If you earn your living telling people that computerising the NHS is an expensive and near-impossible business, don't visit Highland trust at Inverness. The shock could be too great.
By picking targets carefully and using a sound blend of old and new technology, the trust's Raigmore Hospital has put itself in the top rank of NHS IT users. And it has done it at a fraction of the cost and disruption of a major hospital information system project. The lessons for the NHS in England, on the second anniversary of Information for Health, are obvious.
Raigmore's achievements so far include: an intranet providing 7,000 pages of information that staff actually use (including continuously updated information on bed status), electronic results-reporting and discharge letters which communicate with the pharmacy for discharge prescriptions. The results-reporting system, which has more than 500 registered users, now delivers reports from laboratory, pathology and vascular imaging.
The hospital is also piloting direct booking by GPs as part of a Scotland-wide initiative to ensure that by the end of March 2001, half of all GP-referred patients will know the date and time of their hospital appointment when they leave the practice.
Other projects under way include tests of biometric security with fingerprint readers as part of the planned electronic order-entry system. (Managers prefer the term 'test request' over order entry - a small acknowledgement of the professional status of laboratory and radiography staff that other senior managers would do well to adopt. ) Of course, Raigmore is not alone in making progress - the NHS is gradually becoming populated with good IT role-models. What is remarkable is the progress that has been made at so little cost. Mike Lister, head of IM&T, estimates that the results-reporting system cost£80,000. The bed-status system was knocked up in a few days as part of preparations for the millennium.
These are the kind of outcomes that used to be associated with multi-million pound hospital information systems.
No prizes for guessing what made the difference: the arrival of browser-type technology, which, with the right interfacing, creates a friendly and flexible front-end for a legacy patient-administration system. Suddenly, the PAS becomes a repository for an almost unlimited number of systems, with a standard web browser look and feel. Hypertext links a patient's name with the laboratory test results for that patient, for example. The bed-status system updates its data from the PAS every 10 minutes.
The other secret was the picking of relatively easy targets - what management consultants would call 'low-hanging fruit' - and ones that deliver real benefits to care. Hence the concentration on electronic results-reporting before order entry (sorry, test requests).
The direct-booking pilot also sensibly concentrates on routine appointments only: allowing urgent cases would raise fears that GPs might abuse the system.
The NHS in Scotland, rightly, takes a certain pride in getting its IT in shape ahead of the rest of the UK. It's interesting to ponder why. Scottish NHS organisations are less prone to the not-invented-here syndrome. The tradition of central guidance of IT was less damaged than in England - about 60 per cent of Scottish GPs still use the standard GPAS practice-management system, for example. Of course, the picture isn't all rosy: spend long enough in Scotland and you'll hear the same stories of incompetence, buck-passing and wasted resources that you'll hear in health service IT projects the world over.
There's no reason, however, why the best parts of Scotland's experience - such as the Raigmore story - could not be duplicated elsewhere.
This suggests it's now time for government to crack the whip a little harder. The rest of the public sector is working towards a national target of delivering all information services and transactions electronically by 2005. Hopelessly unrealistic? The equivalent target in the US is 2003.
By those standards, coupled with the leaps in affordability and practicality demonstrated at Raigmore, the targets set in Information for Health look distinctly modest.
Let's have some tougher ones.