bitten by asp

The government's ambitious targets to demonstrate improvements to NHS services before the next election are interlocked with a radical restructuring of healthcare information systems - particularly in primary care.

Key among targets set for primary care trusts in England - with a direct impact on patient services - are initiatives to support the implementation of the national service frameworks and national cancer plan, e-prescribing and telemedicine. Perhaps the most important and challenging is the introduction of an integrated primary and community care electronic record by 2005.

Though technology can deliver, there is a question mark over the willingness of NHS organisations and staff to embrace another set of changes in work practice and culture.Yet these are required to achieve this objective. PCTs face practical problems in achieving any of these targets.

They often lack information management and technology skills; they are short of capital and are always faced with bringing together incompatible legacy systems.

Traditional technology solutions are both capital and skill intensive.However, there are new technologies and new forms of relationships with suppliers that offer real possibilities for rapid progress. One of the great assets of NHS primary care is the level of connectivity (via NHSnet) and the underlying base of computers in GP surgeries. The challenge is to make this investment work as effectively as possible.

Application service provider technologies within a web server architecture offer the potential to do just this. The ASP model is well proven in other industries and has a natural fit for the needs of highly distributed patient services, requiring support and information on a 24/7 basis.

Modern ASP approaches allow high levels of security and flexibility to provide safely stored data and account for users' ever-changing needs.Their centralised services provide instantly available upgrades and improvements, keeping site visits to a minimum.Costs are low because the managed-service model means there is no up-front capital investment.

The prospects of achieving these improvements depend on the willingness of NHS clinicians and managers to accept new relationships between the NHS and the private sector.They also depend on agreement over patient consent, where identifiable information is shared between NHS organisations, and the recognition of the need for clinicians to record goodquality electronic information.However, when coupled with extraction technologies that are now available to access information from all the major GP and community systems, the ASP model could deliver the integrated EPR target of 2005 - today.

Kingsley Manning, joint chief executive, Newchurch.