The health service has a problem with computer standards. They keep on changing, just as the NHS catches up. It is a problem senior managers are trying to tackle, mostly by imposing centralised projects and standards. Meanwhile, those on the ground floor trying to implement new systems can get caught in the middle.
In November, junior health minister Gisela Stuart signalled a major shift when she announced that NHS systems will now be based on computer standards mandated as part of the e-government inter-operability framework (e-GIF). This framework has been developed so future IT systems in all parts of government can talk to one another.
The main impact is in two areas: e-mail, where there is a move from the older X. 400 standard to the newer SMTP; and document messaging, where the health service will now migrate to XML, rather than the existing EDIFACT standard.
Although the NHS Information Authority was debating the benefits of XML before Ms Stuart's announcement, it has since endorsed the move via the new IT strategy, Building the Information Core - implementing the NHS plan. XML is widely used as a document-transfer standard. Based on a much earlier standard (see box), it has come into its own over the past few years as Internet-based messaging has taken off. Documents can be transferred regardless of which system is used at either end - unlike EDI standards, where the same system has to be at each end. XML has many supporters in the NHS IT community.
Sean Brennan, head of healthcare strategy at supplier Northgate Information Solutions, says because XML is systems-independent, it cuts down on integration issues, reduces messaging problems and enables people to capture information in a standard format, which can then be analysed.
This will help clinicians as they look at clinical governance, he says. 'At the moment, clinicians have to wade through paper records to try to see how effective they have been. 'Mr Brennan points to the use of XML at the Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry, where an XML system has been live for the past two years. It contains half a million documents, covering 50,000 patients.
Andrew Roberts, consultant orthopaedic surgeon at the hospital, says medical data structured in XML allows examination of clinical activity with a power and scope never previously possible.
Tony Sharer, operations director at software firm Graphnet, agrees. 'The NHS needs a low-cost way to handle information and make free text work like a database, because 80 per cent of medical information is free text, ' he says.
The downside lies in two areas: first, parts of the NHS are already successfully using the existing EDIFACT standard. They will now have to decide whether to migrate. Second, some projects, notably pathology messaging, are in the middle of trying to set technology standards.
In the first case, says Dave Browett, product development manager of CSW Healthcare, there is no point in losing investment in existing systems. 'They should take stock of where they are, but new projects should go straight in. '
What about projects that have been running for some time and still need to make technology decisions? The Royal College of Pathologists has been working with NHS managers since 1992 on developing a computerised pathology messaging system.
Dr Jonathan Kay, pathologist at the John Radcliffe Hospital in Oxford, chairs the college's informatics committee and says managers have a difficult decision. At the moment, the messaging system is based on EDI, which was, says Dr Kay, good technology when the system was first put together. 'But these topdown projects are so slow and so hard, ' he says.
Should people change to XML now, before the project rolls out, or go ahead with the EDIFACT standard?
Dr Kay feels there is little point in rolling out a project based on what is already officially a redundant standard. For many people, Internet browsing is becoming a messaging standard. 'Why not simply access these messages via a browser?'
It seems technology rolls on apace, overtaking the NHS's slow decision-making processes.