Learning lessons from a hidden success of the NHS national programme for ITBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4991 (Published 09 August 2013) Cite this as: BMJ 2013;347:f4991
- Richard G Jones, physician1
- On behalf of Gifford Batstone (Brighton NHS Trust), Christopher Johnson (National Pathology Programme, NHS England), Maureen Curran (Health and Social Care Information Centre), Owen Johnson (School of Computing, University of Leeds), Bernard Croal (Royal College of Pathologists)
Greenhalgh and Keen’s insightful critique of the national programme for IT in England rightly identifies the contradictory narratives that prevail at the policy and public level.1 Despite this, IT provision in the NHS is moderately healthy, although in need of some preventive care. One example is the pathology messaging implementation programme, which delivers test results from NHS laboratories to GP practices. Introduced between 1997 and 2004, this service delivers about two million routine test results every day on 300 000 patients.2 Over the past decade, it has transmitted five billion results, with turnaround times for common tests of under 48 hours for all 152 laboratories.
The system has its faults, however, largely because it mostly works and is not as high on the agenda as more attention grabbing initiatives. Useful lessons can be learnt from this system and the requirements for its upgrade. The fundamental problem relates to data standardisation, not a sexy topic, but one without which seamless IT working across the NHS cannot proceed.
Two main themes are apparent from our work. Firstly, data standards must be professionally developed and endorsed, but they must also be based on sound principles of computer science. Secondly, the development, delivery, and updating of these standards must occur in near real time if large scale interoperating systems are to be delivered and safely supported. The National Laboratory Medicine Catalogue3—sponsored by the Department of Health, governed by the Royal College of Pathologists, and developed jointly by the Health and Social Care Information Centre and the University of Leeds—is, we believe, an exemplar of what is needed. The system is based on open web technology, allowing online peer review and publication of standards that can be consumed widely by the IT systems community. It is designed to replace the antiquated Read code system, with its manual and tardy update process and cumbersome delivery.
The greater the level of local development of solutions, the more important it is to set and monitor professional and technical standards so that the meaning of pathology and clinical data is accurately transferred to those who need it.
Cite this as: BMJ 2013;347:f4991
Competing interests: None declared.