Information is power and the first NHS data leak scandal could destroy years of work, warns Ian Bruce

The government has allocated the money but is the NHS ready to modernise its information and communication technology (ICT)? Have the privacy issues been resolved and is the UK capable of successfully delivering such a massive ICT project.

In concept the NHS ICT project is simple. Medical records will be kept electronically and be available to all people dealing with the patient on a need to know basis. ICT would then be used to ensure that the patient received their treatment in the most effective manner. The data collected during this process and information on costs and resources used would be used in an integrated way to manage the NHS, undertake research and help plan a better patient service for the future. The vision is both better patient care and use of NHS resources.

ICT within the NHS is well established. Many doctors have pioneered the work and many pilot schemes have run their course so that we should now be ready to scale up successful stand alone systems into an integrated whole. The debates about privacy and modality seem to be coming to a conclusion so surely it should now be decision time? Well, no.

Firstly e-government has become stalled by the failure of ICT suppliers to deliver large systems: the Benefits Agency, Employment Service, Air Traffic Control, Probation Service, Criminal Justice Systems, Passports, Immigration Control, Police National Computer and fingerprint records to mention just a few. EURIM, the Parliamentary Information Society group, has analysed past mistakes and unfortunately it looks as though the NHS is poised to repeat these failures and become the biggest disaster yet.

PITCOM devoted its April meeting to electronic health records (EHR). Three very experienced, ICT literate doctors painted a pessimistic picture of trying to make EHR work. Worse still, they described how the small scale pilot schemes had failed to deliver particularly on the issue of transfer of data from one system to another. On a recent visit to a fully electronic GP's practice I asked about data transfer. "Yes," said the doctor, "we are just coming to the end of a three year pilot which has involved all the GPs within this town to ensure that people moving from one GP practice to another can have their EHR transferred with them." "So," I naively said, "at least in this town we can transfer records." "No," replied the doctor, "the software company has failed to make that part of the system work..."

After years of pilot schemes and having the NHS Information Authority (NHSIA) trying to resolve these issues the NHS still transfers information by printing it out and sending it through the post for it to be re-entered into another system. Last year the Department of Health and the NHSIA concluded that while a national database containing basic demographic information was feasible they thought detailed clinical information would best be held and managed locally. The only problem is that no one seems to have told the Prime Minister and the Health Service managers. Indeed the approach from the NHSIA appears to want a universal register of the population to ensure accuracy of statistics and planning while the NHS clinicians are simply working from the basis of providing benefits to individual patients. Added to this the NHSIA is currently working on 41 separate work programmes, few of which are delivering what was promised and which are now all supposed to be integrated into a single national scheme.

The piloting and definition phase of this project is woefully inadequate and now we have to deal with the problems of confidentiality that come from allowing multiple access points to patient records. Doctors appear a little worried about holding confidential information and believe their patients share their view. However in this litigious day and age one can envision that the first data leak scandal that breaks could destroy years of work. Software writers say they can deal with this but their record suggests otherwise. Patients and doctors will also be less happy knowing that information collected about them may also be used for management, clinical audit and even fraud investigation reasons.

Another factor is time scale. It has taken many years to introduce the present level of ICT. During this time most NHS facilities have seen their equipment and software change radically. Four years is about the maximum life. That means the new systems need to be written to be right for the next generation of hardware and operating systems and to enable today's records to be easily transferred. Experience shows this is easier said than done.

All involved must agree on both what is wanted and what is achievable. We must appoint high powered programme managers who must prove by live pilot studies that our methodology is sound and protects privacy. Only then should we proceed to a national roll out.