EPR Systems Analysis (GB) Anna Syrotyuk

1. 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

2. NPfIT The National Programme for IT – NPfIT initiative of National Health Service (NHS) England

3. 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

4. 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.

5. First dates • October 2002 - formally established • April 1, 2005 - NHS CfH was formed to deliver the programme

6. 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.

7. 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.

8. 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

9. 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

10. 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

11. 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."

12. Costs

13. 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

14. 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.

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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.

21. 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

22. 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

23. 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.

24. 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

25. Thank you for your attention!