The use of patient 'smartcards' will ease traffic on the
NHS national data spine, says Maldwyn Palmer.
The provision of timely information throughout the NHS will
be the true test of the information spine
infrastructure.
Although all patient data will be held in one place, the details
must be disseminated at a rate that is useful to end-users.
Clinicians should not have to wait too long for patient details to
appear on their screens.
Replication using local clusters will help, but this will have to
synchronise with the central core, which is another overhead on
resources. The main stumbling block will most probably be the
networking system, rather than the servers.
A solution to this could be the use of personal smartcards, which
would alleviate the load and provide instant information in urgent
cases. For example, if a patient has an accident and is unable to
give their name, a smartcard would enable the clinician to
instantly access any necessary details that could improve the
chance of survival.
Any form of identification has political and legal drawbacks, but
perhaps it is time they were accepted. Some might argue that an NHS
card is an ID card by the back door, but healthcare 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 their owners.
The system would also need a back-up as not everybody would carry a
card through choice. The recall of information from a central
database would be slower than with a smartcard, but would still
benefit from the lack of traffic because of card use.
Cards could be updated by different means, but batch processing
could be used at the core to update non-urgent details such as
addresses. One of the main dangers of the new data spine is the
enormous amount of transactions that would needlessly bounce
around, slowing down the system.
The cards could be updated by the patient, who could type in a
password, for example, to allow access by doctors. Cards could be
updated at local health centres, over the internet or at a local
library, by putting the card in a reader/writer and typing in the
password. This ease of use would inevitably benefit GPs as they are
at the end of a very long IT supply chain.
Maybe this idea has already been discussed, but if it has been
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 is a stumbling
block in any new design. There is mention in the NHS plan of grass
roots supply and design of IT, but suppliers do not appear to have
any autonomy. Additionally, the suppliers are reliant on acceptance
by the local service providers.
If innovation is to be a building block of the new, improved NHS,
an open mind is inherent. Good ideas are not limited to large
corporations or government think-tanks.
Maldwyn Palmer is an independent IT project
management specialist
