For eight years we have been passing clinical data between disparate remote computer systems using simple, cheap solutions. For example, pathology reports are now routinely transferred without human intervention from the computer system in this laboratory to 302 GPs in 47 practices, who use seven different clinical computer systems. Although none of the systems was designed for this function there were few technological obstacles to the implementation.
You are right to reject the option of central purchasing or a single imposed national system. We doubt whether it would even be wise for the Department of Health to 'make a shortlist of approved software and hardware'.
Furthermore your call for guidelines has been answered before it was made, at least in the area of message transfer. The Information Management &Technology Strategy which was launched this year by the NHS Management Executive takes precisely this approach.
We also disagree that doctors should not be involved in the technical aspects. Many useful clinical IT solutions have come about because of enthusiastic practitioners. The problem lies in combining this enthusiasm with the general management of an organisation as complex as the NHS.
Yours faithfully (but unfortunately not directly to your computer),
JONATHAN D. S. KAY
Department of Clinical
John Radcliffe Hospital
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