Computer Weekly Editor's Blog

Jan 16 2013   5:26PM GMT

It is patently obvious the NHS must have online patient records

Bryan Glick Bryan Glick Profile: Bryan Glick


The issue of electronic patient records in the NHS is back in the headlines after health secretary Jeremy Hunt called for the health service to be “paperless” by 2018.

After £6bn or so of taxpayer’s money failed to introduce a nationwide electronic records scheme in the ill-fated National Programme for IT, it’s inevitably a subject of much debate and cynicism – justifiably so, in the circumstances.

But putting aside the history, the concerns about NHS IT capability, and about privacy and data protection, the over-riding consideration here must be that surely it is patently obvious the NHS must have nationwide electronic records, accessible online by patients, if it is to function as any sort of modern health provider.

The issue cannot be whether or not we have online patient records, but how we avoid the IT disasters of the past and overcome the inevitable privacy fears in doing so.

It cannot be a sensible debate if it starts with, “Don’t do it, the NHS will never get the IT right”, or, “The privacy issues of nationwide digital records are too great” – both of which I have seen suggested.

Can anyone seriously claim that while we live more of our lives online, sharing our personal information, even managing our finances on the web, that somehow our medical records should not be a part of that world?

It would be ludicrous to think we could have an NHS without online patient records.

For a start, the vast majority of us already have digital medical records – they sit in our GPs’ systems, lonely and isolated, unreadable to anyone but your GP practice. Remember too that we have a legal right to look at our medical records at any time, whether paper-based or electronic.

Some might say that is enough, but my personal experience is that it cannot be.

Someone very close to me has a long-term, complex medical condition. Her GP maintains the only copy of her entire medical history – but she has no idea how accurate it is. Updates from the hospital at which she is treated are sent to her GP by letter, to be typed in by a secretary at the GP practice. The hospital, meanwhile, keeps its own entirely separate digital record of the medical history she has accumulated under its care.

Parts of the NHS refuse to treat her because they don’t have full access to her medical history to understand the medication she takes and the treatments she has had. For example, she has struggled to register with a dentist, because her condition affects her bones and she needs a monthly infusion to strengthen her bones – to many dentists, unfamiliar with her history, that’s too much of a risk.

I hope it never happens, but if she ever has to go to A&E at any hospital other than the one at which she is regularly treated, doctors there would have no idea of her complex history – and that lack of awareness could be life threatening.

If any suitably qualified NHS practitioner had access to her full medical records, with all the necessary security and privacy controls, it would allow the health service to deliver a significantly improved service and better care.

Of course, neither she nor I want her medical records to be hacked, or accessed by anyone we wouldn’t want to see them – any more than I’d be happy for someone to hack my online bank account.

And I don’t want untold billions of pounds to be wasted again on big, bespoke IT systems that don’t work. But there is no reason why the technology is not capable of delivering a secure, connected solution.

Tell me one reason why we shouldn’t keep on trying until we get it right. I just hope this is the time the NHS finally does.

2  Comments on this Post

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  • Philip Virgo
    Why is it patently obvious?

    The case for investing £billions to give unfettered on-line access to sensitive information to potentially over a million NHS and ancillary staff when access to that which might make a real difference to the treatment of an unconscious patient (e.g HIV or Hepatitis C risk) is routinely blocked or can be readily carried by the patient in ways which do not dpeend on on-line access (e.g. bracelet, dog tags or tatoos wich blood groupp, allergies etc.) is not at all obvious when you consult front-line medical practitioners.

    The problem is not the technology but the people processes and politics.

    Who do you wish to have access to which parts of your medical records? The Doctor, the receptionist or the IT support guy in India on a retainer from ...

    Who do you trust to ensure they are accurate? Remember the case of the NHS administrator who career was destroyed when teetotal was entered as alcoholic.

    and so.
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  • Bryan Glick
    Thanks for the comment Philip.

    You're right to say that the problem is not the technology. In any field, if you get the people, process and policies wrong, then the best, most cost-effective IT in the world won't help.

    My point is that those issues should not stop the NHS introducing online records.

    HMV managers - experts in music sales - thought they didn't need to worry about the online world. Ten years from now, frontline medical practitioners will wonder how they did their job without electronic records.

    In a digital world, why should patients with complex conditions be forced to wear bracelets or dog tags that show the whole world they have a medical condition?

    The NHS administrator you mention was caused by human error, not system error. It was a failure of process, not technology. Arguably, if she had access to her records online, she might have seen the error sooner and had it corrected. (I'm aware that she since went on to run the Big Opt-Out Campaign).

    There will always be exceptions that do not fit the mainstream use of electronic records, so the NHS needs contingencies for those exceptions. You have to have good security and privacy controls too - clearly.

    But I don't see that is a reason not to have online records.
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