Give this man a medal.

Ok, ok, ok, you never know. What this man could be referring with "best of breed" and boasting about success could be just an entangled spaghetti of seemingly complementary applications that hold incomplete pieces of information.

Those environments usually have an array of interfaces sending and receiving information all day, with all the usual problems associated with synchronization and integrity.

But yes, each one of those as an individual system is "best of breed", but is a short term fix that does not solve the long term problem.

I'm not saying that the uber-database approach is better, just have seen the "best of breed" failing too many times, usually victim of the "pragmatic" approach. Just gimme something that works in six months, we'll take care of solving the really difficult problems later (read write a lot of interfaces).

Quite apart from the question of whether a single database could work technically, how would it work in terms of clinical governance and patient management? (not sure about Amazon and eBay - records contain a lot of free text and fuzzy data..)

http://shorterlink.co.uk/14497

Different organisations and clinicians have different record needs - hospitals have flat narratives, GPs have highly structured and Coded records, used for cradle-to-grave patient care and QOF - the Quality and Outcome Framework used for performance related pay.

Can the two needs be served by a single record? who will be responsible for maintaining it, who will be liable for errors and what plans are there for managing prescribing - an area risky for patients?

If any of you have any information of how these issues were addressed when the idea of a single record for every patient - the Detailed Care Record model, either Lorenzo - involving all organisations - or Millennium - limited, AFAIAA to a single secondary care Trust - was first mooted - and contracted for - please tell the rest of us!

And I would trust Amazon with my health care records because, hey, they manage book sales and returns well enough so why not?

I would have to point out that at least in *theory* health data management needs a rather higher level of security and availability (to say nothing of a wider distribution system and more complex ACL) than your average bookseller or yard sale management system.

Desperately Ill Person (DIP): "I'm having an emergency..."

Hospital (H): "I just need to ask you to confirm a few things for us. Your mother's maiden name please."

DIP: "Gaaaaasp"

H: "I'm sorry that's not what I have on record. Can you reply to this confirmation email that we'll send to your email account?"

DIP: "Erg."

H: "I'll take that as a yes. You should receive the email in 20 to 30 minutes, but the servers have been acting up a bit today because we were adding the ability to cross-sell insurance. So it might be a bit longer than usual."

DIP: ...

Speaking as someone who used to work in healthcare IT but escaped before the current fiasco started...

In the beginning was the NHS number.

And it came in 23 different formats, and there were duplicates which had been issued historically.

So a project was created to allocate everyone a New NHS number.

And it ate a lot of time and effort for everyone.

And when it was rolled out... d'you know what happened?

In the early stages... the systems managed to issue duplicates again.

And as far as I know they are still there.

I also used to work in interfacing healthcare IT systems with one another, and was involved in one of the earliest EDI projects in the NHS, to send pathology results from Hospital path labs to GPs.

And just at the point where we had a few pilot hospital sites sending results electronically, using a standard message, to a few GP practices...

Someone at the Department of Health got a bee in their bonnet about the European Standardisation Effort for medical messaging...

...and suddenly started mandating that everyone should implement a new, different set of standard messages - without any additional funding of course - which set the cause of healthcare EDI back a good couple of years.

Then just as that was sorting itself out, some idiot at the Department of Health realised that all this old-fashioned EDIFACT stuff was rather old hat, and there was this new thing on the block called XML, and another argument started over why everyone was using EDIFACT and we should all move to XML as the encoding scheme, quietly ignoring the fact that no message schemas had been defined in XML yet, and we had already changed horses once causing great upheaval.

So the current balls-up is basically just the logical conclusion of that sort of stupidity, with the addition of Tony Blair behaving like an idiot, compounded by the fact that there is now no in-house NHS IT capability since the organisations which used to provide in-house NHS developments were all outsourced to the likes of EDS and CSC many years ago when Virginia Bottomley was the Health Secretary.

Nothing changes...

The NHS is a bottomless pit of money.

"Connecting for Health" are proud to state that the NPfit Contractors only get paid when they deliver, but how many payments have been made for interim software solutions installed whilst waiting for the troubled final solution and who will be picking up the bill to replace the interm software once the product is finally ready considering we have already paid once.

It is a bold project, a waste of public money and an unworkable solution and they are all to blame, the government, the CFH, the PCTs managers on the ground who grab all the money they can from the project, so they do not have to use there own budget replacing old IT equipment, they can waste their budget on something else. The LSPs who have been contracted to hold a monopoly on their area and stifle competition altogether.

Does anyone know if iSoft as an LSP actively promote Emis software, or vica versa? I would doubt it very much. This project was supposed promote competition by splitting up the country into sections, all that it has done is provided a monoply for the LSPs in the areas they have been given.

Now heres an idea, the NHS develops a backend system, but the patient holds their own data at all times, where ever the patient goes the data goes and can be read by the NHS backend. This needs to be worked on, give me 6 billion and I’ll get right on it.