Cross Talk on 1998 and all that
Mike Cross looks back at the Information for Health strategy and finds that it was, on the whole, a good thing.
It wasn't a bad year. Monica Lewinsky gave us something to gossip about. All Saints topped a dismal pop chart and Saving Private Ryan opened at the movies. In the technology world, digital terrestrial TV and airline e-ticketing were born.
In UK politics, 1998 was the New Labour government's first full year in office. Highlights included the Good Friday agreement for Northern Ireland, abolishing the last residues of the death penalty - and promising to computerise the NHS. "Developments in patient-accessible records using smart cards or other technology offer potential new uses of the EHR..."
Yes, it is 10 years since the Information for Health strategy set in train a national scheme to create electronic health records in Britain. And with so much heat being generated by (often badly informed) discussion about the state of healthcare computing, it may be worth going back a decade to put things in perspective.
EHRs and EPRs
When Frank Dobson, the present government's first health secretary, published Information for Health in 1998, NHS IT was perceived to be in a mess. Wessex Regional Health Authority was shorthand for “public sector computer disaster.” Among the chattering classes, there was a feeling that technology had been lavished on men in grey suits rather than on front-line clinicians. “The electronic health record was to emerge in almost biological fashion as individual NHS organisations installed electronic patient record systems...”
Information for Health was no whitewash. Its author, Frank Burns, chief executive of Wirral Hospital trust, spent more than a year assessing the state of IT health across the NHS. His conclusion was that, with coordinated action, the best could become the norm.
The strategy’s central idea was that the NHS' use of IT should progress "in a coordinated fashion" to make the common goal of seamless care a reality by creating an electronic health record (EHR). "This will provide the basis of lifelong core clinical information with eventual electronic transfer of patient records between GPs," it said.
The EHR was to emerge in almost biological fashion as individual NHS organisations installed electronic patient record (EPR) systems capable of supporting their own needs and exchanging information with others.
Difficult issues, then and now
Although standardisation was a theme, the strategy recognised that some parts of the NHS would move at different speeds. Beacon sites were to be “tasked to explore the practical development and accelerated implementation of EHRs and in particular the different approaches that could be adopted to achieve the EHR."
Information for Health also hinted that difficult questions about who should have access to information within the EHR were still undecided. "This requires a coordinated discussion with clinicians at national level and will be the subject of a formally established national project to assess the best way forward."
Overall, the strategy felt that responsibility for the record should lie mainly with GPs. However, it foresaw a possibility that e-empowered patients might become involved. "Developments in patient-accessible records using smart cards or other technology offer potential new uses of the EHR," Frank Burns said.
Great in theory
Almost everyone applauded the theory. Implementation was another matter, however. The timetable was supposed to fall into three phases. The short term, to 2000, dealt with immediate organisational matters and the Millennium Bug ("the current most urgent non-clinical priority").
The strategy thought that clinical systems would start to be installed in the medium term, from 2000 to 2002. By the end of that date, 35 per cent of all acute hospitals were supposed to have implemented a “level 3” electronic patient record.
Among other things, this would handle electronic order-communication and results reporting. A quarter of health authorities were also supposed to have made "substantial progress" towards integrating records in primary and secondary care. "Some parts of the 1998 strategy may now be obsolete, but those critical success factors are as relevant as ever."
The third phase, to March 2005, was to usher in the "widespread availability" of electronic patient records, in which all acute hospitals would have “level 3” systems.
Critical success factors still critical
A prescient section entitled "critical success factors" noted that the programme would need "national consensus on the objectives to be achieved, effective and continuous dialogue between stakeholders and centrally mandated deliverables within specified timescales".
Some parts of the 1998 strategy may now be obsolete, but those critical success factors are as relevant as ever. When Information for Health's tenth anniversary rolls round, they deserve to be pulled out of the cupboard - along with those All Saints singles.
About the author: Michael Cross is a freelance journalist specialising in healthcare informatics and e-government. He is a member of the British Computer Society.