A Computer Scientist's Reactions to NPfIT

This paper contains a set of personal views relating to NHS Connecting for Health's National Programme for IT (NPfIT), and in particular its Care Records Service, written from the point of view of a computer scientist, not a medical informatics expert. The principal points made are as follows: Centralisation: Pulling lots of data together (for individual patients and then for large patient populations) harms safety and privacy – it is one byproduct of excessive use of identification when in fact all that is usually needed is authentication. Large centralized data storage facilities can be useful for reliability, but risk exchanging lots of small failures for a lesser number of much larger failures. A much more decentralised approach to electronic patient record (EPR) data and its storage should be investigated. Evolutionary acquisition: 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 – especially when this process is controlled by the stakeholders who are most directly involved, rather than by some distant central bureaucracy. Thus authority as well as responsibility should be left with hospital and general practitioner trusts to acquire IT systems that suit their environments and priorities – subject to adherence to minimal interoperability constraints – and to use centralized services (e.g., for system support and back-up) as if and when they choose. Socio-technical issues: Ill-chosen imposed medical IT systems impede patient care, are resisted, result in lots of accidental faults, and lose user support and trust. All these points are attested to by rigorous studies involving expertise from the social sciences (psychology, ethnography, etc.) as well as by technical (medical and computer) experts – much more attention needs to be paid to such studies, and more such studies encouraged. Constructive reviews: A constructive expert review, working closely with Connecting for Health, could be very helpful, but should be evidently independent and open and thus essentially different in nature to past and current inquiries. A review of this nature could not just recommend appropriate changes of plan, and speed progress. It could also contribute to the vital task of helping to restore the trust and confidence of the public and the media in the programme and in the government officials involved.