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I don't think that there is any serious problem in this case for reasons discussed by many people above; but if your REALLY worried; or happen to work in a place where infection is a genuine possibility, for example the intensive care unit in your local hospital, you might be interested in this work carried out by Intel and the UK's NHS. http://www.e-health-insider.com/news/2500/medical_tablet_pc_launched_by_intel

Comment from inside the programme is restricted by a number of things, but two significant ones are essentially that the contractors' contracts prevent them making public statements not authorised by the customer (the Department of Health), as I remember it, and the Official Secrets Act.

There are a number of things preventing the UK government introducing change in the NHS:

• The GPs don't work for the NHS, they're self-employed contractors whose contracts take nearly a decade to change
• The hospitals aren't directly under the control of the NHS, they are controlled by the acute trusts
• The consultants are not under the control of the NHS. They have contracts (I forget who with, probably the acute trusts
• 80% of the NHS budget is controlled by the Primary Care Trusts

... so the NHS is not in a position to say "do this" and have it done. It's just not a command-and-control organisation. There are a number of types of change that the NHS has been trying to make for over ten years. The Connecting for Health programme (formerly the NHS National Programme for IT) could be described as an attempt to achieve organisational change by the introduction of IT changes. Manifestly, effecting organisational change by introducing technical change is, to put it mildly, difficult and expensive. So for those in charge of any part of the programme there is a perception of a high risk of failure. Justifiably so, in many people's opinion.

So, there are a number of options on proceeding in an environment as risky as this. You could take an approach where you pilot an idea to see if it is workable before proceeding to full-scale rollout. This happened for example with electronic prescriptions. That pilot was cancelled at around the same time that the NPfIT programme was launched. Another way of tackling the risk would be to find a small number of large suppliers and let a number of contracts to them, with mind-bogglingly punitive financial penalties for lateness, unavilability, nondelivery and so on. This is the approach that the UK department of health took. So vast is the scale of the potential penalties that many potential suppliers were disqualified simply because they did not have the financial stature to sign up to those. Other bidders had the stature but not the stomach for that (I suspect Lockheed Martin was in this category).

So, what does a contractor do when faced with vast potential penalties?

• Adopt low-risk solutions rather than high-risk but cheap solutions (and I'm talking about perception of risk here, as in, "Is it tried-and-tested"?)
• Apply huge amounts of contingency to their estimates/pricing
• Require that the level of potential profit justifies the huge levels of risk being undertaken
• Move all inessential or avoidable deliverables out of scope, and if possible, de-scope the riskiest parts of the job

Those factors mean that the NHS passing on the risk of the programme to the subcontractors would always mean that the contracts would be mind-bogglingly expensive. Moving things out of scope means that even though the contracts are expensive, there are many activities that aren't covered. That means that the NHS has to spend still more money on those activities. The media then acts surprised that having let billions of pounds of contracts, the NHS spends still more. Look at it this way: if an organisation spends X pounds on new IT syetems, how much money will they need to spend on related costs (rollout, training, organisational change, costs associated with upheaval, parallel running, data migration, data cleansing)? I'd say that 2X pounds of additional costs would be an underestimate. Bear in mind here that the NHS has about 800,000 employees (direct and indirectly employed healthcare workers).

The scope of the

More links which I didn't bother to read...

It's because HL7 is a messaging standard, not a medical record standard. If you've looked at what a single lab result looks like in HL7 v3, it fills probably three regular pages. Imagine sending hundreds of those, one for each lab result for each patient, across the network to another hospital to take a look. Imagine doing that for the hundreds of thousands of patients seen daily by care providers everywhere.

It would be insane. Plus v3 is only set up for some billing stuff, and lab and pharmacy results. There's nothing for documents, radiology reports, etc etc.

I know the HL7 organization is trying to do this as well, but they've been having mtgs about it now for almost 2 years and nothing's come out of it. Considering v3 took about 10 years to create, and their website hasn't been updated in about 4, I'm not expecting speedy work out of the HL7 organization...

All of this information about the porogramme is available to the public. Most of it is in the document archive at http://www.e-health-insider.com/Document_Library.c fm (see in particular the 'vision of the future' document), but some of it is in the discussion forums or news archive on the E-Health Insider main site .

It's because HL7 is a messaging standard, not a medical record standard. If you've looked at what a single lab result looks like in HL7 v3, it fills probably three regular pages. Imagine sending hundreds of those, one for each lab result for each patient, across the network to another hospital to take a look. Imagine doing that for the hundreds of thousands of patients seen daily by care providers everywhere.

It would be insane. Plus v3 is only set up for some billing stuff, and lab and pharmacy results. There's nothing for documents, radiology reports, etc etc.

I know the HL7 organization is trying to do this as well, but they've been having mtgs about it now for almost 2 years and nothing's come out of it. Considering v3 took about 10 years to create, and their website hasn't been updated in about 4, I'm not expecting speedy work out of the HL7 organization...

All of this information about the porogramme is available to the public. Most of it is in the document archive at http://www.e-health-insider.com/Document_Library.c fm (see in particular the 'vision of the future' document), but some of it is in the discussion forums or news archive on the E-Health Insider main site .

It's because HL7 is a messaging standard, not a medical record standard. If you've looked at what a single lab result looks like in HL7 v3, it fills probably three regular pages. Imagine sending hundreds of those, one for each lab result for each patient, across the network to another hospital to take a look. Imagine doing that for the hundreds of thousands of patients seen daily by care providers everywhere.

It would be insane. Plus v3 is only set up for some billing stuff, and lab and pharmacy results. There's nothing for documents, radiology reports, etc etc.

I know the HL7 organization is trying to do this as well, but they've been having mtgs about it now for almost 2 years and nothing's come out of it. Considering v3 took about 10 years to create, and their website hasn't been updated in about 4, I'm not expecting speedy work out of the HL7 organization...

All of this information about the porogramme is available to the public. Most of it is in the document archive at http://www.e-health-insider.com/Document_Library.c fm (see in particular the 'vision of the future' document), but some of it is in the discussion forums or news archive on the E-Health Insider main site .

CSC and Accenture are currently implementing a Patient Administration System in some of the NHS regions:
link

Both .NET and J2EE can be made to work. In the UK (where I live) the National Health Service has launched a programme to provide nationwide healthcare record integration. It's going to be expensive (around $6bn so far and some projections estimate a total cost around 10 times that). However, it'll be the first such system in the world and will have useful patient benefits (e.g. get admitted to A+E - the ER for US folk - and the doctors there will be able to access your medical notes even if you've never been to that hospital before). More detais of the programme here and here.

As for what technologies are in use, the local service providers (of which there are 5 with about 12 million patients each) are mostly using Microsoft-based solutions, mainly written in .NET, and the national facilities (which provide services for all 60 million patients [approx]) are mostly built using J2EE on Oracle on Solaris. At the moment, the middleware is SeeBeyond e*Gate.

Speaking personally, I have had difficulty integrating .NET 1.0 with other things using SOAP - it doesn't seem to interoperate well. Maybe that's fixed now though.

Both .NET and J2EE can be made to work. In the UK (where I live) the National Health Service has launched a programme to provide nationwide healthcare record integration. It's going to be expensive (around $6bn so far and some projections estimate a total cost around 10 times that). However, it'll be the first such system in the world and will have useful patient benefits (e.g. get admitted to A+E - the ER for US folk - and the doctors there will be able to access your medical notes even if you've never been to that hospital before). More detais of the programme here and here.

As for what technologies are in use, the local service providers (of which there are 5 with about 12 million patients each) are mostly using Microsoft-based solutions, mainly written in .NET, and the national facilities (which provide services for all 60 million patients [approx]) are mostly built using J2EE on Oracle on Solaris. At the moment, the middleware is SeeBeyond e*Gate.

Speaking personally, I have had difficulty integrating .NET 1.0 with other things using SOAP - it doesn't seem to interoperate well. Maybe that's fixed now though.