Smart Healthcare | SmartHealthcare.com

MSPs want to widen telehealth's range

Fri, 12 Mar 2010 10:33:10 GMT

A report from the Scottish Parliament has recommended that telehealth technology is used across the country, rather than just in a few areas

The sheer geographical spread of Scotland, from an array of islands in the west to vast expanses of land in the north, has always made the delivery of healthcare challenging. Internet technology has made that task easier but the message from the Scottish Parliament's Health Committee is that NHS Scotland could do better.

A report published on 8 March 2010 urges the SNP-controlled Scottish Government to improve NHS computing systems to ensure that patients do not miss out on better care and treatment. MSPs criticised the "slow and inconsistent" provision of clinical portals – which allow clinicians and GPs to access medical data on patients across Scotland – and telehealth over the last decade.

Telehealth systems can remove the need for patients to travel to towns and hospitals to receive care and treatment by using broadband or mobile services such as video conferencing, which is of particular benefit in rural areas. Although widely utilised in Aberdeenshire and the Highlands, provision varies between health boards in other parts of Scotland.

To rectify this, the committee wants targets for all health boards to offer telehealth to patients. "It has the potential to release much-needed resources in these economically difficult times for front-line patient services," said committee convener Christine Grahame. "The Scottish Government has some serious work to do in encouraging health boards to use and evaluate this technology."

Conservative health spokesperson and committee member Mary Scanlon agreed. "The NHS in Scotland and successive governments in Scotland have been far too slow to embrace new technology," she said. "Telehealth could be used much more extensively, particularly in remote and rural areas, to monitor local conditions."

Scanlon added that the integration of the Aberdeen-based Scottish Centre for Telehealth (SCT) – which has an annual budget of £1m – with NHS24 in April should "lead to more innovative solutions to monitor and complement healthcare in Scotland". The merger was the outcome of a review by the Scottish Government, which is also drafting a telehealth strategy to support the process.

A Scottish Government spokesperson said: "Using the latest technologies has the potential to make a huge difference to healthcare in Scotland. Ministers place great importance on the development of a clinical portal – it is one of the priorities of the eHealth programme and will make a significant contribution to the safety, effectiveness and efficiency of care.

"We welcome the committee's support and good progress is being made in partnership with health boards, although we agree with the committee that progress on telehealth has not been fast enough. That's why a review of progress recommended that the Scottish Centre for Telehealth become part of NHS24, Scotland's provider of national telehealth services."

Richard Simpson, a Labour member of the committee, said: "The committee were clearly very frustrated with the fact that we haven't made more progress. We really have the potential to be a world-leader in telehealth but we're not at the moment because the SCT has been purely advisory and health boards don't have to buy into it, so the most important recommendation is the target for telehealth delivery across all Scottish boards."

Other recommendations include the establishment of safeguards around patient confidentiality and IT systems; value for money being placed at the heart of any NHS telehealth strategy; patients, midwives, nurses and other health representatives to be members of the Clinical Portal Programme Board (which oversees clinical portal projects in Scotland); and the creation of an 'eHealth' professional standards group.

The committee also urged "tackling resistance from medical staff in using technology" but Alan McDevitt, joint deputy chairman of the British Medical Association Scotland's GPs' Committee, said: "We have to remember that for some staff, using telehealth will be quite unusual. But they will ultimately decide whether it genuinely saves time and improves services.

"The more geographically remote an area is then the keener staff will generally be to accept new technology. But it's harder to argue for using telehealth in an urban area. Inevitably it's enthusiasts who advocate more widespread use, but it's important that both clinicians and patients think it represents an improvement on existing services."

Despite these qualifications, a professional and political consensus appears to support wider use, where appropriate, of new technology including telehealth. The health committee, meanwhile, expects to see tangible progress towards making Scotland a smaller country – in virtual terms – by 2014.

London GPs offer SCR advice

Thu, 11 Mar 2010 16:16:48 GMT

The Londonwide group of Local Medical Committees (LMCs) has stepped outside of the NHS Public Information Programme to raise awareness of Summary Care Records

The trade association, which represents 6,500 GPs in the capital, has made posters available to GP surgeries highlighting the fact that patients have a choice about whether or not their records are held on a central database.

It claimed that people are visiting local surgeries to express their concern about the SCR system and how to opt-out.

The Londonwide LMCs also hopes the poster campaign will provide GPs with "simple" information to deal with SCR related queries. It plans to launch a guidance document offering further information on the records database, alongside the poster campaign.

Dr Michelle Drage, joint chief executive of the group, said: "Our ongoing communication to practices and their patients on the SCR is not attempting to address the pros and cons of the SCR; this is a national issue which is being addressed by others. Our aim is to simply provide timely and appropriate communication for practices and patients on the roll out across London as it is happening now."

The group told SmartHealthcare.com that the different times at which patients are receiving SCR related letters from primary care trusts is a contributing factor to the lack of awareness.

The news comes after the British Medical Association (BMA) sent a letter to health minister Mike O'Brien on 10 March, saying it was concerned about the speed of the widespread introduction of SCRs. It also said that the haste of implementation means records are being introduced in areas where public information programmes have not yet started, so patients have no knowledge of the system.

If patients take no action when they are sent a letter about SRCs, the NHS will automatically generate a centrally held record of their healthcare data. Five of England's strategic health authorities are moving ahead with introducing SCRs across their areas: North-West, North-East, Yorkshire and Humber, London and East of England.

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

Patient from Hell: Lies, damned lies and statistics

Wed, 10 Mar 2010 09:00:00 GMT

The failures of Mid Staffordshire show that mortality data is not the best way to judge a hospital, argues the Patient from Hell Dick Vinegar

What worries me about Mid Staffordshire NHS Trust is that it was not complaints from patients' relatives that triggered the scandal, but the mortality statistics. And when Dr Foster, in 2007, first exposed these rates as being 25% above the national average, the chief executive tried to rubbish them, putting them down to coding errors and poor quality of data. It then took two years before the Health Commission finally exposed Mid Staffordshire in March 2009.

This reminded me of reading, just after I had had a thyroid operation in 2000, that my hospital topped the post-operative mortality league table. So count yourself lucky, dear reader, that I am still here to entertain you.

A year or so later, I found myself making a sick joke about this to an audience of hospital trust chief information officers, in Portcullis House in the heart of Westminster. The joke went down like a lead balloon, and in the coffee break, they all avoided eye-contact with me. Except one, who shuffled over to ask me whether the hospital in question was 'H' hospital. Indeed, it was.

He introduced himself as the IT manager, and explained that the hospital had presented the statistics all wrong. These were the early days of mortality statistics, but he had already learnt the hard way that massaging stats was an essential part of an NHS executive's management skills. The welfare of the patient is secondary.

So, when Richard Francis QC, in his report on Mid Staffordshire in February calls for a single hospital standard mortality ratio (HSMR) as an "impeccably independent and transparent source", he is crying for the moon. Hospital trusts have become expert in manipulating data, and will do so even if the most rigorous mortality standards are imposed, if they sense that their figures are bad.

And, even if they were scrupulously honest and not trying to massage the figures, different coders will interpret the rules differently. That is a law of nature. And the stats will vary between hospital and hospital.

I have an even more fundamental objection to mortality statistics as a way of judging whether a hospital is failing. They are always out of date, even without the delays caused by hospital administrators trying to rubbish them. The original Dr Foster alert in July 2007 covered the years 2003-06. Yet it was not taken seriously until March 2009. During those years, how many people died?

Even in a world with streamlined and accurate HSMRs, by the time they are published they will be at least two years late. That is inevitable. Hence, another law of nature: stats cannot be both timely and reliable.

And mortality stats are not the only criterion by which to judge a failing hospital. Patients may not die because they are left lying in their own faeces. They may not increase the mortality ratio. What matters more, as Richard Francis has twigged, is that the regulators paid no attention to the concerns of patients and relatives, but responded by referring "to data of a very generic type, such as star ratings, CNST (clinical negligence scheme for trusts) levels and so on". He concluded that "benchmarks, comparative trust ratings and foundation status do not in themselves bring to light serious and systemic failings".

Hitherto, statistical data has rooled OK in the NHS. Maybe Mid Staffordshire will be the turning point when the NHS turns away from computerised dodgy stats and tick lists, and turns to the evidence of patient complaints and the evidence of inspectors' eyes, ears and nose.

I apologise to you readers, who are mostly IT types, particularly coders who have sweated long hours producing all this stuff, for degrading the importance of the statistical data. But a lesson in humility never did anyone any harm. Computer systems are not the most important things in healthcare. Clinical skill, sympathy and common sense are.

It worries me though that the six month review of Mid Staffordshire in September 2009 found that it had not yet implemented an effective complaints system. Ingrained bad habits die hard in the NHS.

Scotland plans health protection IT system

Tue, 09 Mar 2010 12:59:57 GMT

NHS National Services Scotland (NSS) is hoping to use a commercial off the shelf system to support health protection work

In a pre-tender notice in the Official Journal of the European Union on 9 March 2010, NSS said that it is "considering options" for its planned Scottish Health Protection Information Management Solution.

The system, ideally a commercial off the shelf product, will be used across organisational boundaries to support the health protection activities of NHS boards.

The functionality of the system will be expected to cover the case management of incidents and of patients involved in investigations. For scientific users the system will cover national surveillance, analysis and reporting.

NSS intends to begin the process within the next 12- 18 months, depending on funding available.

The pre-tender notice contained no mention of cost. A spokesperson said this was "partly because we will find out from the responses we get back how much a system of this type will cost".

Separately, Scotland's phone and online health advice service NHS24 has announced a contract extension for its customer relationship management system. Its deal with Clinical Solutions, originally signed in March 2007, will now run until 2012.

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."

Scotland plans mobile kit for patient transport

Thu, 04 Mar 2010 16:32:23 GMT

The Scottish Ambulance Service expects to purchase mobile data equipment for its patient transport service

The organisation has published a tender for hardware, application development, system interfacing, installation and maintenance for about 625 vehicles based throughout Scotland.

The patient transport service is used by patients for pre-arranged hospital appointments, or admission and discharge from hospital, rather than for 999 emergency calls.

The tender, published in the Official Journal of the European Union on 2 March 2010, did not provide an estimate of the deal's cost.

In 2009, the Scottish Ambulance Service started a pilot of remote access to the country's Emergency Care Summary records from its emergency ambulances in the Lothian health board area. According to its ICT strategy, it plans to develop this access for frontline ambulances and emergency medical dispatch centres in 2010.

Scotland puts care information for elderly online

Wed, 03 Mar 2010 14:36:16 GMT

The Scottish Government will spend £500,000 annually on a national online and telephone information provider on care services for older people

The website and enquiry line aim to provide a single source of information on the care available for elderly people in Scotland, including services provided by local authorities, the private sector and voluntary organisations.

Scotland's public health minister Shona Robison, opening Care Information Scotland on 2 March 2010, said: "It will make life much easier for anyone seeking information - in what can often be a crisis situation for a family - on care and support for themselves or for older relatives."

The service, which has a budget of £500,000 annually for three years, uses specially trained staff from NHS24, Scotland's health phone service. NHS24 commissioned Conscia to develop and build the website, with involvement from the Leith Agency.

The service was piloted in the Tayside area from mid-October to mid-February. A spokesperson for the Scottish Government said that the trial had seen strong interest online, with 1,500 unique users spending an average of eight minutes on the site and viewing about 10 pages each. Meanwhile, the telephone service received just 150 calls.

The move follows the Welsh Assembly Government's announcement that it is piloting a service for all enquiries on health and social services in the Cwm Taf health board area.

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."