The chief technology officer of the £12.7 billion NHS National Programme for IT has told CIO sister title Computerworld UK that standards bodies must “stop arguing” and work together, so that the NHS can deliver highly interoperable software in hospitals across the country.
Paul Jones, CTO at Connecting for Health, the agency responsible for the delivery of the programme, said the NHS will now reduce the number of standards it uses, from “15 or 20” to two or three,
But he added that “we’re not moving away from the national programme”, which will use two key care records systems, iSoft Lorenzo and Cerner Millennium, supplemented by additional suppliers.
Jones warned that healthcare industry bodies must also not fight over which standard was best. Each healthcare standards body “thinks they’re the most important”, he said. “They need to stop arguing about which is right, and get working together.”
Jones said there were clear benefits to be gained from proper healthcare standards, including lower costs and better interoperability between systems.
The NHS will now reduce the number of standards it uses, from “15 or 20” to two or three, Jones said. It will set key standards in messaging, in terminology so computers understand each other, and in clinical documents.
The NHS will use version 3 of the HL7 messaging standard, the CDA clinical document standard and the Snomed terminology standard. “It helps us in a national programme if we’re running international products,” he said.
All of the standards are set by international bodies that are independent from software suppliers. Jones said “there are governance measures in place” to make sure one supplier did not take prominence over another in standards setting.
But the NHS would also make sure the standards were easily accessible and usable by suppliers, he explained. Rules around data sharing and security are specified in supplier contracts, including the ISO 27001 standard.
Standards in themselves did not necessarily equate to full interoperability, Jones warned, and the NHS would have to work on integrating processes so that systems worked to their full potential. “All suppliers using the same standards does not mean they’ll be interoperable,” he said. “All the business flows and process flows still need to be worked in.”
The NHS was achieving a careful balance between local trust demands and a centrally driven programme, Jones said. The National Local Ownership Programme was put in place last year so that local trusts and strategic health authorities would have “more ownership” and control over implementation.
But he added: “There has to be a recognition of why the NPfIT was started the way it was. If every bit of the NHS wants its own IT, it would be very difficult. But we also want to listen to the local trusts.”
Government health minister, Ben Bradshaw, recently said that it would cost £4.5 billion more for local trusts to choose their IT. And Fujitsu, a key supplier to the NPfIT, recently quit the programme after disagreements over the costs of tailoring its systems to local needs. It had received 615 system change requests from local trusts.
Jones was gave full support for local trust influence on the programme. But he maintained that having a national programme offered strong buying and negotiating power, as well as centrally pooled experience.
“There are such incredible savings to be derived from the NHS wielding its buying and negotiating power,” he said. “We are the 800lb gorilla.”
“Because of our size we can sit on the customer boards at Microsoft and other vendors,” he said. A year ago, the NHS was understood to have saved £330 million by renegotiating licence costs with Microsoft.
Jones continued: “If all we said was we had delivered on the N3 [broadband] network, it would be a flagship success story.” The NHS was delivering successful systems such as GP2GP data transfer, care records on Cerner and Lorenzo technology, and the electronic prescriptions service, he said.
Speaking on the late running of Lorenzo, due to be implemented in early adopters later this year, Jones said in demonstrations that clinicians had admired the system. “It will be successful, [but] there are bound to be some glitches. When Microsoft releases a system they have alpha and beta versions, but everybody expects us to deliver the system perfectly the first time.”
He would not comment on recent suggestions by analysts the NHS should consider giving patients smartcards instead of using a central records database.
The database has raised some concerns over security, and what data will be stored. In his ‘next stage’ review of the NHS this week, Lord Darzi said patients would have online access to their summary care records in the next year, and would be able to suggest corrections. Patients are also able to opt out.
Jones said the other aspects of the NPfIT were success stories too, adding that he “couldn’t understand” why the GP2GP messaging system had not been used before. Regarding the electronic prescriptions service, he said: “Very rarely in IT do you see such a solid business case.”
Paper-based health records systems were "no longer fit for purpose", he said.