In 1992, we were promised that all NHS organisations would be communicating across NHSnet by 1996.In 1998, we were promised that 100 per cent of computerised GPs would be on the net by the end of 1999.We have just been promised 95 per cent by 2001 and 100 per cent by March 2002.By June of this year, the actual figure was only 55 per cent (4,926 practices) with ISDN lines connecting them to NHSnet. What is more, rumour has it that half of them have never used it.
This ever-changing set of targets promotes confusion, which in turn detracts from the service itself. NHSnet has an appalling reputation. Some of this is deserved and some is not. The problem is that so many targets have been missed and user expectations have been dashed so often that nobody believes anything they hear about NHSnet any more, unless of course it's bad.So where are we now?
NHSnet started life as one of the world's most expensive communication methods. It used to be said that it was cheaper and quicker to send large communications by taxi. To make matters worse, the billing calculations were so complex that organisations were afraid of promoting usage, just in case it cost too much.
I sent 91,171kb of data by e-mail last year, and if I had been using NHSnet under the original charging system that would have cost me nearly£1,000.
There is no doubt that by providing NHSnet as a 'free'top-sliced service, the NHS Executive has successfully relaunched it. During 1999-2000, the number of active users doubled, and e-mail messaging trebled to 600,000 units a day.
Compared with nearly 19 million Internet users in the UK, the NHS has some way to go. The new Department of Health target of 25 per cent of trust-based clinical staff with access to NHSnet by April 2001 is clearly an embarrassing admission of how far behind the NHS has fallen.
But now we are definitely on the move.
As well as removing the price barriers, progress has been made in the areas of performance and reliability. Until quite recently, finding someone's e-mail address from the address book synchronisation service was considered an achievement, and sending an email to someone in the NHS gave you that message-in-a-bottle feeling. To add to the difficulties, many NHSnet users had trouble sending and receiving attachments such as simple Word documents. An unreliable mail system is clearly hopeless, and most of the NHS people I communicated with used separate Internet addresses for important or urgent mail.
However, the network and ancillary systems seem to be stabilising after the problems experienced earlier this year. We finally have an NHSnet that is capable of sending and receiving e-mail reasonably reliably, so now we need to get on and use it. For once, the DoH target of 100 per cent of trust-based clinical staff and GPs by April 2002 needs to be taken seriously and achieved.
Another breakthrough is that the system now appears fast enough to run complex interactive applications. My own company has recently taken the plunge by developing an interactive GP booking system, which allows GPs to request outpatient appointments, TCIs and theatre slots online and receive appointments back within a few seconds. All this runs across NHSnet, and although we had to make some last-minute adjustments to the programs to cope with slower than expected, and inconsistent, network performance, it seems to work very well.Had I been a betting man, I would have lost my shirt on this one, which proves you cannot believe everything you hear and read.
A major outstanding barrier to the success of NHSnet is the code of connection. Once you have decided that NHSnet is the thing for you, actually getting a connection is a nightmare reminiscent of getting a phone line in the 1970s.
It took me 15 minutes to set up an Internet account for my father-in-law recently and five months to get my company NHSnet access.We are working on a multidisciplinary care programme approach project which is linking acute, community and social services users in the care of mentally ill patients, and have found that colleagues in social services buildings will not be allowed access at all.
These problems seem to be caused by a combination of bureaucracy and the fact that at present NHSnet security relies on trusted access to the system rather than encrypted messages.
However, if the service is to fulfil its potential this has to be made better.
After all, what's the point of providing systems which enable healthcare professionals to access patients' electronic records from outside the hospital when they are on-call, if they cannot dial in?
There are many arguments about whether or not NHSnet was the right way to go in the light of advances in Internet technology in other markets, and whether or not the approach taken provided value for money. It is time to move on from this position. The money has been spent and NHSnet is here. The important thing now is to maximise the benefits of the investment already made. There is a value-for-money question to be asked about the ongoing costs of running NHSnet, but this can and hopefully will be addressed when the current contract runs out in 2003.
Incidentally, at a recent healthcare computing conference, the NHS information policy unit announced son of NHSnet.
This, we were told, would be similar to NHSnet but give access to other organisations and to the public. Far be it from me to criticise, but this sounds remarkably similar to the Internet.
Another new wheel design from the NHS perhaps. I wonder what it will cost?
See IT Update, centre pages.