Published: 26/09/2002, Volume II2, No. 5824 Page 21

If anybody thought it would be easy to create electronic records that could be shared between the NHS and social services organisations, a 175-page Department of Health document should make them think again.

The draft National Specification for Integrated Care Records Service proposes the creation of a service capable of handling 30 million transactions a day and a huge number of functions. The aim is 'to move away from the concept of separate information systems based around organisational structures, to a situation in which professionals are provided access to the one integrated service'.

The central problem is likely to be the sheer variety of separate information systems it will have to draw on, or replace.

According to the specification, the 'core generic functions'will include a database of patients and social-care clients, information on diagnosis, treatment and care management, booking and scheduling information, ordering and results reporting, prescribing, digital imaging, access to knowledge, clinical governance and operational service management.

Apart from these electronic patient recordtype functions, ICRS will also need to support national service frameworks and maintain the personal details of foster carers and adoptive parents, record road traffic accidents and help with the assembly of documents for mental health tribunals. Among other things.

Comprehensive as the specification is, it tells only part of the story since it concentrates on the NHS's view, with little reference to social care functions, delivered mainly by local authorities.

The specification also treads lightly on the process of implementing ICRS and how existing systems will migrate onto it. Finally, it is unclear how the service will be paid for.

Among the issues to be tackled are:

The single master index.According to the specification, patients and service users will be identified by the NHS number, validated through the NHS tracing service.A possibility the document does not mention is to use the new population register being considered by the Home Office under its consultation for entitlement cards.

Interfaces with legacy systems, especially departmental IT. The document says 'the ICRS service will need to integrate with existing systems such as pathology and radiology, which may be located at different sites within the health economy'. The service must also include interfaces to the National Health Authority Information System Application, the NHSwide clearing service, local authority social service indices and the new central electronic staff records service.

Security and confidentiality. The specification says data must be capable of being anonymised and 'pseudonymised'. The system must also generate customised views of data according to the access privileges of the person viewing it.

Procurement and rollout. The document makes clear that it is specifying a service, not a product. The specification covers issues such as project management, implementation and arrangements for training, but little about how the service would be procured.

There is another worry. The project seems to ignore two lessons learned from public-sector IT disasters. First, it is subject to a tight timetable: all strategic health authorities should be 'actively implementing' elements of ICRS by December 2005 (the government's deadline for all public services to be available electronically).

Second, the project is colossal in scale. The specification says it must handle 3 million critical processes or 30 million transactions a day, around the clock.Yet, with understatement, it says: 'The resilience of the service must be very high.'

National Specification for Integrated Care Records Service (consultation draft version 1.22).

www. doh. gov. uk/ipu/whatnew/specs_12d. htm