Национальный аэрокосмический университет им. Н.Е.Жуковского «Харьковский авиационный институт» Кафедра компьютерных систем и сетей Научно-технический центр "DESSERT“ (DEpendable Systems, SERvices and Technologies - Гарантоспособные (надежные и безопасные) системы, сервисы и технологии) EPR Systems Analysis (GB) Anna Syrotyuk

NPfIT The National Programme for IT – NPfIT initiative of National Health Service (NHS) England

NPfIT Goals move towards an electronic care record for patients move towards an electronic care record for patients connect 30,000 General practitioners to 300 hospitals connect 30,000 General practitioners to 300 hospitals providing secure and audited access to these records by authorised health professionals providing secure and audited access to these records by authorised health professionals

Programme responsible authority The Department of Health agency NHS Connecting for Health NHS CFH is responsible for delivering this programme CfH is based in Leeds, West Yorkshire.

First dates October formally established October formally established April 1, NHS CfH was formed to deliver the programme April 1, NHS CfH was formed to deliver the programme

NPfIT key deliverables The NHS Care Records Service (NHS CRS) The NHS Care Records Service (NHS CRS) Choose and Book, an electronic booking service Choose and Book, an electronic booking service A system for the Electronic Transmission of Prescriptions (ETP) A system for the Electronic Transmission of Prescriptions (ETP) A new national broadband IT network for the NHS (N3) Picture Archiving and Communications Systems (PACS) A new national broadband IT network for the NHS (N3) Picture Archiving and Communications Systems (PACS) IT supporting GPs including the Quality Management and Analysis System (QMAS) and a system for GP to GP record transfer IT supporting GPs including the Quality Management and Analysis System (QMAS) and a system for GP to GP record transfer NHSmail – a central and directory service for the NHS. NHSmail – a central and directory service for the NHS.

The Spine A set of national services used by the NHS Care Record Service The Personal Demographics Service (PDS), The Personal Demographics Service (PDS), stores basic demographic information about each patient and their NHS Number. The Personal Spine Information Service (PSIS). The Personal Spine Information Service (PSIS). A summary of patient's clinical information, such as allergies and adverse reactions to medicine. The Secondary Uses Service (SUS), The Secondary Uses Service (SUS), Uses data from patient records to provide anonymised and pseudonymised business reports and statistics for research, planning and public health delivery The Spine also provides a set of security services, to ensure access to information stored on the Spine is appropriately controlled.

Clusters and Local Service Providers England North East East & East Midlands SouthernLondon North West & West Midlands Local Service Provide r Local Service Provide r Local Service Provider Local Service Provider Local Service Provide r CSC Alliance The Fujitsu Alliance BT Health London

National Application Service Providers - NASPs Responsible for services that are common to all users BT Atos Origin, Cerner Cable and Wireless NHS Care Records Service and N3 Choose & Book NHSmail

Criticisms of the programme (1) In 2000 won "Most Heinous Government Organisation“ Big Brother Award from Privacy International for its plans to implement what would become the NPfIT In 2004 won "Most Appalling Project" Big Brother Award because of its plans to computerise patient records without putting in place adequate privacy safeguards

Criticisms of the programme (2) In August Clinical staff felt that the programme was in risk of becoming a white elephant In April 2007 The Public Accounts Committee of the House of Commons issued a 175-page damning report on the programme. It concluded that, despite a probable expenditure of 20 billion pounds "at the present rate of progress it is unlikely that significant clinical benefits will be delivered by the end of the contract period."

Costs

Review of A research article A computer scientist’s reactions to NPfIT By Brian Randell School of Computing Science, University of Newcastle upon Tyne, Newcastle upon Tyne, UK

What paper contains A paper contains a set of personal views relating to NHS CfH’s NPfIT, Written from the point of view of a computer scientist, not a medical informatics expert.

NPfIT and the NPfIT and the current scepticism surrounding it The Programme could revolutionise the way the NHS in England uses information, and make significant improvements to the quality of patient care. Make key elements of a patient’s clinical record available electronically throughout England

The medical world sceptisism reasons Many occurrences of widely publicised failures of large IT systems It’s easy to reporters and inquiry agents to obtain information from the Police National Computer System and other allegedly secure government systems The humiliating suspension of the Medical Training Application Service (MTAS) in May 2007, when confidential personal data from hundreds of junior doctors’ job applications were made available on the Internet

We are for detailed Specifications Medical IT system safety depends both on how well the system requirements have been identified and specified, and how well the system meets these requirements, that is, how reliable and secure it is. For any significant safety-critical system, the norm is to require that the system suppliers provide a comprehensive and well-argued set of documents It is vital to have a detailed specification System reliability and security specifications, like the functional specifications are necessary at each stage

NPfIT own problems Numerous reported reliability problems (including privacy failures) CfH themselves do not have detailed reliability and security specifications for the various major NPfIT systems

Medical and computer experts issuers Identifying a medical information system’s possible safety hazards medical experts issues Achieving IT system reliability and security in pursuit of safety Provide guidelines as to what levels of reliability and security are achievable computer experts issues

The impact of centralisation Physically and logically distributed systems, employing carefully architected redundancy and diversity measures, are greatly to be preferred. A single careless or malicious act, affecting a central server and its network could have a disastrous effect on all the surgeries and all their patients, in a whole region. (The recent failure at CSC’s Maidstone data centre left clinicians throughout the West Midlands and the North-West without access to their patients’ computer records for the entire 2-day outage) However, centralised back-up facilities, for example, could be very valuable, especially if the backed-up data are encrypted, and all the key holders can be trusted.

NPfIT Fundamental security dilemma Fundamental security dilemma facing NPfIT is that one can (with difficulty) achieve any two of (a) high security, (b) sophisticated functionality, and (c) great scale but achieving all three is currently (and may well remain) beyond the state of the art.

Achieving public trust and confidence The general public needs to trust - IT systems, - The medical staff and - Government officials Trust is gained slowly and can be lost abruptly General public’s trust in the medical profession. This provides an excellent basis on which to build an IT system that will also gain the public’s trust

Recommendations (1) There is a vital urgent need for an open constructive review of NPfIT by independent experts. A review would provide support for indeed many people’s view that specifying, implementing, deploying and evaluating a sequence of ever more complete IT systems is the best way of ending up with well-accepted and well-trusted systems The review would be best carried out by a smallish team, no more than six people operating full-time at least initially, who between them have expertise in all the main areas – medical informatics, computer system dependability, usability, privacy, etc.

Recommendations (2) There is thus a need for central standards for interoperability of local systems, standards that will encourage development of improved functionality and usability of the systems. Allow patients to decide (typically via their GPs) the extent to which information about them should be made widely available

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