NHS: don't underestimate the challenge

The NHS is about to embark on a multibillion pound national IT investment programme to modernise the frontline delivery of patient care.

By improving the capture, management and use of information, every aspect of patient care can be integrated.

This will ensure that data is available to healthcare professionals at the point of care and at each stage of treatment, from A&E, through X-ray and outpatients, to GP visits and the aftercare provided by social services.

While aiming to make the NHS "a modern public service meeting modern public expectations" is both highly commendable and long overdue, this ambitious objective also portends a major integration headache that has the potential to kill or cure those with responsibility for the public service.

A networked NHS will depend upon the implementation of a sophisticated and cost-effective national IT infrastructure. This in turn will necessitate the integration of disparate applications and platforms.

It's a major undertaking for even the most experienced specialists, and the government's poor track record in implementing IT projects is well documented.

Fundamental concerns are consequently being voiced about how a project of such complexity and scale can succeed in a large and fragmented organisation such as the NHS.

Unfortunately, the initial signs are not encouraging. The process to find suppliers is underway, but already blighted with farcical deadlines.

And spokesmen for the national IT plan are declaring that the intention will be to implement a process that is "as rapid as good practice allows".

Complex integration projects are not achieved overnight. They depend upon setting realistic objectives, carefully planned processes and a phased, step-by-step implementation.

The risk is that those in charge of the NHS project may spend first and plan later, in common with decision makers in charge of other large-scale technology projects taking place today.

Licensing fashionable software packages, be they business process management tools or integration brokers, will not solve the enormous challenges facing the NHS.

Public policy decision makers need to recognise that buying bolt-on software is not only flawed but short-sighted. It usually only guarantees a lower, slower return on the taxpayers' investment.

For this reason, the NHS must begin with the basics and establish firm foundations. Once information is automatically and securely exchanged between internal applications, patients, partners and suppliers, further business management layers may then be safely added.

This avoids the potentially fatal consequences of trying to build the house from the roof down.

To see how integration can, and should, be done, the NHS should look to IT initiatives already taking place in Europe and further afield. All have guaranteed success by deploying a 'bottom-up' approach to integration.

The Regional Hospital in Dijon is connecting more than 40 disparate applications. These cover everything from diagnostic data in A&E systems to bedside pay-to-view TV services. The system provides seamless information delivery for patients and healthcare professionals.

And the Australian Health Insurance Commission, the body which administers health programmes on behalf of the country's government, has implemented an e-commerce corporate gateway to transfer messages between its application systems and third-party systems.

The gateway is now used by thousands of doctors, pharmacists and hospitals, improving the delivery of essential medical services to all Australians.

The NHS IT programme is an integration project of unprecedented scale and complexity. But its aims will only become achievable if approached pragmatically.

By adopting a planned bottom-up approach, the NHS can effectively minimise risk and ensure the greatest potential for success. Only then will healthcare delivery become a high-quality, patient-centric service.

And, most importantly, the NHS will live to tell the tale.

Martin Stern is UK and Ireland managing director at integration specialist Axway.