NHS visit today
- Thread starter AHarvey
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My quote specifically says non healthcare.
HELL NO
Do you really think the government can be trusted to create such a master database ?
The labour government tried it. The initiate was called NPFIT - the national programme for IT. The idea was to make one computer system, with one massive database, and have everybody use it. They gave fujitsu nearly 900 million pounds to create it .... and got nowhere
http://www.ehi.co.uk/news/ehi/8665/nhs-runs-up-£31.5m-fujitsu-dispute-bill
Fujitsu were chasing at least 700 million of that and the government has run up 30 million pounds of legal fees fighting over where it all went wrong and how was to blame.
I can tell them for free where they went wrong, somebody somewhere with no actual knowledge of what healthcare professionals do had the same thought as you, and thought "how hard can it be? we'll just give a contractor boatloads of cash and get them to make a master database".
The needs of all the healthcare professiionals in the UK are so vastly different, even among those with the same job but in different regions, that any such system is bound to fail.
That is why we are currently in a scenario whereby NHS contractors who already make such systems are moving towards a "connect all" ethos, of allowing everybodys systems to talk to each other, rather than the "replace all" solution put forward by labour that sought to put all us private sector companies out of business with a massive public sector contract.
This should have the same net effect for you however, in that your hospital can see your GP's clinical record after asking for your consent to see them. However NHS IT is so backwards that getting to this stage where every hospital and every GP in the country are on a system that can talk to each other and allow record sharing is still a long way off. As an example, my wife works at Mid Yorks NHS trust - who only went paperless last month.
The target is to get the NHS paperless by 2018
http://www.ehi.co.uk/Features/item.cfm?&docId=403
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They are conecting systems because there is no budget to replace.
Replacing with a good system would be far and away the best option, but the government, nay the whole public sector management, know nothing about IT at all.
The current way of procuring NHS IT is crap too. Take for example the nurse rota system. From talking to colleagues in the know, there is really only one good system to buy, and it scales to huge levels. Apparently whole counties have bought it and make it centrally, and it works just fine. In the UK it is bought and configured and managed on a trust by trust basis, at terrible expense for the tax payer, but there is no process available for the installment of a centralised system.
The system is a huge mess at the moment, in my opinion a series of large systems should be instated first, and then they should be linked together. Once that is working they will be able to spec a master system to replace it all.
It's the same method being employed (painstakingly slowly, and quite badly due to mass incompetence, but still better than the current set of systems) at the central government bodies I currently work at.
We could do with an entire government department dedicated to running IT projects really.
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and to show how different every hospital is, there probably isn't two hospitals in the country that actually use the same paperwork in their Hospital Notes. This is something that amazes me that something has basic as a Casualty Card is totally different to the next nearest hospital.
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My wife recently had a stay in Hospital and the parking cost me over £80 for the time she was in .....
and this is because most hospital car parks are not owned and run by the hospital they are privately run.
and this is because most hospital car parks are not owned and run by the hospital they are privately run.
They are connecting systems because they tried to replace, and failed.
in NHS IT the government hasn't really had any driving policy to drive towards connect all instead of replace all. That's been done by the private sector companies involved. Its initiates like the MIG - the medical interoperability gateway, where EMIS, TPP and Inpractice Systems have agreed on common standards and a system that provides a single point of entry for all out of hours or hospital requests to view medical records. Between those 3 supplies, about 95% of the UK's medical records can be viewed. All you have to do is point your system at the MIG front door, and the MIG takes care of the rest in working out which system the patient is on, then sending the request for the patients record to the appropriate system.
This was created by EMIS and INPS however, with no government backed contract or initiative behind it. Its thanks to things like this that connect all is becoming possible, because the government has done nothing to contribute to it.
Unfortunately your incorrect in stating that there's one system suited to this task, but the NHS just doesn't use it due to politics. You first need to consider that there is no one system in the UK that meets all the needs of a hospital. There are systems for handling referrals, bed management, document scanning & viewing, electronic health records, digital dictation, record taking etc... In a true paperless hospital you will probably find that to digitize everything, they need several systems for different things. And this is only for the hospital. Then you have to consider outside the hospitals. What about the needs of community nurses, physiotherapy departments, mental health trusts, podiatrists, palliative care, community matrons, health visitors, speech & language therapy, diabetic clinics, occupational health... the list goes on. Then of course you have the GPs & the pharmacists.
Giving hospitals an electronic record system is only one piece of a massive jigsaw, and there is no one system that meets the needs of all these secondary care providers, in addition to the primary care and acute care providers.
And this is before you even think about the issues of getting every NHS trust to follow the same procedures and fill out the same paperwork as dimple says. Because currently they don't. Any such national project would first effectively have to retrain every member of staff to do things differently, in addition to getting them used to a new computerized system they'd never seen before.
I'm telling you now - it can't be done.
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And I'll also add about electronic records - a lot of Clinicians refuse to read them on a PC screen which means in a case this week we were asked (but refused) to print over 5000 pages of a patients online records so a Clinician could read them. The job has been passed to Health Records who will now have to waste all that paper and then it will be destroyed.
There is good news on the radiology front though to a degree.
Our PACS team can electronically send images to some hospitals so that their Clinicians can read them without requesting disks to be made. This is only for some hospitals though because once again a lot don't have a compatible system in place.
I can understand the need for (eg a Ward Nursing Book) being updated when experience suddenly realises that certain information needs to be added so now the book has to be redesigned to cater for that but you would think the book would be rolled out around the country. Even something as simple as a poo chart looks different from hospital to hospital (obviously the Bristol Poo picture stays the same).
I recently had a patient that had written notes all the way back to 1956 and it was a history lesson in design. The earliest A&E card was a piece of paper about 4" x 2", there were then about 15 other designs over the next 50 years which leads to the 16 page booklet we have now.
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Judging from your comments my hospital/GP surgery is quite advanced as it's all digital with regards to sharing notes.
Looking at my x ray it says core patient database if that means anything ?
Looking at my x ray it says core patient database if that means anything ?
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I have access to:
CIS / Dashboard (lots of info here)
PACS (radiology images)
iCris (radiology reports)
ICM (Pathology)
IPM (all sorts especially the patients journey since about 1997)
MedOncology (Oncology)
EDMS (Electronic Documents System)
Medisec (Letters wrote by the secretaries)
Kodak OCG (teeth xrays)
Filefast - this is our hospital notes tracking system and even if the notes follow a patient to the nearest sister hospitals they can't be tracked.
and several others I can't remember at the moment.
GPs are all digital and have been for some time. The government introduced GPSOC in 2007 meaning that all GPs got central government fudning for chosing a computerized medical record system of their choice.
All GPs and all Providers worked to the same contract and service levels set out by the NHS, leaving the GPs to choose whatever system they felt met their needs best, and choosing from a level playing field where everybody provider was providing the same service level for the same cost. The only difference was the functionality and feel of the ssytem.
As a result every GP is now using electronic records. But there is no such government central contract for hospitals and secondary care .... yet.
illustrates my point exactly that anybody wishing to move to a "replace all" solution must first combine that lot, put all the different private sector contractors behind those systems out of business, and that's even before you think about how you overcome the issue of rolling it out nationally.
Thankfully none of your products are from the company I work for, so don't have to worry about getting any flack
All GPs and all Providers worked to the same contract and service levels set out by the NHS, leaving the GPs to choose whatever system they felt met their needs best, and choosing from a level playing field where everybody provider was providing the same service level for the same cost. The only difference was the functionality and feel of the ssytem.
As a result every GP is now using electronic records. But there is no such government central contract for hospitals and secondary care .... yet.
illustrates my point exactly that anybody wishing to move to a "replace all" solution must first combine that lot, put all the different private sector contractors behind those systems out of business, and that's even before you think about how you overcome the issue of rolling it out nationally.
Thankfully none of your products are from the company I work for, so don't have to worry about getting any flack
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and that's easily 25% of what there actually is.
I think we're broadly agreeing with each other, but just getting some wire crossed. I never meant that there could be a "NHS.exe" that magically runs everything, but trusts should be linked, procedures and forms should be standardised, and the IT should be administered more centrally, and yes obviously this would necessitate a large amount of re-training.
When I was referring to replacing the lot with one master system, I was in my head thinking solely about patient records.
What I was trying to point out was the reason why the labour project failed was that it was too ambitious from the start. There should be a series of smaller, but still large, projects replacing groups of the systems and managing them centrally, and then from there you will be able to spec a more complete (set of) solution(s).
It can be done, but only slowly, never cheaply, and not without rustling more than a few feathered nests.
This of course means it probably won't be done, but hey ho.
That was started ages ago and it failed. I was involved with the process about 8 years ago. The problem was nothing could be agreed there and they got clinicians involved who mainly had no clue about what was feasible or attainable whilst disagreeing on what was desirable all led by a lass from Microsoft (in an advisory capacity) who quite clearly had some fantasies about dressing up as a nurse as that's what she seemed to harp on half the time.
I'm not entirely sure that centralisation is what's needed. Centralize IT in the NHS and then all the contracts that are currently awarded nationally end up going to one comapny. One company who will ultimately make a ton of cash while the others get put out of business.
What then does the NHS do in 10 years time when that company is not meeting its targets and the NHS wants to move away ?
The best way for me would be to implement a scheme for acute care similar to what there is for GPs. GPSOC draws up a set of standards that all products must adhere to before they can be put on the shortlist. Once on the shortlist its then up to the trusts / CCGs to choose which product they want. But one of those pre requisites from being on that shortlist is that they need to be able to receive and send data in set formats laid out centrally by the NHS which ensure that all systems across the country can talk to each other to share data and transfer information such as referral letters and scans around the NHS.
This then ensures that all hospital trusts to receive & send partial or complete records of patient care, and at the same time send & receive information electronically into the GP's record also. Thus achieving a system whereby you cannot visit a hospital and the person treating you has no knowledge of your patient record.
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