Staff at UK's massive health service still have interoperability issues with electronic records

UK health professionals remain "skeptical" about electronic patient records, despite the NHS in England achieving more than 90 percent coverage. They described struggling to access notes and test results from other providers, leading to time-consuming efforts to track down patient information In a new report, think tank The …

[Anonymous Coward]

*sigh*

I work in the NHS - it's ... it's just ... waves hands incoherently.

To quote Ghosts (TV show, British version, dunno about the remake) for a second ... "What do you actually want? Specifically! You?"

Because take that rant and scale it up from half a dozen ghosts to a choir of hundreds of thousands of voices and well... you see what happens.

[Anonymous Coward]

Re: *sigh*

Having recently moved from England back to Scotland… nothing works, I don’t have a NHS number anymore, I have a community health index (CHI) number, Pharmacy2U doesn’t do Scottish prescriptions* and NHS App doesn’t work - back to PatientAccess.

* still prescriptions are free to all so some things better.

Devolution has broken much core underpinnings of records, data, prescriptions and different ways of working.

[rgjnk]

Business as usual

Sounds like they've done what they always do when it comes to change; just go through the motions.

Slow inept minimal implementation at massive cost - almost vindictive compliance of mostly ticking the EPR box while in reality achieving little of the possible gains and not really changing anything. You can bet any delivery metrics have been twisted like a corkscrew to be 'met' on paper while utterly missing what they were supposed to represent.

Fair bet the biggest achieved outcomes were in handing out cash to selected suppliers and employing a whole load more staff to manage the thing.

And doubtless to be followed by a demand for a lot more funding as the whole reason for any failure will be pushed as being a result of inadequate budgets...

[plunet]

Re: Business as usual

The problem here is the MVP minimum viable product. Get the new EPR or system implemented with the minimum of kerfuffle. But there's then no finding available to take it to the next stage, sitting down with each ward or clinic team and working out how to exploit the new system to automate stuff they have to do manually within the guardrails of the organisational capabilities.

[UnknownUnknown]

Re: Business as usual

Wash your mouth out with that deviant Agile talk.

[Anonymous Coward]

Well, speaking as an ocassional user of the NHS, it would be nice if the systems talked to each other properly. *Some* of my appointments show up in the NHS app. Wouldn't it be nice if they all did. Or if all the appointments weer announced in a paper letter. Or if I got SMS reminders for all of them. However, what I seem to get is a pick and mix of all three....

[Anonymous Coward]

Brownfield

The NHS is one of the largest post industrial (post apocalyptic) brownfield sites you could ever imagine. There are systems and there are systems and sometimes (not always) those systems talk to each other (and maybe even agree once in a while).

There is no grand overarching architecture that makes sense in all of this - it's just stuff layered on top of stuff (and more stuff added alongside every time there's a new ask).

The fact you actually have an app that can show you some relevant info sometimes ... miracle.

[Missing Semicolon]

Re: Brownfield

My name is not spelt correctly in my NHS record. I don't dare get it changed!

[plunet]

Re: Brownfield

This really isn't the big deal you probably think it is. Contact the secretary at your GP surgery and ask for it to be updated, they are the authoritative source. Most systems should pick up that data change from the NHS Spine.

[Jim Whitaker]

Re: Brownfield

Not so. I changed address a few years ago and told the practice. (Note: I had not moved one inch but just got the postcode changed to something which reflected the position on the ground. Deliveries now find the house.) Letters (!) started to come out with the correct address but I noticed that the prescription paperwork still had the old address. Luckily I checked a few things because the old postcode was sufficiently close to the practice to make be eligible for the practice dispensing service to be available. The new postcode (about 1/2 mile away) would have taken me out of that, very convenient, service. (Restrictive practice from the Royal Pharmaceutical Society which the Government is too spineless to set aside.)

So naturally I have not pointed out that error.

[UnknownUnknown]

Re: Brownfield

Hi ou should see what it’s like Scotland/England border … though the prescriptions being free makes up for the rudimentary systems there (no Home Delivery).

… and that’s just 1 issue.

NHS v’s CHI number ….

[UnknownUnknown]

Re: Brownfield

They will probably end up with 2 NHS records <LOL>

[Anonymous Coward]

Re: Brownfield

People change names all the time. Mostly when getting married. It's a routine thing for NHS systems, and is why you have an NHS number to uniquely identify you.

[plunet]

Re: Brownfield

There is an overall architecture for the data - in England it's called the NHS Spine. A common standard and secure infrastructure for the exchange of patient data between trusts and systems. The problem is the capability of the systems that trusts procure to fully leverage the Spine.

Some of the EPRs, for example Apollo's Epic, can facilitate data exchange between other trusts with Epic quiet well. But to other trusts using something other than Epic, good luck.

[RobDog]

Re: Brownfield

I was gonna say, surely part of the issue lies with Trusts having the choice of defining and deleting their own products? Surely if that was removed and a single set of tools rolled out to all, progress would be much more achievable? The name of the central company is NHS after all isn’t it?

[localzuk]

Re: Brownfield

No no no, that's what the disastrous project back in the early 00's aimed for. The "one ring to rule them all" of IT solutions. A total disaster.

Specifying proper standards, for functionality and interoperability? That is the correct direction. But, it requires those standards to actually be built properly, and then companies who develop the tools to implement them properly.

[UnknownUnknown]

Re: Brownfield

NPfIT was a case study in how fucked upnitbis … and that’s nigh on 20 years ago.

[UnknownUnknown]

Can’t even e-mail my GP surgery. Even with a NHsNET e-mail.

Phone, write a letter or come on down.

[Terry 6]

This is an issue. As far as I understand it (a parallel with quantum mechanics here- if you think you do.....) each GP- or maybe local health board or some such, has their own contract in to a private service that interfaces to the GP part of the NHS App, with a set of properties that someone decides (GP/company/board?).

Where I went to teach residents to us the NHS app a few months back, the patients can directly contact the GP service who hosted the session, in the app. Some of the residents were from other GPs, who couldn't contact theirs ( nor can I. The GP can send me a message- but I can't f****ing reply to it except by phoning them!!!).

They also send me texts I can't reply to btw!

"Please send us a blood pressure reading". Sure, Why not make it as difficult as possible to do so.

[UnknownUnknown]

This !!

[elsergiovolador]

Money

This is why not doing it in house creates a mess.

Delivery is optimised to maximise billable hours.

Never ending mess and chaos and massive profit.

Just sack everyone involved in this, cancel contracts and start over IN HOUSE.

Ensure pay scales allow to hire top talent and RETAIN IT.

[rgjnk]

Re: Money

I think you've misunderstood why the massive bureaucracy with health provision as a sideline might have cocked this up - it's not down to not doing it themselves.

Plus one of the glorious failures of the 'national' health service is actually being lots of smaller local services that each do a lot of their own thing instead of one single unified organisation with a single common solution. So 'in house' would involve lots of independent mini projects instead of (hopefully!) a smaller number of suppliers who should have done the implementation more than once.

[elsergiovolador]

Re: Money

Oh no, this kind of behaviour exactly thrives in massive bureaucracy!

If you have 10 managers with similar responsibilities overseeing the supplier, are they going to call them out for not delivering or scheduling many meetings over non relevant details (billable!). No.

Even slaps on the wrist don't exist.

[anothercynic]

Re: Money

Smaller local services can be persuaded to use common APIs to do stuff. You don't necessarily have to have one big monolithic organisation to run everything, but something that uses specific endpoints to do stuff, and getting the local places to use those endpoints.

Of course, that requires some coordination, but this is where you do need to be strict and have a strong steering hand. And that's what the NHS (NHS Digital/NHS England) should do.

[Terry 6]

Re: Money

Absolutely. The history of big, monolithic all-in-one solutions hasn't exactly been glorious. Even with much smaller and less complex organisations.

Let's have the NHS with a unified data sharing system based on common protocols, so that information can be shared securely as required..

I'm guessing that this would be a big enough project. And would create significant benefits.

Then maybe if something else is needed, maybe that can be developed with compatible protocols. Maybe.

[plunet]

Re: Money

The common API already exists. At least in England. It's called the NHS Spine

[Anonymous Coward]

Re: Money

Well, in part. I know the SPINE, I've used it in the past but it's more about messaging and data exchange than data architecture (to be fair it may well have been this as well in the past but ... events. The barbarians have stormed the gates). There are other areas of the NHS working on this but once you get beyond the "we'll use SPINE to exchange data" piece you get right back into the mess.

[David Beck]

Re: Money

Too bad the NHS didn't try to get IATA to manage the build. I worked for Univac in the 1970/80s when we were replacing the IATA messaging system. About 130 airlines, using a variety of booking and baggage systems, all connected by IATA's message protocols.

[LybsterRoy]

Re: Money

How about its down to them not even understanding what it is they're trying to do to start with.

I'm old enough to remember the start of the "big is beautiful" craze for companies/organisations. Maybe we need a "you can get too big" craze.

[Terry 6]

This could be the problem....

....to produce £35 billion ($44 billion) of savings.

That might well be the end point, but as a starting point it's just total crock of shit. You can't design a system by deciding the savings and working backwards. That's just magical thinking. All that does is create a list of corners to cut.

The best you can do is design a more efficient system, and then work out how much it might save- if anything.

[Anonymous Coward]

Don't know where to start is part of the issue. There are probably over 10,000 different systems if you can count all the desktop with local apps with no overall control off their IT and no clear goals of what they want to achieve let alone how to do it. And at the same time got to keep legacy apps going and hopefully not killing to many patients in the process.

[Anonymous Coward]

I hope they actually comply with Data Protection law unlike the "NHS" in Northern Ireland

The HSC NI (that what the "NHS" is actually called in Northern Ireland) managed to rollout Electronic Care Records via the NIECR project/system back in June 2013. Since then, right up to the present day, all the participating Data Controller and Data Processor organisations have failed to comply with Data Protection law. That's 12 years during which hundreds of organisations have been breaking the law on a daily basis...

It has been an ongoing farce and it is almost amusing to watch how whenever I raise a new point of non-compliance the NIECR organisations (eventually) try to address said non-compliance by making changes that do not actually correctly address that particular non-compliance.

Meanwhile the ICO stands back and does nothing.

[Anonymous Coward]

Palantir is going to do well. Their main service is big data and interoperability but they also do CRUD apps so I expect they have dreams of stealing EPIC's lunch.