The establishment of a health care network between the hospital and the general practitioner

Amsterdam 23 April 1998 As the Managing Director of the National Health Service (NHS) Telecommunications Branch in the United Kingdom (UK), Mr. Tony King was offered the occasion at ITIS'98 to present the recent evolution of the network facility tender, issued by NHS. The overall idea is to build a system network, connecting the general practitioner's (GP) offices to the hospital sites to allow direct access to essential patient related information as well as to book immediate hospital consultant appointments. By the end of 1998, several demonstration sites will be set up for testing. A year later, it should be possible to transmit the hospital test results to the GPs' surgeries. Finally, in 2002, the network services will be made available across the country.

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As the Managing Director of the National Health Service (NHS) Telecommunications Branch in the United Kingdom (UK), Mr. Tony King was offered the occasion at ITIS'98 to present the recent evolution of the network facility tender, issued by NHS. The overall idea is to build a system network, connecting the general practitioner's (GP) offices to the hospital sites to allow direct access to essential patient related information as well as to book immediate hospital consultant appointments. By the end of 1998, several demonstration sites will be set up for testing. A year later, it should be possible to transmit the hospital test results to the GPs' surgeries. Finally, in 2002, the network services will be made available across the country.

The Telecommunications Branch within the NHS only exists since four years. Before, a lot of money was being spent on aging analogue systems which were quite expensive to maintain. Since sufficient funding always forms a painstaking issue, Mr. King and his team decided to bring together a group of telecommunications experts to establish voice telephony in order to save money. They reduced the number of lines in hospitals and started to invest in handheld telephones. The NHS was rather keen on establishing a modern network to decrease the vast amount of paper records and to dramatically reduce the time for making test results available.

Since eighty percent of the GPs in the UK were already computerised through health link, the experts had to try and incorporate this service into the new network. Currently, four to five hundred GPs are connected to the NHS system and this will rise to a number of 20.000 in the future. The original concept aimed at one spine network to which other networks had to connect. Ten organisations responded to the tender for the establishment of an X400 1988 MMHS system. It was important to assign the contract to a company to which networking constituted the core business, in order to allow the NHS to draw from a large pool of resources. Further more, the system had to be equipped with built in firewalls.

The organisational structure consists of a head office in Birmingham and eight regional branches. In addition, local user representative groups, consisting of GPs or hospital authorities, have been appointed to guarantee efficient functioning of the network. Each of these groups has a chair, who takes part in the nation wide network board. This board informs the NHS Telecommunications Branch of what is expected from the network capability. The telecom and cable suppliers are managed by the NHS and these four parties, which all together own the network. Thus, the open management structure allows for true user participation.

As for security problems, it is quite easy to make a network so secure that it becomes unusable. The challenge is to find a balance between sufficient risk reduction and efficient access to the system or in other words, between value and safety. The major problems relate to unknown external connections; general support of dial-in services; inadequate access controls on end systems; unsatisfactory internal systems management; and unknown impacts as a result of incident. The NHS met these issues both on a technical and a procedural level. The King team introduced authentic measures, access controls in the network, controlled gateways to other networks, and the use of encryption. A security officer has been appointed to manage the authorisation procedure.

A few difficult hurdles still need to be taken, namely the search for funding, the need to convince the critical mass of GPs, the implementation of new security arrangements, the delivery of applications, and the divergence between computer power and bandwidth availability. But, as Mr. King states, "The future is only limited by fear". He has a dream of a Universal Mobile Telephone System which soon may come true, considering the rapid progress in satellite technology. In this way, network facilities promise to become available to nothing less than 99.5% of the addressable population.


Leslie Versweyveld

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