Monday, 28 January 2013

The world's most digital health service - the NHS?




There has been a recent spate of articles alluding to the NHS becoming the most digital health service (see http://www.telecareaware.com/index.php/the-nhs-to-become-the-worlds-most-digital-health-service-uk.html).  For over ten years I have been listening to people telling me that the NHS is to become paperless.  To some degree I think it will and it has, but I am always alarmed by the notion of a paperless office or paperless business.

I do as much as I can on line, this is not because I do not keep paper records, because I do, rather it is because there is insurance from storing things online and completing things digitally, which is the digital footprint.  When I pay a bill online, I leave a digital footprint behind, and I receive online confirmation as well as, in most cases, an email confirmation that the bill is paid.  For me, this is a double insurance policy that I have two forms of proof of payment. This is traceability.

The addition of cloud services have allowed me to use online storage space to keep track of important data which I might require wherever I am. This storage means I can access my data wherever I am located as long as I have an internet connection.

This same principle is used in the new NHS. People can stay at home whilst their medical information is in virtual space.  This allows health practitioners to undertake virtual consultations, and telehealth some products to function appropriately. 

I fully embrace the digital health record and the ability for my health data to be shared between practitioners at a touch of a button.  All this is brilliant.

What I am concerned about is what happens when electronic data is corrupted or lost - when there is a critical failure.  The necessity for paper backup data is even more important if we are to use paperless working practices.

When I worked for a local authority, as well as when I worked for universities, and even now when I work from home as a writer and consultant, I require data to be available 24/7 and in a range of forms. In the event of a power failure, I have back up power from the batteries in the devices, this is limited but does allow me to continue working. I have things stored offline as well as online so I can refer to the most important data whether power is on or not. Similarly as the Internet is prone to being hacked or ISPs crashing off line printed data is critical to maintaining my working practices.

There are so many difficulties with relying solely on the use of online data and online data storage that it does not require me to even start to describe them, but it is important to realise that although online data is preferable in many cases the limitations within the health arena are many.  A good illustration of this is the use of Xrays or MRIs which provide images to the Dr’s desktop within minutes.  This allows the Dr to make a speedy diagnosis.  If this were changed to pictures of moles looking for cancerous indications, this will depend on the quality of the camera image and the screen image to make diagnosis a possibility.

As we increasingly rely on health technology, such as telecare, telehealth and mHealth systems to be used to support and ameliorate care in the community it is critical that the powers that be understand the areas where critical failures are likely to occur and take steps to prevent this causing a system that could work well from crashing.

So digital future is good as long as the paper is available to keep it from failing.

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