Given the track record of project failures in NHS IT, some might say that Matt Hancock - former Minister for Fun who now runs the Department of Health - is marching with ill-founded confidence towards what he describes as a “tech revolution”.
It is 2018 and the NHS is still counting the cost of WannaCry. Carry the 2, + aftermath... um... £92mREAD MORE
A little bit of knowledge - Hancock once coded an app criticised for flouting data privacy regs he used to tout in his day job - in the wrong hands can be a dangerous thing.
“The tech revolution is coming to the NHS,” he boldly claimed yesterday, as he outlined his “vision” to erect a modern tech architecture that will provide the basis for a new generation of digital services.
These digital services and IT systems will, he said, meet open standards so they can “talk” to each other and ensure that vendor lock-in becomes a thing of the past.
All trusts and Clinical Commissioning Groups will have the “freedom” to buy whatever they like, which the DoH said will “encourage competition on user experience and better tools for everyone”. But with choice comes complexity, surely? Standards and free choice can mix like water and oil.
“These robust standards will ensure every part of the NHS can use the best technology to improve patient safety, rescue delays and speed up appointments.
“A modern technical architecture for the health and care service has huge potential to deliver better services and to unlock our innovations. We want this approach to empower the country’s best innovators - inside and outside of the NHS - and we want to hear from staff, experts and suppliers to ensure out standards will deliver the most advanced heart and care service in the world”.
The ‘Vision for Standards’
Patient records for “health and care setting” will use UK residents' NHS numbers - the one given when they register with the health services in England, Wales or the Isle of Man. Use of the number is already prevalent in the NHS, “but we will move to the position where the NHS Number is available at the point of care” so every patient is ID’d correctly and this matches their records.
The NHS systems will be used by patients to check personal details via the NHS Login, and another system will verify the authentication of NHS staff using the NHS Identity platform. This standard will be mandatory once the NHS Login and NHS Identity programs are in live operation.
Clinical data will adhere to the Systematised Nomenclature of Medicine Clinical Terms (SNOM CT) - owned, managed and licensed by SNOMED International on behalf of 35 country members, and maintained and distributed in Britain by NHS Digital. SNOMED is already a Data Coordination Board (DCB) published standard for “all patient clinical” info.
This standard is used to “define how a patient’s information is recorded, shared and analysed so that every clinician, care provider, NHS organisation and arms-length body can be confident of the information they see to the information provided by the treating clinician,” the framework stated.
DCB will replace the current standard for procedure based statistical analysis of hospitals, the Office of Population Censuses and Surveys, to provide better integration with SNOMED. And the standard for detailing clinical tests and clinical test results will be the Unified Test List, with the first version scheduled to be published next year.
NHS Digital Reference Data Registers - open lists of NHS info such as healthcare pros, and GP practices - is going to be the data source of choice in NHS systems. It can use the registers through REST APIs including CSV and JSON formats.
All software and health IT systems “must be designed, developed and operated safely to conform to new international standards that are being development by organisations including NHS Digital and the Medicines and MRHA (Medical Healthcare products Regulatory Agency).
Similarly, all digital, data and tech services must use the Data Security and Protection Toolkit (DSPT) to show they are “practising good cyber security” in relation to the performance of the National Data Guardian's 10 data security standards.
This means no “unsupported” operating systems - and keeping kit up to date - unlike what happened with WannaCry and all those unpatched Windows 7 boxes. A strategy is to be agreed based on a “proven cyber security framework” that is reviewed annually and that IT suppliers are “held accountable via contracts for protecting the personal confidential information” they manage.
From April, the toolkit will be “uplifted with elements of the government Minimum Cyber Security Standards” that are not already incorporated in DSPT. This will allow the DoH and Social Care to monitor compliance and push through improvements, the framework stated.
All data models and APIs developed will use the Fast Healthcare Interoperability Resources standard so that providers can share patient data between systems “no matter what setting care is delivered”.
NHS digital systems must be “coded in the open and take full advantage of existing open source solutions”. This point rather flies in the face of an ambitious NHoS Linus project that was effectively shelved in January when the team behind it said they’d received no support from the DoH.
Infrastructure buyers in the NHS should always consider “public cloud options”, in line with the government’s cloud-first policy, which was set up in part by Liam Maxwell, the government CTO who is this month hot-footing it to AWS to become its director of international government transformation.
“Such decisions should be underpinned through an understanding of total cost of ownership of operating services for their full lifecycle including exit.”
Sorry if some of these good intentions and words sounds familiar. Lest we forget the billions already poured into the British health service via the National Programme for IT (NPfIT), a failed system upgrade that cost £9.8bn.
This £9.8bn, it should be noted, does not include the cost of terminating the contract with Fujitsu.
Fujitsu told us that it is unable to comment on the kill fee because it is under a legal sanction.
NPfIT launched in 2002 to revolutionise data: digitising patient records and scanning and integrating systems across the estate from hospitals to GPs and community care.
It was shelved in 2011 following technical woes and contractual disputes, though the UK government did renegotiate £3.1bn worth of contracts with CSC, which still worked on Lorenzo, a patient care record database for parts of England.
This project failure was previously described by the Public Accounts Committee as among the “worst and most expensive fiascos” to be run is “public sector history”.
Other smaller but calamitous events litter the history of NHS tech: the GP Extraction Service IT System; the paperless office that still hasn’t happened, not least judging by the number of fax machines still in use across the NHS; the Primacy Care Support service that Capita has botched; the coding cockup that saw 150,000 patients' data distributed against their wishes. We could go on but you have jobs to do and families to see.
Sam Smith, coordinator at medConfidential, which campaigns to improve uses of data and tech in the NHS, told The Register the NPfIT “started out with similar lofty vision”.
“This is yet another political piece saying what “good looks like”, but none of the success criteria are about patients getting better care from the NHS.
“For that, better technology has to be delivered on a ward, and in a GP surgery, and the many other places that the NHS and social care touch. Reforming procurement and standards do matter, and will help, but it helps in the same way a good accountant helps - and that’s not by having a vision of better accounting.”
Good luck Matt, looks like you and the rest of us will need it. ®