Saving lives with technology

It is four o’clock on a Sunday morning and a 35 year old man is brought by paramedics into a hospital Accident and Emergency department following a road accident on a country lane. His injuries are life threatening and he will almost certainly need an operation. He does not live in the area and there is no time to contact his own GP for his health records.
    
Does he have any pre-existing medical conditions that may affect his treatment? Is he on medication that could interact with drugs given as part of his emergency care? Does he have any allergies? Can he be given penicillin?
    
Wider use of information technology in the NHS has the potential to give healthcare professionals greater, and more superior, access to patient information and medical data, transforming the delivery of care to patients. The 35 year old road accident victim would be in safer hands with core medical data instantly available on a computer to health professionals working in hospitals and GP surgeries in England.

Controversial it programme
The National Programme for IT (NPfIT) was intended to revolutionise access to health information, providing integrated systems and services across the NHS. Yet its implementation has been beset with problems and attracted plenty of controversy. The body charged with delivering the programme - NHS Connecting for Health (NHS CfH) - has stumbled from one crisis to another. Many blame the lack of user involvement in the early stages, most notably the failure to engage clinicians, the primary users of the new technology. Widespread concerns about confidentiality and security of data have fuelled further criticism in the programme.
    
Most doctors believe that there should be an investment in IT to bring the NHS into the 21st century and new developments should be backed by evidence, informed by clear strategy and evaluation with independent and audited pilots. The Government has invested billions in its ambitious project and doctors have sought reassurances that this is money well spent.

Frustration among professionals
At the BMA’s recent annual conference, doctors called for a public inquiry to determine the true cost to the taxpayer and whether it has been a cost effective use of public funds. Their frustration is understandable. Many doctors believe they are seeing few returns for the investment at a time when hospitals are making cuts in patient services in order to balance their books.
    
Doctors’ trust and confidence in the programme was lost early on when the Government failed from the outset to sufficiently consult clinicians in the early stages of the project. They questioned whether the programme was fit for purpose, believing it was driven by politics rather than seeking to improve working practices and ultimately benefit patient care.
    
The lack of transparency caused doctors to question whether the money was being invested wisely. Others were concerned about the choice of suppliers selected by the government to deliver new systems, some of whom lacked a proven track record in healthcare systems. Early deadlines were unrealistic, prompting fears that systems were being rolled out too quickly before sufficient piloting.

Efficiency benefits
Despite these concerns, doctors can see the potential benefits for patients and the wider health economy. The use of IT could improve efficiency by speeding up administrative processes and minimising duplication, for example less paperwork, more accurate information for charging purposes, and better communication between hospital departments. Faster access to information could improve patient safety, particularly in emergency situations when patients’ details and test results need to be obtained quickly. A single electronic record could also increase safety by avoiding errors due to illegibility or mistakes caused by having multiple records.
    
Electronic prescribing will soon become a welcome reality through the Electronic Prescription Service (EPS) with pilots starting later this year. It will allow prescriptions to be sent electronically from the GP surgery to the local pharmacy. This is designed to significantly reduce the administrative burden placed on both the surgery and the pharmacy and make it significantly easier for patients to get repeat prescriptions. Prescribing errors are also minimised and patient safety is enhanced with eprescribing systems in place to detect allergy warnings and drug interactions.

Transferring records
GP2GP transfer enables patients’ records to be easily transferred between GP practices with different systems. It means that when a patient registers with a new GP surgery their record can be instantaneously transferred electronically eradicating the often lengthy and cumbersome process printing out an existing record and then re-inputting the data at the new surgery. Feedback shows this to be one of the more successful and welcome IT developments.
    
It is the electronic shared care record that has sparked the most controversy. Worries about security and confidentiality have topped doctors’ concerns. Whilst there is agreement that greater sharing of information within the NHS should exist, a centralised system would only be acceptable if it was secure, reliable, and the data was of high quality.

Data sharing beyond the NHS
Such a system would, in theory, allow for data sharing beyond the NHS for example with social care to assist with planning of long term care. It is generally felt that rather than allowing access to the full record it would be more appropriate for the local healthcare community to work in partnership sharing relevant information, when necessary, on a need to know basis, with the patient being fully informed beforehand so that they can prevent sharing of data if they want to. When data is used for statistical purposes such as research, audit or commissioning it should be anonymised.
    
Choose and Book – the software that allows patients to book their hospital appointment at the time and place of their choice – has also received much criticism. Many doctors feel that an electronic referral system, which had the potential to speed up and refine the referral process, has been hijacked by a political agenda and this is one of the reasons why the initiative has not been welcomed.
    
The booking procedure can be time-consuming and cumbersome and is open to manipulation by hospitals and PCTs. There is often insufficient time during a consultation for the GP to explain the options and practicalities to patients, and the necessary funding to cover all the additional work failed to materialise at practice level.

Staying cautious
A change of leadership at NHS CfH provides an ideal time to review progress so far and formulate a clear strategy for the way forward. Clinicians want to know what is being developed in their area and how they can engage locally. Can NHS CfH be certain that it has sufficiently heard and acted upon the concerns of clinicians and patients? Are there adequate mechanisms for reporting problems and giving feedback on the systems or suppliers?
    
The Summary Care Record (SCR) should not be rolled out any further until the independent review has been completed. Doctors remain cautious that the system is not as secure or confidential as it could be. The BMA has advised doctors, who are not involved in the early adopter phase, to refrain from uploading information onto the SCR until a review has been completed and agreed.
    
Seeking consent from patients on uploading information onto the central spine has been another contentious area. Doctors have been concerned about the extent to which patients have been properly informed, whether they understand how their information will be shared, and what choices they have if they wish to restrict sharing. Early signs from the early adopter phase are encouraging but the wider success of the programme will be largely determined by an extensive and honest public information campaign. Reassuring patients that their personal health records are safe is the biggest challenge yet.