FT Editorial- Electronic records
The biggest failure to date of the National Health Service's £6.2bn programme - the biggest civil information technology project in the world - has been one of communication.
The programme is intended to provide an electronic patient record and much else - e-booking of appointments, electronic transmission of prescriptions and digital images available in hospitals up and down the land.
The potential benefits are huge - in terms of increased patient safety and convenience, better quality medicine and greater efficiency and flexibility in the way healthcare is delivered.
Repeated surveys have shown that the programme has failed to engage adequately with the doctors, nurses and therapists who will use it. But, worse, it has failed to explain clearly to the most important people of all - the patients - how the system will work and what their rights to confidentiality will be under it.
It is quite incredible that two years into the programme, and within a year of the first records beginning to go live, this issue has yet to be settled.
Patients will have two concerns. First will be security. Here there can be, in practice, no absolute guarantees, as the bitter experience of banks and other businesses that increasingly rely on IT-driven systems shows. Anything and anywhere, even the Pentagon, has proved hackable. And in the NHS as in other businesses, employees may prove bribable or subornable to provide information that should remain private.
That said, what is known about the planned security sounds reassuring. Access to patient records by NHS staff will be on a need-to-know basis. There will be a clear audit trail of who has accessed records and when, and clear penalties for misuse.
The second concern will be over confidentiality. It seems clear from ministerial statements that patients will have a right not to join the system - forgoing the potential benefits in terms of their own treatment and safety that the record can bring. But after that there is confusion.
The programme originally proposed that there should be a "sealed envelope" containing information patients might regard as sensitive - past mental illness, an abortion, sexual history perhaps - that would only be opened in an emergency or with their permission.
But the board that advises ministers on the programme has gone further and suggested that patients should have the further right to withhold information entirely while still having, in all other respects, an electronic record.
But it is unclear whether these proposals will be accepted and, even if they are, precisely how they will work.
A resolution to these issues has been long promised - and is now long overdue. If that does not happen soon - with patients' rights clearly spelt out - faith in the electronic record could well be seriously undermined and a £6.2bn investment could turn into a £6.2bn fiasco.
Published: April 1 2005 03:00
http://news.ft.com/cms/s/1aa8ef0c-a24b-11d9-8483-00000e2511c8.html
The programme is intended to provide an electronic patient record and much else - e-booking of appointments, electronic transmission of prescriptions and digital images available in hospitals up and down the land.
The potential benefits are huge - in terms of increased patient safety and convenience, better quality medicine and greater efficiency and flexibility in the way healthcare is delivered.
Repeated surveys have shown that the programme has failed to engage adequately with the doctors, nurses and therapists who will use it. But, worse, it has failed to explain clearly to the most important people of all - the patients - how the system will work and what their rights to confidentiality will be under it.
It is quite incredible that two years into the programme, and within a year of the first records beginning to go live, this issue has yet to be settled.
Patients will have two concerns. First will be security. Here there can be, in practice, no absolute guarantees, as the bitter experience of banks and other businesses that increasingly rely on IT-driven systems shows. Anything and anywhere, even the Pentagon, has proved hackable. And in the NHS as in other businesses, employees may prove bribable or subornable to provide information that should remain private.
That said, what is known about the planned security sounds reassuring. Access to patient records by NHS staff will be on a need-to-know basis. There will be a clear audit trail of who has accessed records and when, and clear penalties for misuse.
The second concern will be over confidentiality. It seems clear from ministerial statements that patients will have a right not to join the system - forgoing the potential benefits in terms of their own treatment and safety that the record can bring. But after that there is confusion.
The programme originally proposed that there should be a "sealed envelope" containing information patients might regard as sensitive - past mental illness, an abortion, sexual history perhaps - that would only be opened in an emergency or with their permission.
But the board that advises ministers on the programme has gone further and suggested that patients should have the further right to withhold information entirely while still having, in all other respects, an electronic record.
But it is unclear whether these proposals will be accepted and, even if they are, precisely how they will work.
A resolution to these issues has been long promised - and is now long overdue. If that does not happen soon - with patients' rights clearly spelt out - faith in the electronic record could well be seriously undermined and a £6.2bn investment could turn into a £6.2bn fiasco.
Published: April 1 2005 03:00
http://news.ft.com/cms/s/1aa8ef0c-a24b-11d9-8483-00000e2511c8.html
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