The Government's new strategy for health service IT, Building the Information Core - Implementing the NHS Plan, has drawn a mixed response from doctors and ITmanagers, but a huge sigh of relief from Nigel Bell, head of the NHS Information Authority (NHSIA).
Bell does not underestimate the challenges involved in turning the document's words into deeds, particularly on security, but, talking to Computer Weekly, he gave the impression that NHS IT is now on the starting line in the race to e-enable healthcare.
The new document focuses the delivery of IT on the patient-centred strategy laid out in the NHS Plan and mandates the basic e-government infrastructure of Internet technology and SMTP (Simple Mail Transfer Protocol) for e-mail and XML (Extensible Markup Language) for messaging.
"When the NHS Plan came out there was a lot of conversation about what a care system designed around the patient meant for information systems," said Bell.
"Initially, people were talking about adding things to what we were already doing, but it is clear it means a fundamental shift.
"The new document is a lot more focused on what we have to do. It is not just about outlining targets and saying there is money available, but making it easier to actually do something."
The Government's initial IT strategy for the NHS, Information for Health, was about supporting clinicians in their delivery of care, said Bell.
"In the past we have been so many steps away from making a difference to patients that it has been quite difficult to maintain motivation and focus on that," he said.
"Now, with NHS Online, NHS UK, the Electronic Library for Health, the focus is about getting information to patients and citizens.
"If we can realign ourselves along that quality of care axis, we can be quite effective."
Bell is proud of the progress made by the NHSIA, both in terms of influencing policy and with key projects like NHSNet.
New service level agreements reached last summer have seen an improved service and the NHSIA is on target to get 95% of GP practices connected by March, said Bell.
Bell answered critics who say having a NHSNet connection is not the same as using the system, by insisting that his next priority is to provide services, such as electronic libraries and directories, that will drive usage.
Welcoming the decision to standardise on SMTP, rather than X.400, Bell said almost half the e-mail traffic on NHSNet was already SMTP. Converting between the two standards has proved a headache for IT managers in trusts across the NHS.
"We don't have to wait until the contract for NHSNet is re-tendered in 2003 before SMTP kicks in," said Bell.
"But until the Government's interoperability framework came in, we were focused on developing features using X.400. Now we need to catch up."
Bell insisted that the NHSIA will manage the transition from electronic data interchange (EDI) for messaging to XML standards. It will not scrap projects such as the EDI-based pathology messaging system, which is ready for roll-out, and wait for the development of XML alternatives.
He said that the outcome of key pilot projects for electronic patient records would not produce any fundamental changes in direction but admitted that plans to develop a public key infrastructure (PKI), to be available for use across the NHS by 2002, were extremely challenging.
Bell offered no blueprint or timetable for the PKI project, simply a determination to meet the tight deadline imposed in Building the Information Core - Implementing the NHS Plan.
Arguments over security have long plagued NHS IT and, despite the progress the NHSIA has made so far, much will ride on getting it right over the next 12 months.
Public Accounts Committee highlights need for good NHS information systems
The influential House of Commons Public Accounts Committee underlined the importance of health service IT in a critical report on hospital bed management, published last week.
The committee estimated that poor management of NHS beds was costing £1m a day and denying vital hospital services to those in need. "Good information systems that provide real-time information on current and planned use of key resources are essential in helping bed managers and other hospital staff to plan patient admissions effectively," said the committee.
But it added, "The NHS has a record of slow and patchy progress in implementing IT projects."
It noted the NHS Executive's plan to incorporate in-patient planning and bed management within its wider strategy for developing network systems and the electronic patient record.
However, the committee said, "Until these systems are available, many trusts will continue to operate for the foreseeable future without the information they need."
The committee expressed concern that when successful systems are developed, with demonstrable benefits to patients, the executive needs to invest in implementing them more widely, rather than leaving NHS Trusts to re-invent the wheel.
"In taking forward the new NHS IT strategy the NHS Executive therefore needs to work with NHS trusts to ensure they have a clear understanding of the likely timing and impact of new systems and of the costs and benefits if implementing interim solutions in the short term," the report said.
Nigel Bell of the NHS Information Authority told Computer Weekly that encouraging the sharing of information among health service informatics professionals, rather than simply laying down standards, would be a key priority.
Committee of Public Accounts: Inpatient Admission, Bed Management and Patient Discharge in NHS Acute Hospitals, The Stationery Office, January 2001