Information revolution – from healthcare to i-care
Authors: Stephen Gatley, Ricky Richardson
Journal: Journal of the Royal Society of Medicine (2011)

Health Minister Simon Burns1 and DH IT Director General Christine Connelly2 have recently painted a radical picture of the way in which the new UK Government wants the NHS IT to operate and one that will see the introduction of new information systems that put patients in control of their health records.

The Government feels that there is a need not only to allow patients to access their records – but also for them to be in control of the data that the NHS creates in their name. The concept is that patients will increasingly make decisions about where their records are kept and who is allowed to access them.

This new approach to health informatics, coupled to the Government's Equity and Excellence White Paper,3 suggests that we may be approaching a turning point in the way that the NHS – and therefore by implication all healthcare in the UK – will be delivered. But new developments in IT have traditionally been ahead of the curve of technology adoption and the NHS is no exception. Clinicians have been slow to adopt the benefits that IT can offer healthcare.

So why should we expect things to be different this time?

The answer lies in part in the i-Phone App Store, which has delivered a new way of looking at the world through a computer window.

Through their individual and collective experience of Google, Facebook, i-Phone and other similar systems, politicians, clinicians and their patients are now for the first time AHEAD of the healthcare IT development curve – they know how to drag and drop software applications to create their own particular information world – and how to re-shape it when necessary.

The result of this collective mind-shift is that suppliers who make healthcare IT systems as easy and as accessible as the ‘Apps’ they use in their phones will have a competitive advantage over those who do not. It is also likely that there will be a shift towards those that facilitate collaboration rather than towards those that do not.

Through their increasing exposure to online and mobile device applications, the healthcare community is emerging well prepared for 21st-century IT-facilitated working practices – and it appears that the Government is keen to help this new dawn to break over the UK healthcare economy.

There is currently, however, a massive gap between the IT needs of a busy hospital department and the world of the i-Phone App Store and Facebook page. The Government's strategy to bridge this gap is to ensure that ‘traditional’ hospital information systems are increasingly able to output information to places (such as your own personal health record) that are accessible from outside. If this happens, then these new databases have the potential to fuel the gold rush of a completely new healthcare economy and one in which independent sector clinicians can play a major role in service innovation and delivery.

There are some major obstacles to negotiate before this comes about, not least the issue of how independent healthcare providers are going to connect to the ‘System’. Access to the NHS secure network (N3) is currently restricted to organizations with sufficient funds and expertise to fulfil security requirements. Smaller independent practices will need to be provided with some form of ‘proxy’ or gateway through which they can efficiently and inexpensively communicate with NHS patient records. Access will also need to be provided for innovative devices such as on-line blood glucose monitors. Whether these are provided by the NHS or bought in the High Street, patients are going to expect them to be linked to their growing database of personally held and managed healthcare information.

The second major hurdle is to develop a safe and at the same time proportional approach to managing the risk of inappropriate access to patient data, and while the current paradigm of NHS ownership and control remains in force, this is going to be a difficult act to balance. You are currently much more likely to get fired for letting data out than you are for keeping it in.

The answer to this very thorny issue may lie in the suggested creation of a place where patient data could be copied from NHS systems and to which the patient controls access. The Facebook or MySpace model of ‘x or y wants to be your friend’, could then be used as a model for ‘x or y wants to be your clinician – click here to accept’. A patient-owned copy also opens the way for healthcare information systems and devices, whether they be private, public or personal to communicate with an individual's medical record without risk that this will interfere with other systems (NHS et al.) that do likewise.

We are clearly teetering on the edge of a precipice – over which we are all going to have to jump at some time over the next few years. Behind us will be 60 years of NHS domination of healthcare in the UK and in front of us (or below us depending on what happens next) will be a future in which networks of patients/citizens and clinicians will need to work together to mitigate and manage the lifelong risk of getting sick.

Through Equity and Excellence, all ‘willing providers’ in the independent sector have been invited to play their full role in re-configuring the way that the NHS delivers care; and whatever the NHS decides to do, patients will increasingly expect that all those involved in delivery of healthcare services should be connected together, with their personal record being the central point.

In carrying out its Information Revolution consultation, the DH has in its hands one of the most important jobs that it has ever done and one that has the potential to facilitate the emergence of a new form of networked UK healthcare workforce with global potential.

One of the keys to achieving this goal will be to recognize that enabling the involvement of independent sector clinicians is not simply an add-on; it is the acid test of whether the new approach is fit for purpose.