Joining up is hard to do

The history of IT and the NHS is not as bad as it is often painted. It's taken a while but computerised GP records are the norm. This forms the backbone of the health promotion agenda at the heart of the Quality Outcomes Framework (QOF) delivering major preventative benefits. Preventing illness is not dramatic in the sense of Casualty or ER, but personally speaking I'd rather avoid the hospital and the illness if at all possible. Routine decision support seeks to prevent prescribing errors both in terms of conflicting medications and personal adverse reactions.

In hospitals, things are a little less advanced in many cases, but digital X-rays are starting to aid diagnosis and electronic records are starting to appear.

Where the NHS has failed over the years is in joining all the bits up. The 2003-2010 national programme for IT quickly renamed as Connecting for Health is the most spectacular example. But even in general practice until very recently, printing out your electronic record and re-entering it by hand was the normal way to transfer a patient record when you moved practice.

Now we are entering a period where the NHS is about to become more fragmented than ever with commissioners and multiple providers including those from the private and third sectors. Even foundation Trusts badged as NHS bodies will operate more autonomously than ever before.

So, if we've not managed it yet, and the task just got harder how can we succeed?

The first lesson is that the NHS is not a command and control organisation and hasn't for years, so a top down centralised approach won't work. I once described the NHS as a collection of cottage industries from GP practices to clinical specialties. Urban myths like the "NHS is the world's biggest employer after the Indian railways" miss the point. The staff are employed by private businesses contracting to the NHS, mostly GP practices, not big commercial corporations and autonomous entities such as FTs.

So we need to reflect this in our information solutions providing systems that meet local needs as well as national priorities.

The second lesson is about how join those systems up. Everyone said that the NPfIT failed because it was so big. Well to paraphrase a great man "you may think that the NHS is big, but that's just peanuts to the world" and the modern world is joined up, by the Internet, the World Wide Web and by global social networks such as Facebook. That's how you can read this blog, even on the other side of the world, if you wish.

The secret of this connectedness is standards, lots of different systems written by lots of different people but all working to global standards such as HTML5, CSS3 and the ISO 7 layer network model protocols. Even global giants such as Microsoft and Apple have had to conform to these standards.

The NHS as the commissioner of services needs to specify standards for

1. Technology
2. Networking
3. Record structures
4. Clinical terminology (what we used to call coding)
5. Governance and security

It needs to adopt standards that are recognised by industry beyond the NHS, and adopt standards from bodies such as ISO, IEEE and the W3 consortium. It also needs to embrace more enthusiastically the work of organisations such as the Information Commissioner's Office. It needs to stop re-inventing the wheel and adopt standards which will allow multiple providers to compete whilst offering compatible solutions.

Then we may finally start to have information systems fit for purpose that can meet the needs of patients, clinicians and commissioners.