patients taking particular drugs and providing statistical monitoring of a wide range of information. Users can get the same information in a variety of different ways to suit their individual needs.
That’s where it all stops.
There are no links between GPs (those that are computerised either use their own in-house written systems or have purchased software) and no links from them to the hospitals, other than by paper records. The Government wants integration between all levels of the NHS and some GPs believe that this could release an extra 30% in staff time to do other, more important things. It would appear that some GPs are on top of the problem at their level. However, they need a common data transmission medium (EDI or XML protocol) to exchange data between themselves and upward to the Trusts. This, in itself, should not be a problem provided a committee could specify the standard message structure. Unfortunately the priorities for what data could be shared or passed to the next level cannot be decided and, as ever, it would appear that everyone is getting bogged down in committees. User requirements cannot be agreed. Does this sound familiar to you? GPs, though, know what they need to integrate into their systems, fragmented as they are, so perhaps this should set the priority.
There is money for the project but it doesn’t necessarily get to those who need it. When it does get to a Trust or GP, it can be spent, not on the IT project, but directly on patient care. Or it may not be sent to where it is needed (we have all seen our budgets cut or borrowed from). We are talking of figures in the region of a billion pounds annually and it’s currently predicted that in excess of 2 billion pounds a year will be required just to support this initiative. Of course, there’s always a danger of money being diverted by people who have no idea of what the IT could do for them, especially when there is so much pressure on them to provide health care. So it’s proposed to ring-fence the funds to make sure they’re used as originally intended.
This sort of money obviously attracts the large software companies who are forming bidding groups to provide the whole range of what is required, even though no one seems to know what that is. At the GP end of the market, it should be possible to create off-the-shelf packages that cater for their requirements. The costs here could be quite low, although the large central systems will, by their nature, be expensive.
So here we are:
The management (the Government) wants a system. It’s willing to put in the money. The departmental managers and budget holders (Trust executives) are tasked to decide what is required but are not that interested and probably don’t understand the problem. The users (the GPs etc) are doing their own thing almost at odds with everything else. This must sound pretty familiar to project managers in organisations all over the world.
We need people who know what’s wanted to specify a set of initial requirements. These should be people from the coal face; the GPs seem to be the best place to start. Get the user requirements together and signed off, and get the thing underway. Then a planned series of projects should follow on (to avoid scope and feature creep), adding more functionality as required.
Who sets the priority will be the issue. But work, not political issues, should drive this. What the public see is improved (or not) services, not reduced costs. Using the system to predict future trends for political reasons is less visible still.
Finally, there’s security. While much of the information in a healthcare system is necessarily sensitive, individuals’ records are not of value to most people. Nevertheless, it’s important that any data being transmitted are encrypted by PKI and point-to-point email security will be a necessity.
[Interesting project or development? Let us know at eo@iap.org.uk!]

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