Information In Practice

Ten ways to improve information technology in the NHSCommentary: improve the quality of the consultationCommentary: Clinical focus might make it work

BMJ 2003; 326 doi: (Published 25 January 2003) Cite this as: BMJ 2003;326:202

Communication is the key

Dear Sir,

It is important to note that of the ten points raised, seven directly
relate to the communication of data between professionals and
organisations. This is no surprise; when a casenote is reviewed it is
entirely composed of communications. It is here that information
technology has its greatest benefit.

The NHS needs to create open, extensible standards for the
communications that make up a patients notes. Creating huge centralised
systems that meet today's needs temporarily and adopt a "one size fits
all" will lead to NHS IT yet again
mimicking past IT disasters, such as the scrapped benefit cards payment
system, the new air traffic control centre at Swanwick and the national
insurance recording system.

Once national standards in messaging, authentication and
authorisation are created, individual system suppliers can connect their
disparate software, new and legacy data to create a seamles integrated
electronic patient record, that can slowly evolve, develop and keep pace
with developments - both in IT and medicine. It is important not to forget
the legacy data that is out there - in pathology, and even in radiology.
Bespoke radiology imaging software should be able to publish patient's
data in a standard fashion allowing it to be integrated at the desktop.

Local systems can be designed with local users in mind, all operating
on the same secure network. When a local rapid access endoscopy unit wants
to start prospectively auditing requests, customising their own request
"messages" should be straightforward and seamless to those that use them.

In creating a working, living, evolving distributed electronic
patient record, it does not matter that data is stored by a number of
different organisations, and it does not matter when in fifteen years time
the NHS organisational landscape changes. Centralising data away from the
people who create it would be a mistake. A distributed flexible system is
easy to centralise in the future when needs change. The converse is not

The recent Welsh publication "Informing healthcare" [1] talks about
created a Wales-wide electronic patient record. It goes on to ask whether
Welsh systems should be aligned to information standards in their English
counterparts. I find it difficult to believe that such a question even
needs to be asked, and it is this lack of far-sightedness that means the
millions of pounds will yet again be squandered on IT systems that its
users can't use.

[1] "Informing Healthcare".

Competing interests:  
None declared

Competing interests: No competing interests

28 January 2003
Mark Wardle
Royal Glamorgan Hospital, CF72 8XR