NHS IT Systems

[nichomach]

We're all familiar with the headlines and soundbites concerning the failure of "the new NHS IT system", but there's a slightly different take on it HERE , and I think the guy might have a point...thoughts?

[b0redom]

I've worked on two different parts of the NHS systems, and although there is slippage etc there are massive potential benefits, including:

No need to develop x-rays (at £20/pop) or whatever as they are all electrionic.
No need to store paper records which can be lost/misfiled and which require huge amounts of physical space.
When you're at the doctors and they refer you to a specialist, they can book you in, then and there, rather than having to wait on an appointment.
Following on from your appointment with a specialist, if you then go and see your doctor about a related/unrelated issue, they can see what the specialist has done/advised/prescribed.

It does have a potential massive upside and savings could be pretty big in the longer term.

[nichomach]

Good examples - so do you think there might be a bit of opportunistic bandwagon-jumping obscuring the benefits?

[b0redom]

Politicians engaging in spin? To the detriment of sensible ideas? Headline grabbing just before an election? Surely our right honerable members would be above such trivialities?

[MSIC]

massive potential benefits

I 100% agree, potentially it's a winner.

When you're at the doctors and they refer you to a specialist, they can book you in, then and there, rather than having to wait on an appointment.

In theory yes - however when politics comes in to play (or perhaps some senior business / management decision, or whatever), how I have observed it to work now is that instead of booking an appt straight away, the GP contacts a number of services under the 'Chose & Book' system, who then contact the "customer" by post, who can then go back to the GP with their chosen hospital / treatment pathway
All in the name of customer choice, and was very, very annoying.

[b0redom]

I am quite willing to concede that there are conflicts and wastage in the system. Occasinally it took days for a decision to be made. I'm further willing to concede that MSIC's experience seems flawed, but that's down to a badly specified system, not the system itself. You could argue that the system is working perfectly correctly, but whoever decided it should work like that should be shot.

Perhaps the GPs should be the gatekeeper, and unless there's particularly odd circumstances the treatment of the 'customer' and their treatment pathway should be up to them? It is, after all, what they spend 5 years training for.

[MSIC]

Indeed - no fault whatsoever of the IT system or the IT staff.

[peterb]

I have certainly seen Hospital IT systems at work (as a 'customer') - ordering blood samples for example produces a barcoded label for the sample - which is read by the analysis machine so the results can be automatically made available on line, and the same goes for other diagnostic tests. So linking that to a nationwide system makes sense - on one level.

My concern remains the security of my data - and while audit trails may indicate who has looked at my data, its a bit late after the event.

[megah0]

I use part of these systems day to day on the "frontline" as it were.

They are absolutely brilliant.

We use handheld tablet PCs which are are wirelessly networked, need a particular drug prescribing? Just bleep a doctor, make the request over the telephone and minutes later once they have access to a computer it is prescribed and ready to be given, no need for the doctor to physically come to the ward and fill out a form.

Run out of a drug? Simply tell the system you are out and an order is automatically generated at pharmacy to send up more.

Want to know how your patient is doing? You can call up all of their blood results, blood pressures, heartrate etc and have it all displayed graphically infront of you instantaneously. Same with imaging results.

It is a fantastic system, true there have been teething troubles but from what I have seen these are being dealt with quite quickly and efficiently. As for data security, I can see why there are some concerns over exactly who can access your data but that is an upper management decision. As far as using it....I love it.

[AledJ]

The system does have its benefits but its not the data security that concerns me. What happens when the system goes down, or is taken out by a virus/hacker, what will happen then? Are we not replying a little too much on technology ?

[Saracen]

... As for data security, I can see why there are some concerns over exactly who can access your data but that is an upper management decision. As far as using it....I love it.

And one for patients, especially after Freedom of Information requests apparently led one NHS trust to recently disclose that in that trust alone, some 2000+ non-medical staff had access to confidential patient records.

Personally, I do not want my medical records, any of them, being available online. Period. I have opted out of everything I'm allowed to opt out of. I'm aware of the implications of that, and that it might slow down or adversely affect treatment, especially emergency treatment, and am fully prepared to take that risk.

[nichomach]

Hang on, is that really so shocking? You don't say which trust it is, or how the term "access" is defined - whether it's access as in "has teh oberlord passwerd for eberyfing", or access as in "Yeah, that's Fred, he moves the records trolleys around...". Let's say they had a centralised records department for a large-ish geographical area with a few hospitals and other ancillary treatment centres or what have you; that might be in the hundreds who would technically "have access" right there. Throw in ward clerks, receptionists, clinical manager types, staff collating records of notifiable illnesses, whatever, it adds up quite quickly, I'd imagine, to the point where "big scary sounding number" becomes "actually quite sensible and necessary". If you imagine 2000 people handling a single record, it IS a scary number, but if those two thousand are managing the records for a geographical area with hundreds of thousands, perhaps millions of clients, and some of those counted are those who might technically "have access" (hello again Fred...), but not actually beyond the point of hoiking stuff around then it might be impossible to do the job with less.

[Saracen]

Hang on, is that really so shocking? You don't say which trust it is, or how the term "access" is defined - whether it's access as in "has teh oberlord passwerd for eberyfing", or access as in "Yeah, that's Fred, he moves the records trolleys around...". Let's say they had a centralised records department for a large-ish geographical area with a few hospitals and other ancillary treatment centres or what have you; that might be in the hundreds who would technically "have access" right there. Throw in ward clerks, receptionists, clinical manager types, staff collating records of notifiable illnesses, whatever, it adds up quite quickly, I'd imagine, to the point where "big scary sounding number" becomes "actually quite sensible and necessary". If you imagine 2000 people handling a single record, it IS a scary number, but if those two thousand are managing the records for a geographical area with hundreds of thousands, perhaps millions of clients, and some of those counted are those who might technically "have access" (hello again Fred...), but not actually beyond the point of hoiking stuff around then it might be impossible to do the job with less.

It was a computer system that was the subject of the access. I didn't say which trust it was because it was a newspaper story and I don't even remember which paper, let alone which Trust it was. From memory, the phrase was something like "staff with no medical need".

But regardless, I do not want any such access to my records except for those with a very clear and absolute medical need for it, which is why I say it should be something over which the patient has the final say, not management. If the price of removing access to those that shouldn't have access to my records is preventing some that should, so be it. My choice, and I elect to opt out.

[b0redom]

Well, think about it. I had to pop down to my local GP today as I've got a throat infection. All of the receptionists there, the nurse and all the doctors 'have access'. That's likely to be in excess of 20 people right there.

The correct way of approaching data security is to deny everyone, and then have granular access control, so that receptionists can see maybe only DOB etc, whereas consultants/GPs have access to everything. You also ensure that the people dealing with the systems which theoretically have administrator access are security checked.

You can't mitigate data loss completely unless you're prepared to live in a state where everyone is constantly audited by the security services. If someone inside the NHS really wanted your data that badly, I'd be surprised if they couldn't already get it. If you were a HIV+ teacher, you'd probably have more to worry about with information leaking from your local surgery.

I guess it comes down to a risk assessment. I'd prefer a nosy receptionist had access to my notes and could potentially see something to gossip about (although I don't think I have anything worth gossiping about), and in the event of a car accident or similar have the A+E ward know everything about my medialca history.

[cookie365]

And one for patients, especially after Freedom of Information requests apparently led one NHS trust to recently disclose that in that trust alone, some 2000+ non-medical staff had access to confidential patient records.

Personally, I do not want my medical records, any of them, being available online. Period. I have opted out of everything I'm allowed to opt out of. I'm aware of the implications of that, and that it might slow down or adversely affect treatment, especially emergency treatment, and am fully prepared to take that risk.

Depends on what you mean by 'access' of course.

And how many non-medical staff would have had access to the records if they were in paper files?

I'd hazard a guess that it'd be pretty much the same 2000+ people with the maintenance and cleaning and catering staff thrown in for good measure.

[megah0]

To be honest all those staff have access to your medical records anyway.

Porters carry them around all the time from place to place depending on where they are required, the notes are physically present on the ward at all times when you are an inpatient so in theory anyone working on that ward will have access to them. Not to mention all the staff in xray or theatre if those trips are required (the notes travel with you for any procedure).

As far as access over the network goes I have only experienced the system from an inpatient perspective and a limited part of the outside/social service referral sections of the system. If someone is not logged on the system as being on your ward then it is not trivial to access their records. I've tried looking myself up on the system to see if were possible and it is not an easy thing to do, I wasn't able to look up anything about myself and I would imagine there is a very clear audit trail of access attempts.