History does not reflect well on healthcare informatics. The massive National Programme for Information Technology (NPfIT) programme proved to be undeliverable and the loss of political backing at the end of the last decade resulted in it being wound down prematurely, leaving a legacy of some things done well, some partly and some not done at all.
The key, essential, element that it was intended to deliver - the interoperable, shared electronic patient record - proved too challenging and was arguably its undoing.
Indeed, attempts to mandate a centralised programme ultimately led to a situation where the information systems and processes in the NHS in England ended up as a patchwork of many different types of computer system on a common, NHS-wide network. Whilst these systems generally provide much of the basic functionality that is needed locally, levels of interoperability between systems are low or non-existent. While digital records have now been implemented in the overwhelming majority of GP practices, NHS providers in hospitals and other settings are at different stages of digital maturity and many still rely on paper based records and have a substantial amount of work to do to provide clinical staff with easy access to the information needed to provide optimum levels of patient care. Furthermore, this lack of shared patient records constantly undermines the NHSs’ ability to deliver the much needed efficiency and productivity improvements.
The lack of access to patient records is most evident in our treatment of frail elderly patients who turn up at or are transported to their local Accident and Emergency Department with alarming regularity. On arrival, the lack of access to their full medical history means they are often admitted, diagnosed and treated for the admitting condition when better information about the complexity of their health needs could improve their treatment and reduce the scale of readmissions. Indeed, comprehensive information on the patient’s condition could help the NHS reduce the need for an emergency admission in the first instance.
In recognition of this urgent need for high quality data and information so that everybody can make the right decisions at the right time, NHS England have embarked on a series of initiatives to establish a new modern data service. The aim being to provide NHS organisations, citizens and researchers with accurate, timely information which, in turn, is expected to radically transform the way patients are treated and cared for. These include the flagship patient data service, care.data “linking” data from patients’ GP records to their hospital records by June 2014, and by 2015:
- enabling and supporting people to access and interact with their individual health records online
- re-launching the Choose and Book service to make eReferrals available to patients and health professionals for all secondary care
- enabling primary care providers to offer the facility to book GP appointments and order repeat prescriptions online
- supporting hospitals to implement safe and effective electronic prescribing services for their patients.
And by 2018:
- ensuring that integrated digital care records become universally available at the point of care for all clinical and care professionals
- a paperless NHS.
The Government and NHS have invested £1 billion in technology to improve patient care and ease pressure on A&E departments, including a £500 million Safer Hospitals, Safer Wards technology fund. One of the key things this money is intended for is a system that finally allows hospital staff, GP surgeries and out of hours doctors to share access to patients’ electronic records. By having this information at their fingertips the intention is that: staff should be able to spend more time seeing patients and less time filling in paperwork; errors should be reduced and drugs less likely to be prescribed incorrectly because patients’ paper notes have been lost.
The biggest challenge though is the Government’s requirement that the NHS should be paperless by 2018, which will require local clinicians and health services to come together to find innovative solutions for their patients. However, while the ambition is clear there are doubts that it can be realised. A recent technology survey by the Health Service Journal of 419 health and health IT professionals found that while most think it is a good idea, 91 per cent were concerned that NHS senior managers’ lack of knowledge about the clinical and cost benefits of improved IT systems could thwart the 2018 target date for a paperless NHS. With only 29 per cent thinking the target is realistic.
Ironically the lack of joined up working between different parts of the health and social care system is cited as the biggest single reason the sector could fail to achieve the health secretary’s ambition – ironic because the lack of a shared patient record and healthcare informatics is regularly cited as the main barrier to integration. Other reasons were cultural problems among staff, lack of funding and the lack of compatibility and integration between different IT systems.
For the sake of patients everywhere we have to hope that the ambitions for an information technology-based NHS does materialise, not only is it important for managing patient information more effectively, it is desperately needed to help deliver the NHS’s most pressing business outcomes. These include: integrated, joined-up care; improving the way the patient and healthcare providers interact, with greater patient involvement and shared decision making; and doing more for less, keeping the operational lights on in the face of a funding gap of 20 -30 per cent over next five years. Good healthcare informatics is essential, not optional, for the first two outcomes and will help massively with the third.