Epr systems analysis gb anna syrotyuk
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Epr systems analysis gb anna syrotyuk

Национальный аэрокосмический университетим. Н.Е.Жуковского«Харьковский авиационный институт»Кафедра компьютерных систем и сетейНаучно-технический центр "DESSERT“(DEpendable Systems, SERvices and Technologies - Гарантоспособные (надежные и безопасные) системы, сервисы итехнологии)www.stc-dessert.com

EPR Systems Analysis (GB)

Anna Syrotyuk


Npfit

NPfIT

The National Programme for IT – NPfIT

initiative of National Health Service (NHS)

England


Npfit goals

NPfIT Goals

  • move towards an electronic care record for patients

  • connect 30,000 General practitioners to 300 hospitals

  • providing secure and audited access to these records by authorised health professionals


Programme responsible authority

Programme responsible authority

The Department of Health agency NHS Connecting for Health

NHS CFH

is responsible for delivering this programme

CfH is based in Leeds, West Yorkshire.


First dates

First dates

  • October 2002 - formally established

  • April 1, 2005 - NHS CfH was formed to deliver the programme


Npfit key deliverables

NPfIT key deliverables

  • The NHS Care Records Service (NHS CRS)

  • Choose and Book, an electronic booking service

  • A system for the Electronic Transmission of Prescriptions (ETP)

  • A new national broadband IT network for the NHS (N3)Picture Archiving and Communications Systems (PACS)

  • IT supporting GPs including the Quality Management and Analysis System (QMAS) and a system for GP to GP record transfer

  • NHSmail – a central email and directory service for the NHS.


The spine

The Spine

A set of national services used by the NHS Care Record Service

  • The Personal Demographics Service (PDS),

    stores basic demographic information about each patient and their NHS Number.

  • The Personal Spine Information Service (PSIS).

    A summary of patient's clinical information, such as allergies and adverse reactions to medicine.

  • The Secondary Uses Service (SUS),

    Uses data from patient records to provide anonymised and pseudonymised business reports and statistics for research, planning and public health delivery

    The Spine also provides a set of security services, to ensure access to information stored on the Spine is appropriately controlled.


Clusters and local service providers

BT

Health

London

The

Fujitsu

Alliance

Clusters and Local Service Providers

Local Service Provider

Local Service Provider

Local Service Provider

CSC Alliance

Local Service Provider

Local Service Provider


National application service providers nasps responsible for services that are common to all users

BT

Atos Origin,Cerner

Cable and Wireless

NHS Care Records Service and N3

Choose & Book

NHSmail

National Application Service Providers - NASPsResponsible for services that are common to all users


Criticisms of the programme 1

Criticisms of the programme (1)

In 2000 won

"Most Heinous Government Organisation“ Big Brother Award from Privacy International for its plans to implement what would become the NPfIT

In 2004 won

"Most Appalling Project" Big Brother Award because of its plans to computerise patient records without putting in place adequate privacy safeguards


Criticisms of the programme 2

Criticisms of the programme (2)

InAugust 5 2005

Clinical staff felt that the programme was in risk of becoming a white elephant

In April 2007

The Public Accounts Committee of the House of Commons issued a 175-page damning report on the programme. It concluded that, despite a probable expenditure of 20 billion pounds "at the present rate of progress it is unlikely that significant clinical benefits will be delivered by the end of the contract period."


Costs

Costs


Review of a r esearch article

Review ofA research article

A computer scientist’s reactions to NPfIT

By Brian Randell

School of Computing Science, University ofNewcastle upon Tyne, Newcastle upon Tyne, UK


What paper contains

What paper contains

Apaper contains a set of personal viewsrelating to NHS CfH’sNPfIT,

Written fromthe point of view of

a computerscientist,

not a medical informatics expert.


Npfit and the current scepticism surrounding it

NPfIT and the current scepticism surrounding it

The Programme could revolutionise the waytheNHS in England uses information, and make significantimprovements to thequality of patient care.

Make key elements of a patient’s clinical recordavailable electronically throughout England


The medical world sceptisism reasons

The medical world sceptisism reasons

  • Many occurrences of widelypublicised failures of large IT systems

  • It’s easy to reporters and inquiry agents to obtain information fromthe PoliceNational Computer System and other allegedlysecure government systems

  • The humiliatingsuspension of the Medical Training Application Service (MTAS) in May 2007, when confidential personal data from hundreds ofjunior doctors’ job applications were made available onthe Internet


We are for detailed specifications

We are for detailed Specifications

  • Medical IT systemsafety depends both on how well the systemrequirements have been identifiedand specified, and how well the systemmeets theserequirements, that is, how reliable and secure it is.

  • For any significant safety-critical system, the norm is to require that the system suppliers provide a comprehensive and well-argued set of documents

  • It is vital to have a detailed specification

  • System reliability and security specifications, like thefunctional specifications are necessary at each stage


Npfit own problems

NPfIT own problems

  • Numerousreported reliability problems (including privacy failures)

  • CfH themselves do not have detailed reliability and security specifications for the various major NPfIT systems


Medical and computer experts issuers

Identifying a medical information system’spossible safety hazards

medical experts issues

Achieving IT system reliability and security in pursuit ofsafety

Provide guidelines as to what levels ofreliability and security are achievable

computer experts issues

Medical and computer experts issuers


The impact of centralisation

The impact of centralisation

  • Physically and logicallydistributedsystems, employing carefully architectedredundancyand diversity measures, aregreatly to bepreferred.

  • A single careless or malicious act, affecting a central server and its network could have a disastrous effect on all the surgeries and all their patients, in a whole region.

    (The recent failure at CSC’s Maidstone data centre left clinicians throughout the West Midlands and the North-West without access to their patients’ computer records for the entire 2-day outage)

  • However, centralised back-up facilities, for example, could be very valuable, especially if the backed-up data are encrypted, and all the key holders can be trusted.


Npfit fundamental security dilemma

Fundamental security dilemma facing NPfIT is that one can (with difficulty) achieve any two of

(a) high security,

(b) sophisticated functionality, and

(c) great scale

but achieving all three is currently (and may well remain) beyond the state of the art.

NPfIT Fundamental security dilemma


Achieving public trust and confidence

Achieving public trust and confidence

  • The general public needs to trust

    - ITsystems,

    - The medical staff and

    - Government officials

  • Trust is gained slowly and can be lost abruptly

  • General public’s trust in the medicalprofession.

    This provides anexcellent basis on which to build an ITsystem that will also gain the public’s trust


Recommendations 1

Recommendations (1)

  • There is a vitalurgent need for an open constructive review of NPfIT by independentexperts.

  • A review would provide support for indeed many people’s view that specifying, implementing, deploying and evaluating a sequence of ever more complete IT systems is the best way of ending up with well-accepted and well-trusted systems

  • The review would be best carried out by a smallish team,no more than six people operating full-time at leastinitially, who between them have expertise in all the mainareas – medical informatics, computer systemdependability,usability, privacy, etc.


Recommendations 2

Recommendations (2)

  • There is thus aneed for central standards for interoperabilityof local systems,standards that will encouragedevelopment of improved functionalityand usability of the systems.

  • Allow patients to decide (typically via their GPs) theextent to which information about themshould be madewidely available


Thank you for your attention

Thank you for your attention!


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