Connecting for Health - What For?

WHAT IS NHS CONNECTING FOR HEALTH FOR?



The NHS Connecting for Health project is in further trouble, losing another of its big corporate suppliers. Reading about this took me back to a meeting I had about 6 years ago with a bright young management consultant. His mission was to go round the universities, talking to a range of experts on health service management and delivery, to persuade them to get more interested in Connecting for Health (though it had another name at that time.)

I asked him what Connecting for Health was for. He seemed taken aback. It was obviously so that every professional in the NHS could have access to every patient’s records whenever they presented for care. I asked him what was wrong with the patient (or parents in the case of young children) telling the doctor what their main problems or important background conditions (for example diabetes) were. His response was that this was no use in an emergency when the patient was unconscious. My response was to point out that anyone dealing with a patient in an emergency would need to be sure they had the right address and other details on a patient – there are over 70 J Smiths in my local phone book – before relying on an electronic record, even if it could be downloaded instantly. I also pointed out that a simple bracelet, neck tag or card in the wallet could provide important health information such as diabetic status, without the need for either a download or finding the correct address.

This conversation is at the heart of many of the difficulties of Connecting for Health. It is immensely ambitious and yet does not have a really clear business case for its model, compared to simpler and cheaper models that would give individual hospitals electronic records for their own use, which could be sent to others when requested. Why connect everyone to everything?

Even though it looks appealing, there are flaws in the system. Not everyone carries their address on them in case of theft. If you lose purse or wallet and keys in the same bag, then someone has access to your house. For those treating the patient in an emergency, direct treatment of symptoms of heart attack or trauma may make more sense than trying to find the right address details and then waiting for a download.

Some years ago, when working in a hospital, I received a large file of patient notes meant for a real doctor, in neuro-surgery. I phoned at once and offered to bring them over at once. He laughed. His reply was that they might have been of some use on Saturday night when the patient was transferred, though he appeared to doubt the quality of what another hospital would send, but four days later, there was nothing in them that he needed. He had worked from the symptoms of the current problem and not relied on the record of past problems. If the record of past problems takes a long time to download, this makes sense.

And what will be downloaded? Medical records on patients with complex and chronic problems are enormous. They can take up four or five inches of filing on the shelf. Yet I know from research using case-note review that sometimes important information is not in the records, including whether they are receiving such significant items as cancer chemotherapy. It is unlikely that a patient who had an operation last week and has relapsed and been taken to another hospital will have a record that contains all the information on their operation. Files are often not updated that quickly in the NHS.

Medical records committees in hospital, and in Connecting for Health, must also struggle with the question of which pieces of information are most important. Every specialty wants its records close to the front of the file, to save time, and it has proved a hard struggle in some hospitals to introduce structured medical records. Deciding what to include and what to leave out of a long medical record is challenging and is probably at the heart of many of the problems of Connecting for Health.

What we should have established right at the start of the programme are some key benefits and the cost of obtaining them. Then we should have tested them. Important questions include the ease of identifying a patient who is unconscious and not with friends or families and the difference between what patients say about their health and what their records say. Recent research suggests this can vary with the type of medicine they take or the medical problem they suffer from. It would also be important to know the number of patients not treated locally where symptoms cannot be used as a reliable basis for treatment and the extent of additional benefits from electronic solutions compared to bracelets, tags and personally held record cards of varying degrees of complexity. A short record in my wallet or phone, accessible to health professionals or protected with a readable electronic bar code, could be as useful as what Connecting for Health has to offer. Connecting for Health might in the end be better but much of the gain could have been tested more rigorously right at the outset. Like many IT projects, the buyers appear to have been seduced by a big-bang, all-singing-and-dancing solution when the alternatives, including some very low-tech approaches and some with more technology but mainly containing records within a hospital, may have been just as good.

Unfortunately we are still suffering the consequences of failing to test the benefits and costs of Connecting for Health fully at the start.