If patients carried around their own health
'smartcards', to plug in at the GP's surgery, the hospital or the
pharmacy, the NHS spine will be even stronger, says Maldwyn
Palmer.
The implementation of providing timely information
throughout the NHS will be the true test of its new
infrastructure.
Holding data is not enough as the particulars must be
disseminated at a rate that is useful to the end users. Holding
details on a patient is not acceptable on its own if the clinician
has to wait ages for the transaction to appear.
Replication by using local clusters will help but they have to
synchronise with the central core, and this is another overhead on
resources. The main stumbling block will, most probably, be the
networking system rather than the servers.
The use of personal smartcards would alleviate a large amount of
the load providing instant information for urgent cases. What about
the person knocked down in the street and cannot give their name or
any details? Carrying a card would enable the clinician to read all
necessary details instantly that could increase the patient’s
chance of survival.
Any form of identification has political and legal drawbacks,
but perhaps it is time to accept that this is the way of the real
world. Some might argue that it is an ID card by the back door, but
saving lives must be given precedence. The method of accessing
these cards would have to be carefully considered as clinicians
must be able to read them as well as the owner.
Of course, not everybody would carry a card through choice or
whatever and a backup system would be called into action. The
recall would be slower if central data has to be called into play,
but still faster as the infrastructure would have less traffic.
Cards could be updated by different means but even batch
processing could be used at the core to update non-urgent things
such as addresses. One of the main dangers of the new initiative is
to see enormous amounts of transactions needlessly bouncing around
in cables and slowing down the whole reporting system.
The cards would also enable doctors to have an instant view of
their patient’s records. The patient may have to type in a password
to allow the doctor access, and even the most ardent freedom lover
would not mind taking their card with them to see their local
physician. The ease of use would be most apparent at this level as
the GP would, inevitably, be at the end of a very long IT supply
chain. Cards could also be updated at your local health centre, the
internet or even your local library. Put your card in the
reader/writer, type in your password and away you go.
Maybe this idea has already been mulled over, although I have
not seen any discussions about it so far. If it has been mentioned
but dropped as unworkable, perhaps it is time for a rethink as the
advantages could be considerable.
The idea that everything has to be centrally managed will be a
stumbling block in any new design and is not the way of the future.
There are mentions of grassroots supply and design, but they do not
appear to have any autonomy and are reliant on the local service
providers' acceptance and future good will.
If innovation is to be a building block of the new improved NHS,
then open minds must be inherent in that credo. There are a lot of
clever people out there with good ideas and they are not limited to
large corporations or governmental think tanks. If this is for the
people, then listen to them.
What's your view?
Would you be happy to carry your medical details on a smartcard?
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Maldwyn Palmerwas one of the first people to use
the C programming language in the UK. He wrote the original mobile
phone texting software for Orange and ran his own consultancy
during the dotcom boom. He now writes technical articles and
humorous books.