If only because no-one will do it, here's an attempt to piss into the
prevailing wind on GP-UK.
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Starting point: improving communication will be a good thing for
healthcare. Assumption: developments in technology can be exploited to
improve communication.
Tricky bit: the NHS family operates a myriad of internal computer
systems. Making them all use the same system is not an option.
Thing to avoid: anarchy of incompatible communication. Reason: B cannot
receive anything from A, greater costs to the NHS as a whole, inability
of local clinicians to judge whether local standards are safe.
Solution: specify the bits in between these computers, i.e. the standards
which must be used if A is to be able to receive something sent by B.
Helpful extra: make available communications services which incorporate
the said standards and which can be bought by A or B.
Another helpful extra: use the communication infrastructure to also offer
web stuff.
Insurance: set up more than one communication service to ensure
competition, but make sure that they inter-operate.
All done by: pan-NHS and profession organisations. IMG and Royal
Colleages. Who else?
So far, so good. Or can this logic be challenged? No? Well then the
unhappiness must be to do with making it happen. Several categories of
unhappiness exist:
1. The standards are daft. Anyone got better standards which meet basic
criteria such as proven robustness and availability/ cheapness of
software products which support them?
2. Security and confidentiality related to communication is a worry.
Well, it's now being addressed. Leaving the major threat: dodgy practice
internal to each organisation.
3. The wrong suppliers are offering the communications services. Are
their contenders to BT and Mercury operating nationally, especially when
they submitted the best tenders?
4. The prices are staggering (at last, says Ahmad!). The prices quoted
by Ahmad certainly are staggering - if compared to Demon, Compuserve,
etc. But the key thing is that these prices are for a lot more than
Internet, which essentially is offered as a freebie. So the comparison
is spurious. And anyway, considered NHS-wide, such prices are maybe of
the order of 0.00001% percent of the total budget and save many times
that amount while improving healthcare.
5. The NHSweb, being an intrAnet ring-fenceded by firewalls, is the
wrong approach. How else to safely get helpful web page stuff to the
clinical coalface?
6. Not enough's being done to ensure everyone in the family gets hooked
up. (if it's such a good idea, then why not come up with the dosh to kit
everyone out and pay their running costs?) Head office doing this means
no local control. Plenty examples of previous disasters of that ilk.
PS I don't work for IMG and can't therefore speak for them. Scotland
has it's own strategy. In many respects the words above apply.
;-)
Alan Hyslop
Computing & IT Strategy
Management Executive, NHS in Scotland.
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