Smart Healthcare: England | SmartHealthcare.com

DoH launches no smoking iPhone app

Wed, 10 Mar 2010 11:49:37 GMT

The health department has spent around £10,000 developing an iPhone app to help users stop smoking

The application will provide daily hints and tips on how to manage cravings and keep a tally of how much money quitters have saved since they stopped smoking.

It will also direct people to local NHS Stop Smoking Services and include a direct link to the stop smoking helpline. Launched on 10 March 2010, No Smoking Day, it is available from iTunes, www.smokefree.nhs.uk and NHS Choices.

The department said that a similar iPhone application it launched in December 2009 to help people keep track of their alcohol intake has been downloaded 65,000 times so far.

It justified releasing this only for Apple's mobile equipment on the basis that 61% of mobile online access to NHS information is currently through an iPhone. For the iPod Touch the figure is 17%, 2.75% use a Nokia 5800, 2.11% a Nokia e71 and 4% a BlackBerry.

Smokers who do not have an iPhone or iPod Touch can text the word calculator to 64746 to receive information on an NHS Choices smoking calculator.

BMA calls for suspension of SCR uploads

Wed, 10 Mar 2010 11:44:44 GMT

The British Medical Association has written to health minister Mike O'Brien, expressing 'serious concern' about the widespread introduction of Summary Care Records

The BMA also repeated its recent call for opt-out forms to be included with the information being sent to patients, and demanded that comments made by the BMA be withdrawn from a promotional video made by NHS Connecting for Health.

The letter, signed by BMA chair Dr Hamish Muldrum, GP committee chair Dr Laurence Buckman and NHS IT working party chair Dame Deirdre Hine, expresses "our serious concern about the recent accelerated roll out of the Summary Care Record," referring to the decision to introduce SCRs in five strategic health authority areas in December 2009.

It said the BMA has accepted only a limited introduction of SCRs, on the basis of "a further thorough independent evaluation". "We are therefore very surprised and disappointed that a much wider roll out was announced in December 2009 and this is in progress counter to the BMA's position above," it added.

The letter says that "a significant number of members" of the BMA's GP committee are calling for a boycott of uploading patient information onto the Spine to create SCRs. Although it does not go that far, the writers urge the Department of Health to halt SCR introduction in new areas, so that research on its introduction by University College London can be considered.

"Failure to do so will jeopardise the earlier gradual implementation and potentially the whole programme," it adds. "We are deeply disappointed that the current national roll out has bypassed the BMA's views, and ignored our goodwill which we have provided up until now."

The Department of Health denied that the introduction of SCRs was being rushed, as it has taken place over five years. "All patients in England over the age of 16 who are registered with a GP will be written to personally about the introduction of Summary Care Records. We absolutely support the right of any patient to opt out of having a record and have provided various options to make this process straightforward," said a spokesperson.

"Patients have at least 12 weeks to decide if they want to have a Summary Care Record. After this period, they are able to change their mind about having a record at any time," the department added.

The spokesperson pointed out that access to SCRs is open only to healthcare professionals who are directly involved in a patient's care, with the patient's permission, with use of smartcards using Chip and PIN technology and with all accesses recorded so they can be audited.

EHRs: who is setting records?

Wed, 10 Mar 2010 09:00:00 GMT

NHS organisations have a complicated choice when choosing electronic health record systems. The first of two articles looks at three established suppliers

If all goes well over the next few years, most NHS trusts and boards across the UK will be implementing electronic health records (EHRs) as a replacement for the medical records paper chase that has been in place at most health organisations for decades.

In England at least, however, bringing in EHRs will have been a tough job. The National Programme for IT's Care Records Service, which should already have provided a centrally-bought system for many NHS trusts, has not delivered this for more than a handful.

"There are many reasons why the CRS is so far behind schedule: poor security standards, poor reliability, limited capacity and – most importantly – little customisation," says Kable's senior health analyst Victor Almeida. "Trusts were offered one vendor under the NPfIT scheme and – given the benefit promises made – very few chose to opt out of the initiative."

Almeida points out that, as a result of the delays and the resulting political notoriety, the CRS is at risk of being scrapped or substantially rearranged in the next few months. This looks set to put the onus on trusts to choose an EHR provider. "It is almost inevitable that the pool of suppliers will be expanded," he says. "Most clinicians and patients are not against health records. They just want a solution which is both secure and reliable."

Those suppliers already involved with the CRS could lose guaranteed customers, but would arguably be left in a strong position to compete, given the years of work they have already undertaken with the NHS, and the (few) reference sites this has generated.

Cerner and iSoft are the chosen CRS providers to London and the North, Midlands and East regions of England respectively, although they are already selling to trusts outside these areas. Emis is in a slightly different position, but also has a very strong NHS presence: it is best known for supplying the majority of GP surgeries, and is now aiming to add larger NHS organisations to its customer list.

Cerner

US-based Cerner has been working with the NHS for more than two decades and its flagship EHR system, Cerner Millennium, has so far been installed across 16 trusts and 70 hospitals since being launched in 2004. It also supplied the software for NPfIT's Choose and Book appointment scheduling system, which processed more than 15m patient bookings during 2009.

Its existing customers include Kingston Hospital - which went live just inside the government's November 2009 target date - and Homerton Hospital in London, while other sites, such as Newham University Hospital Trust and Wirral University Teaching Hospital NHS Foundation Trust are extending their use of its technology. Newham is planning to extend its Millennium installation to deliver integrated patient care pathways for its citizens.

In partnership with its neighbour, Homerton University NHS Foundation Trust, Newham was the first NHS site to implement Cerner Millennium around five years ago, and plans are now in place to implement fully-electronic prescriptions and electronic workflow for all aspects of the two trust's patient care process.

A version of Cerner Millennium modified by University of Pittsburgh Medical Centre has been bought by Newcastle-upon-Tyne NHS Foundation Trust Hospitals: the patient administration elements of the software suite went live across the trust on 7 November 2009. The trust is planning to extend Millennium's use to two primary care health centres which it runs in the city.

iSoft

The second major firm offering EHR systems to the NHS on a wide scale is Australian company iSoft Health, which has a customer base of more than 13,000 health organisations in more than 40 countries. Formerly known as IBA, it bought UK-based iSoft and took its name. This represents a new chapter for the organisation: four former executives of the old iSoft, none of whom now works for the company, appeared in court in January regarding financial irregularities dating from before the purchase.

The firm is best known for its Lorenzo suite, and is expecting to go live with v1.9 of this at University Hospitals of Morecambe Bay NHS Trust this spring. In April of last year, iSoft Health secured a £2.5m deal with Heatherwood and Wexham Park Hospitals NHS Foundation Trust for its i.Patient Manager patient administration system (Pas) technology, as well as a refresh of its i.Clinical Manager platform. The trust serves a population of more than 450,000 in six locations. What was notable about the deal was the fact that the trust negotiated directly with iSoft for a replacement Pas rather than waiting for this to be developed by the National Programme for IT.

According to Adrian Stevens, iSoft's managing director, this contract was one of the first major deals in the NHS southern cluster, and is being serviced by Fujitsu – which formerly acted as the local service provider to the whole area, before abandoning this role in the National Programme.

In November last year, iSoft signed a similar deal with Sheffield Teaching Hospitals NHS Foundation Trust for a common Pas across the trusts' Northern and Central campuses. The Northern campus is seeing an upgrade of its current iSoft Pas, whilst the Central campus will move from McKesson TotalCare Pas to the iSoft platform.

Emis

Emis – Egton Medical Information Systems – has also been central to implementing EHRs in the NHS, ever since it started operations in the 1980s when Dr Peter Sowerby and Dr David Stables wrote the software for their GP practice in Egton in North Yorkshire.

Today, the company claims that more than half of GP practices across the UK use Emis software, with more than 30m patient records being handled by the technology. The company recently announced it is planning a listing on the AIM stock market later this year.

Last November, Emis previewed its Web v2 EHR system, an internet-based cross-organisational healthcare system, since when it has been released to more than 1,000 clinical users across the NHS. According to the company, Emis Web v1 is already being used by more than 1,000 early adopters across the UK, including GPs, community and secondary care clinicians in NHS Tower Hamlets, NHS Liverpool and NHS Cumbria primary care trusts. In Tower Hamlets, the firm says that 300 community staff are now using the system to access relevant data from the GP record and recording their consultations, leading to the trust making time and efficiency savings, as well as improving data capture and reporting.

Managing director Sean Riddell says that a unique feature of Emis Web v2 is an integral record interrogation tool which conducts instant, automated searches of the whole electronic patient record. This is meant to allow clinicians to pull together key information about a patient's care on a near on-demand basis. He adds that it is the biggest piece of software, requiring the most detailed testing, that his company has ever undertaken in the history of the company.

Next week: the EHR challengers

Liberty and Patients Association join SCR protest

Mon, 08 Mar 2010 10:57:40 GMT

Campaigners for civil liberties and patients' rights have joined the British Medical Association in attacking England's opt-out requirement for electronic patient records

The NHS in England is introducing Summary Care Records using a policy of "implied consent" – patients are assumed to agree to the creation of a record unless they refuse, reports The Guardian. The BMA wanted these to include an opt-out form. But Connecting for Health (CfH), the NHS body running the scheme, refused.

Instead, patients who do not want to participate have to get an opt-out form from their GP or request one by letter, helpline or website. Some 1.24m records have already been created and another 8.9 million patients have received a letter about the programme, according to the Department of Health. A record will be automatically created for each patient after 12 weeks unless they specifically withhold their consent.

Isabella Sankey, director of policy at Liberty, the human rights organisation, voiced serious concern about the summary records. "There would have been very good arguments for clear public information and an opt-in policy for this scheme," she said.

"But the worst of all worlds is to alleviate political criticism by providing a so-called opt-out which is inaccessible and virtually meaningless. How do you expect people to trust you with their most sensitive and private information if they can't even trust you to be honest in trying to gain their consent?"

Katherine Murphy, director of the Patients Association, said summary records could improve the care patients receive, but that they should all be given an opt-out form. There should also have been a national advertising campaign so people could start thinking whether to participate or not, she said.

Some doctors accuse the NHS of trying to scare patients into agreeing by claiming that future medical care could be impeded if they refuse. The opt-out form asks the patient to acknowledge that any future treatment may suffer if they do not have a summary record. "There is no evidence to say that is the case. It is scaremongering," one London doctor said.

Some GPs are refusing to release their patients' details until each one has specifically agreed. "We will not upload anyone's records without their explicit consent," said Dr Neil Bhatia of Yateley, Hampshire. "We control the data records and we are responsible for its release. No one can force us to upload it without a court order."

Wirral primary care trust in Cheshire was recently warned that pursuing summary records could be illegal. Despite these reservations, it accepted almost £70,000 from the NHS to pay for packs to be sent to patients.

Prof Ross Anderson, a security expert at Cambridge University, said there was no guarantee that only NHS staff treating someone could access their records. Hundreds of thousands of health service personnel would have a swipecard to enter the system.

"You just can't keep a secret if 300,000 people have access to it. All celebrities should definitely opt out," he said. "The sort of things you can find on SCRs, such as prescriptions for anti-retroviral drugs, can also be highly stigmatising."

The BMA is writing to Andy Burnham, the health secretary, to say that while it supports the idea in principle, it has serious concerns. Dr David Wrigley, the BMA council member for Lancashire and Cumbria, said: "How do we know that people have received the material in the post? Doctors in my area wanted a tear-off strip to be included at the bottom of the letter for patients to fill in and hand in to their GP's surgery to say no they didn't want a SCR, but CfH told us we couldn't do that."

A Department of Health spokeswoman said that the model of implied consent being used was adopted in accordance with national information governance good practice and was supported by the Information Commissioner's Office.

BMA criticises SCR enrolment process

Fri, 05 Mar 2010 15:33:38 GMT

It should be easier for patients in England to opt-out of having Summary Care Records, according to the British Medical Association

The BMA has criticised the fact that there is no opt-out form included with the information sent to patients about SCRs. Instead, patients have to request the form online, through calling an 0845 phone number or by informing their GP.

If patients take no action, the NHS will automatically generate a centrally-held record from their healthcare data. However, as in Scotland healthcare practitioners will have to ask patients for permission to view records on each occasion.

The association also said that patients are inadequately informed about whether or not to opt-out, citing a 2008 evaluation of the records' introduction by academics from University College London, which found that seven in 10 patients in early adopting areas were unaware that their records would be added to a national database.

The criticism comes as five of England's strategic health authorities are moving ahead with introducing SCRs across their areas: the north west, north east, Yorkshire and Humber, London and east of England.

"The Summary Care Record roll-out is now happening too hastily," said Dr Grant Ingrams, chair of the BMA's GP IT committee. "While we believe it has the potential to improve both the quality and safety of patient care, we are concerned at the speed because it means patients are very unlikely to be aware of what they are automatically being enrolled into."

The Department of Health replied that it has changed the process to make it easier for patients to opt-out. "Patients are given at least 12 weeks to decide if they want to have a Summary Care Record and are provided with full information about how to opt out if they wish to," said a spokesperson.

"We have a coordinated information programme aimed at increasing patient awareness of the initiative across the country. However, this aims to alert and inform patients, rather than speed up the process by which they take a decision."

Freeing health's data: opening access to government information

Michael Cross — Wed, 03 Mar 2010 09:00:00 GMT

Politicians are trying to open access to government data, but this may expose problems with the accuracy of NHS information

Even before the Francis report into mortality at Mid Staffordshire trust, the quality of NHS data was emerging as a hot political topic. Over the past year, the government and the Conservatives (but, surprisingly, not the Liberal Democrats) have been trying to outdo each other with promises to empower patients with openly available data about the NHS. As yet, however, there are few signs of the promised consumer revolution.

The centrepiece of the government's efforts is the website www.data.gov.uk, launched last November by worldwide web inventor Sir Tim Berners-Lee and Professor Nigel Shadbolt of Southampton University in their roles as the prime minister's cheerleaders for opening up the vast resource of public sector information (PSI).

The idea, originally floated by the Cabinet Office in its 2007 Power of Information programme, is to create a central clearing house for access to PSI data sets and information about what use is being made of them. The site emulates a similar effort launched in May 2009 by the Obama administration in the US, where there is a long-held assumption that federal government data should be freely available for re-use. It is too early to say whether the same culture will take off in the UK.

Officially, of data.gov.uk's 7,500 data sets, 400 relate to healthcare. They provide the basis for a handful of applications already listed on the site, including iPhone apps for finding GPs, pharmacies and dentists from supplier Elbatrop. Another recent offering is Best Care Home, which helps people find the right care home for themselves, family members or clients from Care Quality Commission data. The site includes extracts and the full text of all inspection reports from the regulator, and ranks 18,500 care homes in order of quality performance.

The bulk of NHS datasets listed on data.gov.uk come from England's NHS Information Centre, including hospital episode statistics (HES) and national care quality indicators. The Welsh health service has also contributed data and access to a mapping visualisation system, and Scotland has also released a limited number of datasets on areas including abortions and alcohol interventions.

The launch of data.gov.uk coincided with that of a new licence model for re-using government data by the National Archives, replacing its pioneering, but little used, "click-use" licence. Unlike the click-use licence, the new "non-transactional Creative Commons approach" explicitly allows data to be re-used both for commercial as well as non-commercial purposes.

Right to open data

If the Conservatives form the next government, a sizeable number of new datasets could be made available under these arrangements. David Cameron, who can now count among his advisers Tom Steinberg of the MySociety web activist group (and co-author of the 2007 Power of Information report) is relying heavily on free data as a tool for improving public services.

While decrying the "Google government" tag, he says the web "allows us to make big change in the relationship between government and citizens, giving power to people on an unprecedented scale". Cameron's most eye-catching pledge is to publish in full every government contract worth over £25,000. But he has also promised that health data "currently locked away in vaults" will be published "in an open and standardised format".

The promised explosion in the availability of NHS data raises two interesting problem for the next government. First, if a new generation of commercial and community websites springs up on the back of the new data, what role remains for the NHS's own citizen-facing presence on the web? One pillar of the Power of Information agenda is that the state should not duplicate or compete with independent web-based services. The government has not yet followed this logic through, but a Cameron government might. An obvious way to cut the cost of the NHS Choices website, for example, would be to trim it to a core of essential data feeds and rely on the private and third sector to create citizen-facing applications.

The second problem concerns the quality of information. The more use is made of NHS data sets, the more their accuracy, currency and comparability will come under scrutiny. Commenters at the data.gov.uk website have already observed that the most recent available list of GPs dates from 2006 - and covers only England.

If as simple a list as the up to date GP register is impossible to open up, what hope is there for more sophisticated and controversial data sets? One key finding of the Francis report into the Mid Staffordshire scandal is that a working group led by Professor Sir Bruce Keogh, the NHS's medical director, develop a "single, clearer" measure of hospital mortality ratios for use by the NHS and its patients. The problem is that clarity and simplicity don't always go together with accuracy.

Michael Cross

Comment on NHS mobile IT: Let's have more connecting for health

SA Mathieson — Wed, 03 Mar 2010 09:00:00 GMT

The NHS National Programme for IT's core strength is infrastructure. It should turn its attention to mobile and wireless connectivity

Anyone who does not closely monitor NHS IT may regard England's National Programme as a failure, one of those great British government IT projects that has blown billions on very little, imperils civil liberties and is years behind schedule.

This is, of course, only partly true of only a few parts of the programme, most importantly the Care Records Service (although there have been other problems such as take-up of Choose and Book). Westminster did bodge the plans for installing patient records systems in trusts by assuming it would be much easier than it has been, exacerbated by its cavalier attitude towards citizens' privacy in assuming that it didn't need to notify people about their records being uploaded – a mistake since partly corrected. Luckily, by paying by results it has not blown billions in doing so.

NHS Connecting for Health has done pretty well on several other projects, many of which involve connecting. The most obvious is its N3 broadband network, along with applications which take advantage of improved bandwidth between NHS sites. These include N3's free on-net voice, picture archiving and communications systems (PACS), NHSmail email and GP2GP patient records transfers.

These give the NHS systems from the 21st century – specifically, those from about the middle of the last decade. In consumer terms, CfH has provided the NHS equivalent of, respectively, cheap broadband deals, Skype, Flickr, Hotmail and bulky file transfer website YouSendIt.com. Given that the health service has to provide systems that are more secure and reliable than those given free to the public, this represents good work.

The missing element is mobility. In the last few years, consumer IT has been about wireless hubs at home and smartphones on the move, both allowing users to take computing away from a desk.

Such ideas have huge potential for health and social care, both within and without NHS buildings. Last week's Mobile and Wireless Healthcare event heard some inspiring stories – full coverage here. But such successes appear to be the rare exceptions.

Why? Within buildings, short range wireless networks are the obvious technology to use. These are easy to install when new hospitals are built, and through private finance initiative schemes the NHS has been building quite a few of these recently. But retrofitting existing buildings is much more expensive and disruptive.

Outside, mobile phone networks provide the connectivity. The difficulties here involve finding the right devices – powerful enough to process information, large enough to be readable, while unobtrusive enough to avoid attention from muggers. There's also the issue of patchy mobile network coverage.

Currently, individual trusts have to solve these problems. They would be better handled nationally – ideally with the UK's health services banding together, as they have for the likes of N3 (used in England and Scotland) – to get the best deals from vendors which tend to be international in scale. CfH, along with National Services Scotland and Informing Healthcare in Wales, are the obvious organisations to make this happen.

The ideal would be framework deals with the makers of wireless equipment and hardware providers, consultancies able to install wireless networks economically within existing NHS buildings, and network operators – the last including Airwave as well as the consumer networks to maximise coverage. At the same time, CfH would commission software (or apps, in the mobile jargon) for its existing national systems such as NHSmail, allowing them to be used in a secure and workable fashion on mobile handsets.

Smartphones had been around for several years before Apple reinvigorated them as mobile computing devices. The NHS should probably avoid Apple's overhyped yet underpowered – in battery terms at least – iPhone. But for the NHS, Apple's concept of easy-to-use mobile computing represents low hanging fruit.

SA Mathieson

DoH plans amended NPfIT deals within weeks

Tue, 02 Mar 2010 15:05:38 GMT

The government is hoping to agree on a memorandum of understanding with NHS IT suppliers by the end of March

The Department of Health confirmed it is looking to conclude the first stage of negotiations to amend National Programme for IT contracts during this month, as part of the attempt to cut £600m from its budget announced by chancellor Alistair Darling in December.

Health minister Mike O'Brien told BBC Radio 4's Today programme that his department is looking for a memorandum of understanding by the end of March. "I'm certainly not going to get into a situation where, because we're approaching an election some date soon the whole of government stops, and we can't make any contracts with suppliers of key NHS equipment," he said. "That would be complete nonsense."

The department said it is not attempting to "tie down deals" before the election, but is instead seeking to amend existing contracts. "Nothing in these contracts is decided by the proximity of an election," it said.

Shadow health minister Stephen O'Brien accused the government of trying to lock in deals before the general election. "It is devastating for taxpayers to watch the government sign away billions more pounds on a failing IT programme and tie the hands of the next government," he said on 2 March 2010.

Both the Conservative and Liberal Democrat parties plan major changes to the programme if elected to government, with greater choice for individual NHS trusts and changes and cancellations of some contracts.

"Much of the Programme has already been delivered within budget but there are some additional elements which we are considering whether or not to proceed with," the department added. "We are discussing these with the IT suppliers involved and the local NHS who set priorities. It would be irresponsible to delay negotiations on contracts because the opposition demands it for party political reasons."

Buying Solutions seeks telecare framework deal

Mon, 01 Mar 2010 11:43:13 GMT

The Treasury's buying agency is setting up a contract for assistive technology worth up to £300m

In a tender published in the Official Journal of the European Union on 25 February 2010, Buying Solutions says that its telecare, telehealth and telecoaching solutions framework will be worth between £50m and £300m.

It will be available to government departments and agencies, as well as the NHS and local authorities.

The framework is divided into six lots. The first will cover the supply of telecare products, including base units connected to a telephone network or broadband, call monitoring, and personal telecare products such as activity monitors.

The second will include call monitoring and response services. Lot three will provide remote monitoring hardware and software, home hubs and other personal application hosting and communication devices, such as PCs with an internet connection and smart phones.

Lot four will cover off the shelf equipment, rather the bespoke technologies covered elsewhere in the contract.

The fifth lot is for video or audio conferencing between patients in the community and clinicians or care services to support the delivery of health and social care. This will include the installation and hosting of services.

Lot six, for managed services, will include the management of accounts, customer liaison and training.

Each lot will have up to 40 suppliers and will be let for two years, with the option to extend for two additional periods of 12 months.

Victor Almeida, senior analyst at Kable, said: "This represents a vast array of applications, which will be welcomed by patients and health professionals, such as doctors, community nurses and health visitors.

"But the budget is not large enough to provide an extensive application portfolio for the entire country, so that innovation could be confined to pockets of excellence."

N3 opens up for videoconferencing

Wed, 24 Feb 2010 12:12:50 GMT

NHS trusts will soon be able to use the N3 private broadband network for videoconferences

BT, which runs the network, has said the centrally managed service will be available from June 2010. Video calls will be free between N3 users, although organisations will need to have appropriate equipment.

Len Chard, NHS Connecting for Health N3 programme manager, said: "Videoconferencing has huge potential to save the NHS money and make it more efficient, both in clinical and business terms.

"The new managed service will take away a lot of the hassle in running and using videoconferencing, making it easier to use and maintain, at the same time as reducing costs."

Chard added that he expects videoconferencing to encourage innovation, for example in the diagnosis of patient scans by groups of experts.

"We have already seen examples of this in a number NHS trusts where videoconferencing is available. The greater take up can only open up more exciting possibilities," he said.

N3, a key component of the NHS National Programme for IT, combines broadband connections and network services to link all NHS sites. Although N3 has been fully delivered across England as well as Scotland, the videoconferencing service will initially only be available in England.

John Abbott, BT's chief executive for N3, said: "In some trusts we are aware that the complexity of running a videoconferencing service has been a barrier to greater usage and the equipment has ended up hardly being used.

"That's where the N3 service has the advantage… by making it easy to set up calls within a trust as well as to other trusts."

No to SCRs: NO2ID's Phil Booth on Summary Care Records

Wed, 17 Feb 2010 09:00:00 GMT

NO2ID, which has played a major role in the campaign against identity cards, also opposes Summary Care Records

Beneath the headlines about the National Programme for IT – billions wasted, systems underperforming or failing to deliver – lies another story, one that will outlast any particular NHS IT system.

It's the push for control: control of your and your children's medical records – and their children's… and theirs.

This is a fundamental shift, and one that cuts to the heart of the patient-doctor relationship. Putting everything into one pot, no matter what protections you attempt to bolt on, makes compromises inevitable – as both Gordon Brown and Alex Salmond have been unfortunate enough to discover. NHS smartcards are being stolen, lost and abused. It was the same with passwords, and will be with any form of access control.

The creation of centralised systems that make sensitive personal information accessible to many, and not just those directly involved in providing care, undermines the confidence patients can have – must have – if they are to disclose things about themselves for their own treatment and well-being, and for the wider public health.

The myth is that the patient is at the heart of these systems; that they are for our convenience or safety, or purely administrative and not to serve Whitehall's explicit goal to 'overcome current barriers to information sharing' or the interests of a powerful medical research lobby.

In reality the vast majority of patients are highly motivated to look out for their own data and, being the person most likely to be affected, are the smart choice if you're trying to 'join systems up' – especially in the sorts of critical situations being used to sell the Summary Care Record. Those with potentially life-threatening conditions or allergies to particular medicines already wear Medicaid bracelets. Pregnant mothers carry their maternity records.

Like many massive, centralised government IT programmes, NPfIT initiatives are presented as if there were no alternatives. And a huge amount of effort is being expended to manufacture consent.

From 2006, NO2ID has helped campaign for patients' rights over the Summary Care Record. To exercise what control they could. Though the vast majority of GPs and the public opposed the uploading of patients' information without explicit consent, Connecting for Health pushed on regardless, uploading the details of anyone who failed to respond to a single letter.

No-one knows how many of the hundreds of thousands of patients whose details have been uploaded actually received or read the mailshot. No-one knows how many simply binned the envelope, thinking it was yet another mass-mailed circular. No-one knows how many who actually read the leaflet, heavily weighted against opting out, were dissuaded from acting when told they would have to confirm their decision in person.

Connecting for Health is using what are effectively inertia selling techniques, making those who might wish to opt out jump through unnecessary hoops. Which is why, with pre-election "purdah" almost upon us, it's multi-million pound inducement to ramp up the mass roll-out of SCR is all the more extraordinary. Surely the Department is not playing politics with patients' records, in the face of Conservative and Liberal Democrat proposals for more localised or decentralised approaches?

Let us hope that this time every mailout will contain the required opt out form, conveniently absent from previous mailings. Failing to include the form may seem trivial, but it will have significantly reduced the numbers taking action. For the only action patients can take on receiving the information is to opt out. Inaction implies consent.

A radical rethink is long overdue. It's not just about IT – it's never just about IT. But whatever systems get built, it is vital that they provide meaningful mechanisms of informed consent and put doctors and patients back in control.

Emis sells shares for patient record push

Mon, 15 Feb 2010 12:08:47 GMT

The dominant supplier of GP systems plans to float 25% of its shares before it launches a web product launch later this year

Emis, which is currently privately owned, hopes to raise around £50m through its share placement on London's Alternative Investment Market. It said it plans to launch Emis Web, a service for shared electronic health records held at its own data centres, later this year.

The move will see the firm competing with suppliers of patient record systems outside its speciality of GP practices, where it dominates the market, counting 52% of GPs with 34m patient records as clients. The product could also fit with Conservative plans to allow patients in England to control their own online health records.

The firm is already introducing Emis Web in Tower Hamlets in London, Liverpool and Gateshead. The company said that this has helped reduce waiting times for minor surgery from an average of nine months to, in some cases, same day appointments. The company wants to sell the product to primary care and multidisciplinary teams.

"In the UK, we see Emis Web as a key component in the future of NHS IT because it enables healthcare practitioners to deliver quicker, better patient care through the sharing of key patient information between different healthcare teams," said chief executive Sean Riddell.

"Emis Web is a core part of our strategy and will provide us with both organic growth and acquisition opportunities as we continue to develop its potential across the whole healthcare spectrum – including primary, secondary and community care settings."

"This shows Emis' desire to cement its position within the software sector of the health care market," said Chris Pennell, a senior analyst at Kable, adding that the funds raised would give it the ability to develop its current products and provide staff incentives through shares and share options.

"There is clearly an opportunity for suppliers who can fill the gaps between the differing service delivery channels within the health sector in a cost-effective manner, something the Emis is trying to achieve through its Emis Web offering," Pennell added.

NHSmail passes half million mark

Fri, 12 Feb 2010 14:43:40 GMT

Connecting for Health has said that more than 500,000 NHS staff have registered to use the email system, and that they have sent over 500m emails since it went live in January 2009

It claimed that the figures show a 'growing commitment' from local trusts to switch off their local email services and move to NHSmail.

The service quickly took on 350,000 users who migrated from old services, but it has now taken more than 150,000 new sign-ups. CfH said the trend is gathering steam.

"NHSmail on Exchange 2007 is now accepted as a viable alternative to local email services and we must now realise the benefit of running one national service in place of thousands of local ones," said Will Moss programme head for NHSmail.

He added: "This will not only save the NHS valuable budget but will help to facilitate faster and more secure communication between clinicians, in order to ensure better patient care."

Over half a billion emails have been sent since the migration of 350,00 users from the old service, to the new NHSmail in January 2009.

NHSmail, which is based on Microsoft Exchange 2007, is free for trusts to use under a CfH contract with Cable & Wireless that has run since 2004. The deal is worth between £50m-£90m depending on usage, and the system has the capacity for 1.2m users.

In April 2009, head of CfH Martin Bellamy told the HC2009 conference that he wanted all trusts to gradually close down local email services and move to NHSmail. He added that if all trusts did this the NHS would save £100m by 2013.

CfH said the new service allows better access through mobile devices, with Blackberries now able to connect. There is also a facility for sending automatic text messages to remind patients of appointments.

Later this month, Sussex Health Informatics Service will become the latest organisation to migrate to NHSmail.

DoH tenders for flu contact centres

Wed, 10 Feb 2010 17:30:00 GMT

The Department of Health has said it will pay up to £500m over four years for telephony services to cope with future pandemics

The supplier will provide managed contact centre services to deal with flu outbreaks and other health related issues at health and social care bodies across the UK under the framework agreement, the DoH said.

The DoH plans to procure the extra resources for emergencies. A spokesperson told GC News: "The deal includes contact centre services to NHS Direct as well. It's just another tender that we can stand up quickly if there is a severe pandemic."

According to the notice published in the Official Journal of the European Union on 10 February 2010, the winning bidder will also deliver contact centre services for the National Pandemic Flu Service.

The supplier will provide storage and retrieval services, voice recognition software development and onshore and offshore services. The winning bidder may also supply additional services such as speech recognition, call recording and languages.

Philippe Martin, senior analyst at Kable, said: "This is a sensible initiative considering the recent failure during the swine flu outbreak. However it may be more appropriate for the DoH to consider partnering with other departments already setting up call centres, as opposed to going on their own and spending up to £500m."

Start-ups move into data and e-learning

Cath Everett — Wed, 10 Feb 2010 09:00:00 GMT

Two young enterprises are aiming to help health providers pseudonymise their data and teach staff about IV pumps

Just because an idea starts life in one area does not mean that it has to remain fixed there for ever. And so it is with start-ups and young companies. Some take concepts from one sector and simply transfer them to another, while others adopt an ink-blot approach and allow their idea to spread into new but related areas.

Two examples of just these tactics are Sapior and Virtual Tutor. Sapior opened its doors in 2000 providing data integration, data management software and consultancy for financial services organisations, but switched tack to focus on the NHS about six years ago.

Rob Navarro, the firm's managing director, explains that the company was "a fusion of my two interests in data management and data privacy". When writing a paper exploring how organisations could effectively share or reuse sensitive information, he realised that it was the health sector rather than financial services that really required a way to tackle the issue because of the "super-sensitive" nature of its data.

His own research indicated that in a large teaching hospital, each patient's health record was copied between 10 and 30 times – not for use in direct patient care but for secondary functions such as auditing, research and data analysis. The figure was closer to 10 when records were stored in clinics or specialist facilities.

"It was clear that the protection of patient data needed to be increased in line with increased reuse and so we wanted to fill that gap," Navarro said.

As a result, the company, which currently employs three people, developed a so-called pseudonymisation system, which replaces identifiers such as name, address or NHS number with pseudonyms to protect patient identities.

By the end of 2005, Sapior had signed a nine-year deal with BT, the primary contractor for the NHS Care Records Service. The firm's Redbridge ES offering was used to remove identifying data from between two and 10 million patient records per day held on the central Spine database, so that they could be employed anonymously in the Payment by Results scheme.

But Navarro realised that there was "a much bigger need for this kind of thing around the country, not just in the centre. There are many more sources of data to integrate and services to evaluate regionally than would never make their way into the centre".

As a result, the company developed a black-box "web-server-like appliance" to cater to this new market. The device sits on an organisation's network and ensures that health records are stored in databases and data warehouses in a de-identified state, although such information can be "re-identified" on demand as required.

The move coincided with the Pseudonymisation Implementation Project's mandate that all trusts must start de-identifying their data by 11 March this year for completion by 2011, and Sapior hopes to sign its first customer this quarter.

Licences and maintenance charges for a primary care or acute trust with 200,000 patients will be about £16,000, while one-off fees for implementation, which takes between four and six weeks, will cost about the same.

The offering will be sold primarily through the firm's partners. They include database vendors, IT services and information governance organisations which undertake the "people training piece", says Navarro.

Within three years, however, the aim is to start focusing on the social care market before moving to target local authorities. "It'll be like an ink blot moving from the centre where the first mandate appeared," Navarro explains.

Ink-blot approach

Another organisation that is taking an ink-blot approach is e-learning provider Virtual Tutor. The company was set up two and a half years ago by director Michael Ter-Berg after being spun out of City University in London.

It came into being after Ter-Berg, a seasoned healthcare technology entrepreneur, was introduced to Professor Maggie Nicol at City University's School of Community Health Sciences. She was looking for a simple way to deliver effective intra-venous (IV) pump training to clinicians in general and nurses in particular.

Ter-Berg explains the rationale: "IV pumps are the biggest area of medical device liability and more people are seriously hurt or killed with them than anything else. They're complex instruments that are used in intensive care, but the fact that they can be faulty or training can be inadequate means that they generate big clinical issues."

On this basis, he hired specialist e-learning software developer Exor to build and support an e-learning system based on input from Nicol as well as other clinicians and educationalists. Exor is now a shareholder in the company alongside City University and Ter-Berg.

Some 32 NHS trusts have already taken part in a four month trial, which started at the end of July using Graseby 3100 pumps, with the aim of adding support for Fresenius-based models by the end of March.

But while the offering is currently available on an ad hoc basis at a cost of about £1,000 a year for an unlimited site licence, active selling to nurse trainers and junior doctors is not scheduled to start until the middle of the year.

The service will be available in either standalone form or integrated into an existing learning management system and will be positioned as complimentary to the Department of Health's e-Learning for Healthcare scheme.

The latter targets a wide variety of areas and is intended to be "supportive" in nature, according to Ter-Berg, while Virtual IV Tutor is meant to provide more comprehensive and specialised training. But the eventual aim over time is to provide the "online training portal of choice for all medical devices", he adds.

Cath Everett