Decentralise NHS data

Maldwyn Palmer believes the use of patient 'smartcards' will ease traffic on the NHS national data spine


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

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