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British aim for a ‘national’ electronic health recordBy Jerry Zeidenberg This month, England launches one of the largest IT projects in the world – a bid to wire-up the National Health Service and its myriad of hospitals and physician practices. At the same time, the project aims to spur the use of computerized communications, including a standardized, ‘national’ electronic health record. Prime Minister Tony Blair’s government has given the effort the green light, and this year will boost spending on information systems at the NHS by 40 percent to £1.4 billion, with increases to £1.7 billion in 2004 and £2.2 billion in 2005. That’s £5.3 billion, nearly Cdn$13 billion over three years. The NHS also hired, for the first time, a director of IT. Richard Granger, 37, was selected last year over 100 other contenders for the job and will be paid $600,000 annually – reportedly the highest salary in the British civil service. It’s a measure of the importance of the project – and its difficulty. Critics have been sniping at Granger and the government for months. They point out that IT projects have a high rate of cost overruns, delays and outright failure in Britain and abroad (just look at Canada’s gun registry; the UK, for its part, has had similar computer project failures.) They’ve also carped that British hospital physicians are loath to use computers – some refuse to change their old-fashioned ways, while others see computerization as a mechanism for government snooping to rate their performance. Nevertheless, there’s much agreement, by the British public and high-level government officials, that a connected system of health records would do much to improve communication among physicians – leading to faster decision-making and service delivery, along with better outcomes. That’s why the wheels are in motion to link healthcare providers in Britain’s 28 strategic health authorities with a high-bandwidth network called NHSnet, and to create standards for shareable health records. As the NHS’s blueprint for the program puts it, “The core of our strategy is to take greater central control over the specification, procurement, resource management, performance management and delivery of the information and IT agenda. We will improve the leadership and direction given to IT, and combine it with national and local implementation that are based on ruthless standardization.” The key document outlining much of this effort is “Delivering 21st Century IT Support for the NHS: National Strategic Programme.” It can be found on the Department of Health’s web site at www.doh.gov.uk/ipu The ambitious strategy has four parts. The components are to be installed nationally in at least nascent form by 2005 and at a comprehensive level by 2008. In a nutshell, they consist of: • the broadband network linking healthcare providers; While the effort is centrally directed by the National Health Service, the 28 health authorities will be allowed to purchase systems from vendors of their own choosing – provided the companies and consortiums offer up solutions that meet standards created by the NHS. As might be expected, there’s a tremendous amount of activity under way on the part of vendors and health authorities alike, and a torrent of words is being produced on the subject of computerized health systems in Britain. Here’s a summary of the main components of the program. • Networks. In January, a £45 million upgrade to the NHSnet for hospitals, GPs and NHS trusts was announced. The network is regarded as the foundation for the whole system, and will enable physicians and clinicians to converse with each other via computers. The upgrade will give every GP practice a 256Kbps connection to the main network, while trusts, primary care trusts and strategic health authorities will be upgraded to a 2Mbps fixed link connection. The project, lead by British Telecom and Cable and Wireless, is due to be completed by March 2004. The current project is said to be an initial measure to connect providers and to give them adequate speeds for data communication. In parallel, the NHS has begun the procurement process for an entirely new network. • Electronic bookings. The goal is to allow patients more power to book appointments with hospital specialists of their choice, at convenient times, and to quickly change appointments when needed. It’s all to be done while patients are at the GP’s office, instead of waiting for a phone call and being told where to go and whom to see. • Electronic prescriptions. Partnerships have been created with the private sector to conduct three pilot trials, all of which were to be completed by the end of 2002. It’s anticipated that the trials will continue to grow and attract an increasing number of GPs and pharmacists. The main benefits are expected to be more accurate communication of information about medications, and automatic drug interaction checking, resulting in greater patient safety. • Electronic health records. The first generation of a national, electronic patient record is expected to appear by the end of 2005. A full system is expected by 2008; the Department of Health sees it as a project that will evolve as it goes along, to account for changes in technology and the experiences of pilot projects and end-users. The goal is a record that will have information most useful to care providers, enabling treatment of individuals no matter where in England they seek it. As part of this, a master patient index is being built; it is to be based on the NHS Number, even though it is recognized that some members of the public don’t have an NHS Number. The NHS Information Authority currently has four key demonstration sites taking part in its Electronic Health Record Development Implementation Program (ERDIP), along with 13 smaller focus group communities. The projects are all aimed at developing standards and practices for the British electronic patient record. It appears the British are aiming to develop a ‘virtual’ patient record, the parts of which can be pulled when needed from a variety of databases, such as various physician offices, hospitals and other organizations visited by patients. But in recognition of the current limitations of technology, in the immediate future, information may have to be concentrated in regional databases. There’s a good deal of concern about the chances of success for such a large-scale project. For this reason, the British are subjecting it to their new Gateway review, a program that checks and re-checks the progress of large-scale public projects at five points from conception to finish – and asks whether the efforts live up to their billings at each step. For more information, search the Department of Health web site; for a higher level of detail, check the National Health Service Information Authority web site, at www.nhsia.nhs.uk BACK TO TOP OF PAGE
Digital cardiac hospital emphasizes patient safetyBy Jerry Zeidenberg You realize just how computerized the new, Indiana Heart Hospital is when the CIO tells you there are 795 workstations in the 88-bed facility – nine computers for every bed. “It’s a $60 million hospital, and we’ve put 25 percent of that into information technology,” said Neal Bowlen, chief information officer at the facility, which opened in February. Bowlen was part of a panel discussing the Indianapolis-based cardiology hospital at the recent Healthcare Information Management Systems Society (HIMSS) meeting in San Diego. He emphasized that there’s no paper and no diagnostic film generated at the medical centre. All of the imaging modalities are digital, and any scrap of paper that’s brought into the building is scanned into the system. The thrust on computerization isn’t just a matter of trying to look up-to-date. Instead, it’s the hospital’s core strategy for improving patient safety and outcomes while simultaneously lowering costs. Hospital execs are aiming to reduce medical errors by 80 percent or better through the use of physician order entry systems, drug checking databases, and other methods. Most of the computer hardware and software, along with diagnostic
equipment, was supplied by GE Medical, which is the main partner
of the Indiana Heart Hospital. Greg Lucier, president of Milwaukee-based
GE Medical Systems Information Technologies, doesn’t mince
his words about the patient safety issue. The computerized systems are designed to make orders for drugs and medical tests more clear – eliminating the confusion that sometimes surrounds handwritten notes. Various databases, moreover, check drug doses and interactions. They also ensure the right patient is receiving the correct medications. Finally, the information flows more quickly, enabling decisions to be made faster. For example, all medical devices are connected to the clinical information system. Doctors and clinicians – from anywhere in the hospital – can check on a patient’s status through physiological monitors, IV pumps, ventilators and other equipment. “We have a tight integration between medical devices and I.T.,” said Bowlen. Point-of-care lab work is also part of the equation. It, too, speeds up the flow of information and allows doctors to make faster decisions. Bowlen said 75 percent of lab tests are done right at the bedside.
This includes enzyme tests for heart damage when myocardial infarction
is suspected. Instead of shipping off the blood sample to the
lab, it can be analyzed by a device at the point-of-care, with
the result integrated into the patient’s electronic health
record. Recognizing that much simpler computerized systems have given hospitals difficulties in the past, one might wonder: will all of this actually work when you throw the switch and start operating in this new fashion? Bowlen explained the hospital didn’t leave this issue to chance. Instead, it built a 5,600-square-foot test facility that replicated all of the systems to be used in the actual hospital. Over the past 12 months, members of the Indiana Heart Hospital put the mock-up through dry runs to see how well the systems worked. During that time, Bowlen and his team also analyzed the work processes of doctors and clinicians, to determine if they could be improved – and if some steps could be eliminated in the quest for greater efficiency. As one example, the partners were able to start connecting data collected by paramedics to the Emergency Department information system. “We’re grabbing information right from the ambulance,” said Bowlen. “We can take out the need for triage in that way,” he said, explaining that treatment of the patient can then begin even sooner. “We analyzed what every doctor, nurse and clinician does, and asked ourselves, where can we make an improvement?,” said Bowlen. “It was the most labour-intensive part of the whole process.” Additional information can be found at www.hearthospital.com BACK TO TOP OF PAGE
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British aim for
a ‘national’ electronic health record