May 30, 2008

NHS must rethink central patient record plan: Analysts

Would patient smartcards have been a better option?

By Leo King

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The NHS should rethink the idea of a central database, IT industry commentators have said in a damning outlook for the £12.4 billion National Programme for IT.

A central database was troubled from the start, prominent IT industry figures told Computerworld UK. Fujitsu’s departure from the programme, following disputes that are understood to have centred on the payment for localised service provision, meant urgent action needs to be taken to avert a crisis, they said. Fujitsu is the second IT contractor to leave the programme, after Accenture handed over its work to CSC in 2006.

The NHS could consider bringing in BT or CSC to run Fujitsu’s work, or allow local trusts to choose from the many additional suppliers that have framework agreements in place, a source close to the NHS and Fujitsu talks has said. “At the moment, either is possible,” the source said.

But security risks associated with a central records spine far outweighed the benefits, according to Martyn Hart, chairman of the National Outsourcing Association.

“I would challenge the rationale for having one central system. How likely are you to be outside your local area, where the records are held anyway, when you need to see a doctor? It’s only when you’re on holiday or on a quick trip.”

“The only place you can make that kind of arrangement work is where there is strict control and governance, like in the army. Not in a health organisation.”

Hart said for the government to reconsider the system it would be a “loss of face”, and it was unlikely to do so. “It would be the right thing to do, though,” he said.

A sensible alternative to a central database could be smartcards that patients carry, containing their own record, some industry commentators have suggested.

Richard Bacon MP, a member of public spending watchdog the Commons Public Accounts Committee, said: “I agree that smartcards would solve the question over data security. It would mean the data is only held locally, like GP records. Most GPs are very IT literate.”

Bacon questioned the safety of a system where NHS staff could access the patient record database using only a staff smartcard and a password, as it could fall into nefarious hands. “It’s only a question of time before those smartcards are being traded on the secondary market. There’s still a question as to whether the central electronic patient record will ever work.”

Bacon said local stakeholders, such as NHS trusts and doctors, had not been allowed to be closely involved in the project at the start, and this is where many of the problems had begun. “There are hospitals praying they’re at the back of the queue and might get the chance for another system,” he said.

It was unlikely, though, that the government would “slam on the brakes” for a rethink, he said. A recent report by the National Audit Office said that the project was running four years late.

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