Lamb proposes radical changes to two of Labour’s key NHS IT projects: Choose and Book, and the National Care Records System (NCRS).  Choose and Book, he argues, should be a streamlined service which allows patients to book appointments online.  The NCRS, on the other hand on the chopping block, as he viewsa centralized database is unnecessary, and that connectivity between primary, secondary, and social care is more important.

His plans reflect the frustration felt by many with the NHS National Programme for IT, which is hugely expensive, behind schedule, and still rife with controversy over the implications for personal privacy and technical security.  In fact, many of Lamb’s proposals bear similarities to the Tories’ proposals to scrap the central database.  However, there are issues with this approach. While localized databases might eliminate some concerns about personal privacy, they wouldn’t necessarily reduce costs: the NHS has long-standing contracts with IT companies who would expect compensation for their work thus far if smaller, local IT companies stepped in to finish the job.

Nor do localized databases address the concerns for communication between primary, secondary, and social care.  It is still unclear how much access other medical personnel such as care workers and pharmacists would have, and whether they would be able to put that information into a database for a doctor to see later.  Furthermore, some would argue that abandoing the national Summary Care Records service – which contain basic patient information such as allergies, blood type, and operational history- means giving up a significant benefit to patients receiving out-of-hours or emergency care.

Lamb also suggests that patients should be able to consult with physicians via email or telephone, which is currently not permitted.  This proposal opens up an interesting discussion on modern communication.  Given some of the firewalls and high-security passwords that keep our email hidden from unwanted eyes, it could be argued that email is even more secure than the post.  To date, however, it is not illegal to open another person’s email from an account left open on a desktop, whereas it is illegal to tear into someone’s letter.  How can we ensure security for minors, who may be forced to give their internet passwords to their parents?  Would those without the internet effectively be marginalized, demoted as GPs address their bulging inboxes first?  Perhaps email consultation could happen on an “opt in” basis, where patients sign a form consenting to email communication and the potential conflicts involved.  Such a system could very well improve patient-physician communication and lower NHS costs, but it does open up a new set of risks to security.

But while Cameron’s announcement that patients will “be able to check your health records online in the same way you do your bank account” is very appealing, there was less detail about how this would be implemented. At present, no one GPs’ surgery or hospital has all the information about every patient so an online access system will need to be able pull together data from multiple places into a single coherent display for the patient – no easy task. And much historical data is still locked away in paper files so, if complete records are to be made available, the huge NHS programme of transferring records to computer will need to carry on in earnest.

In fact, despite their reported hostility to the big NHS databases which have been a feature of Labour health IT policy, any online access system is going to rely heavily on the infrastructure that’s already been put in place, from the N3 national broadband network, to the Spine database which links different patient records systems. Even Cameron’s other announcement – that patients have access to detailed performance statistics for different GPs and hospitals, will rely heavily on patient data collected via the Secondary Uses Service database which has attracted a lot of criticism from privacy campaigners.

If the Tories do win the next election, it’ll be interesting to see how likely Health Secretary Andrew Lansley tackles these apparent contradictions – especially in an environment where money for new projects is extremely difficult to find.

Here’s to an interesting 2010, eh?

In a couple of years … your local hospital will be able to securely pull up a summary of your patient record (after you have given consent, unless unconscious, when there is an override with audit trail) and know your background and all the information they need to treat you. This is already happening in pilot sites in the UK. They can fill in a template which will feed information back into the GP system.

…If you need access to care outside normal surgery hours, your surgery phone will direct you to an ‘out of hours’ service. The doctor there will be able to pull up details of your previous treatment to care for you safely, and feed back what they have done into the GP system, ready for your next appointment. This is already happening in parts of the country.

Your GP will be able to access your secondary care record details which the hospital has submitted to the Department of Health for payment, thus viewing your entire pathway through care. The second biggest GP system, In Practice Systems, has now signed a contract to exchange data with Emis Systems, so that 80% of the country will be able to use these facilities. Of the other two systems, one is in discussions with the big two, and the other has a different coding system, which has its own problems, but is now more open to co-operation.

On top of this your surgery can, if it wishes, offer you on line re-ordering of your prescriptions, booking your GP appointments, a way of sending messages to your GP, and a means of accessing your records from anywhere in the world.

Although this is currently just a suggestion from the opposition, handing data over to a private web provider raises a whole new set of questions – ones which we will no doubt need to face as healthcare becomes increasingly electronic.

Taking the records system outside the NHS could be a way for patients to gain increased control over their own records. Unlike the NHS’s proposed HealthSpace, patients on Google and Microsoft can not only view and comment on their health records but also add to them, delete them or change them. While this will no doubt infuriate various healthcare professionals, it would give patients greater ownership over their healthcare – one of the aims of the IT programme.

But it would also re-cast previous debates about privacy and security. These companies make their money from advertising. John Caulthard of Microsoft argues that sharing patient data with companies could be ethical and beneficial, allowing the NHS to target those with potential health problems. But could we also see nightmare scenarios where those with a history of anorexia were targeted by beauty experts, or by dieting pills? And would Google staff be added to the list of hospital staff, clinicians and GPs secretaries who can get access to our records? Regardless of privacy policies, such a system would have greater security risks with data moving between the NHS and private providers. Privacy advocates have long been critical of the amount of data which Google accumulates on its users – search histories, emails, documents and much more – but the storage of health data would be far more significant.

Like so many questions at Who Sees What? this one comes down to who the public trusts more with their personal information. At present, the answer is far from clear.

This announcement puts Scotland leaps ahead of the NHS in England, which is only beginning to scan patient records into electronic form. It is hoped that even this step will have massive benefits in reducing the large amount of space currently needed to store paper records, and two Mid-Yorkshire Infirmaries have buildings opening in 2010-11 which will have no resources for paper records at all, and no trolleys to deliver files.

In the midst of so many announcements about set-backs in the NHS IT programme, this news reminds us that change is here and it’s happening, even if slower than expected. While those involved are quick to proclaim success, however, the scale of this success so far is surprisingly small. Just seven MCRs have been trialled in Scotland so far, and another 100 are being ordered for next year. Many IT problems occur only with the scaling up of IT systems, and it might worry some that experts are proclaiming Scotland could be paper free in just five years on the back of this 7-strong trial. It’s difficult to carry out small-scale test runs when the un-knowns lie precisely in the size of the system. However, if the NHS is to avoid some of the well-publicised recent government database disasters, it must find a way to do so effectively

Telehealth lets patients measure vital signs such as blood sugar levels or blood pressure from home and submit it to professionals electronically. This, it is hoped, will allow patients with long-term illnesses to avoid endless tests and visits to hospitals. For example, a diabetic patient could simply prick his finger and hold it onto a test strip. His doctor, on the other side of the city, can then check that the dosage is correct and intervene if necessary. Although the NHS is beginning with the monitoring of vital signs, the potential for telehealth’s effect on the way that we get healthcare is staggering. ‘Real Time’ telehealth could include examinations and consultations through video conferencing or teleradiology, which allows x-rays to be conducted remotely.

Telecare, however, although it is often used by those with healthcare problems, is part of social care, rather than healthcare.It is provided by social service departments, rather than the NHS. It is essentially an emergency service, including push button alarms, flood sensors and smoke detectors. Telecare supports elderly or frail people to remain independent in their own homes safely

While allowing chronically ill people to manage their own health, and elderly people to remain in their own homes is generally thought to be a good thing, this is not the main impetus behind telehealth and telecare. They are responses to the huge costs of caring for a growing and ageing population.

Although these techniques seem promising, it’s vital to gather evidence on how effective they are and the best way to use them. Last July, the Department of Health launched the Whole System Demonstrator programme.

This is a study to test whether telehealth and telecare reduce hospital admissions, lengths of stay, and doctors’ workloads. The program is running a trial with 6,000 people with long-term illnesses in the boroughs Kent and Cornwall and Newham, East London to test the cost effectiveness of telehealth and telecare.

The Department of health has been very quiet on how these initiatives relate to the NHS’ wider IT development, particularly Electronic Patient Records. Telehealth is clearly another move to storing patient information in electronic form, but little has been said on how or where this information would be stored if telehealth and telecare were adopted more widely. As Smarthhealthcare.com reports, before the WSD programme it was ‘difficult for stakeholders, ranging from local authorities to primary care trusts, ambulance services, police and mental health bodies, to share information due to data protection issues.’

For privacy campaigners the project’s emphasis on an ‘integrated networks’ needed to provide ‘integrated care’ might ring alarm bells. Although sharing potentially highly sensitive information between organizations about patients who require a range of social and health care is nothing new, doing so electronically is new in many cases. It remains to be seen how this information will be integrated into NHS databases and its implications for patient privacy.