Why don’t hospital computer systems link up in the NHS?
In this article we will explain why hospital computer systems do not link up in the NHS – and what else they don’t link to.
Key points
- The NHS is very big, perhaps too big. It spends 10% of your hard-earnt taxes. Costs £180 billion a year. The biggest employer in Europe, 5th biggest in the world etc etc. This is a big part of the problem
- They should
- They could. They can (Amazon do it, internationally and nationally .. there isn’t a County Something-shire Amazon)
- Hospital and other NHS IT systems don’t link up either. Most hospital computers are not linked to other parts of the NHS, e.g. your GP or pharmacist (where it would be useful to share knowledge)
- They all may do one day (don’t hold your breath).
Hospitals and hospitals
With very few exceptions .. different hospital computer systems do not link up,
Consequences (examples .. there are many others)
- If you see a hospital specialist at a bigger teaching hospital further away and a specialist at a smaller local hospital, they will not know what the other is doing (or even their name) or tests they are doing; this can easily lead to mistakes especially related to prescribing
- This is why hospital doctors will (infuriatingly) often ask you to have blood tests etc at their (distant) hospital (10+ miles away and nightmare expensive parking) when its alot easier to walk to your local pharmacist. Why? If this is not done, the doctor requesting your test will not be told its done, or be able to see the result and act on it
- If you are admitted to one hospital and then another (even if its nearby) the teams will not know why you have just been admitted somewhere else, what the diagnosis and treatment was, and what tablets you were sent home on. Ditto.
Other IT systems, hospital computers could usefully link to
Hospitals and GP systems
Not much. A little (locally)
Consequences
- Your GP is not reliably informed of every hospital admission. A thing called a discharge summary is written after every admission summarising it and giving the drugs you were sent home on. They are also not reliably informed about every procedure, operation or outpatient visit. Tablets are often changed at the latter, and the GP and pharmacy computer systems are not updated. So you need to make sure all information (especially including your mediation) are aligned by keeping good medical records
- The hospital doctors cannot see what the GPs are doing
- If you have a serious (and well documented on one computer system) drug allergy, the ‘other side’ will not automatically know you have it; so you can receive a drug that causes a fatal allergic reaction. No, not good.
Hospitals and your local pharmacy
Nada.
Consequence. As outlined above, if a hospital doctor changes your tablets, your local pharmacy is not informed, so your next prescription will be your old drugs. This is why hospital doctors ask GPs to prescribe new drugs. They are not being lazy. They are usually only allowed to prescribe a drug for 2 weeks; and this (potentially new) drug does not become a recurring prescription at your local pharmacy, even if it is meant to be.
Hospitals and mental health
Nyet. “Now why would we want to know how physical and mental health are linked and affect each other?”
Consequence. There is poor and uncoordinated holistic care of physical and mental problems in the NHS.
GPs and dentists?
Yes, you guessed it. Zero links
Consequence. If you have a well documented serious antibiotic allergy (e.g. to penicillin) on your GP system, your dentist will not know this and can easily prescribe those antibiotics for a dental abscess for example.
Hospitals and dentists
Zero zero. “Ok Ok. Thankyou MyHSN .. we get the pattern” [“well you did ask if they were linked up!” MyHSN Ed]
Hospitals and ambulances
不
Definitely no links. Ambulance staff cannot see anything on your hospital or GP record .. not even where you are getting specialist hospital care, or for what illnesses.
Consequences
- They may well take you to the ‘wrong hospital’. They will usually take you to the nearest hospital. This can have disastrous consequences, e.g. if you are on dialysis and are taken to a hospital with no dialysis facilities
- If you are frail and elderly, and have a community ‘do not resuscitate’ form written for you, stating you do not want to be admitted to hospital (say after a fall), ambulance staff will not know this; and you will be taken to hospital and potentially admitted.
Hospitals and social care
No was hose.
Consequence. There is poor and uncoordinated holistic care of medical and social problems in the NHS, council, and UK in general.
NHS and private hospitals
Ditto.
Consequence. With ever growing NHS waiting lists (especially for operations) more and more people are having them done privately. Your hospital doctors and GPs are not automatically informed about this care. Private doctors also cannot see information about previous and planned NHS care.
Hospitals and anything else that they could usefully link to
Nil pointe.
Overall consequences
- It’s an awful mess.
- “Oh, so not being linked up can damage me? Potentially kill me?” [“well .. yes .. sorry” Ed].
SO. Why don’t they link up (when technically possible)
- Money. Electronic patient records (EPRs) – that can link hospitals – are very (very) expensive
- Lack of long-term strategic vision – and ‘joined up thinking’ at DHSC, NHS England and NHS Digital (perhaps over-focused on the NHS app), combined with constantly changing governments, and changing Ministers of Health – all with different priorities
- Poor choices. There are not that many off-the-shelf ‘healthcare EPRs’ out there. And the ones that do exist, are usually designed for other countries (especially the USA); and are either OK and extremely expensive (EPIC), or poor and expensive (Cerner, e.g. £200m to buy, £7m a year to run .. and takes 2 years to set up!).
EPRs (e.g. EPIC and Cerner)
EPIC and Cerner are called ‘electronic patient records’ (EPRs) and are designed to link up local hospital groups (e.g. in county-sized subregions). They are starting to be set up in the UK, presumably with a view to linking up with nearby similar systems; which one day, when all linked up, maybe become the IT Holy Grail .. a National NHS EPR (maybe!).
Being American, these are really IT billing systems with the clinical information added on; and are presented illogically and confusingly. They are clunky, non-intuitive and hard to use. This makes the NHS staff using them grumpy, not a good start when you got to see them.
Also, being American, where GP care is poor, they are not designed to be used in a larger and more complex healthcare system like the NHS; where GPs, hospital and mental health doctors (and pharmacies) are theoretically part of one system.
When NHS hospitals and subregions choose these, they make things worse; as it stifles other better UK-based software designers coming up with something better. Or indeed the NHS could come up with better systems.
Let’s be positive
One day (maybe in mid 2030s) there will be some form of more complete regional (or subregional (county sized) medical record), used by hospitals, mental health and GPs in your patch.
The long-term goal of an ‘everything national system’ seems a long way off here in 2024.
What you can do to help
There are things you can do to help. And, yes, it is partly your responsibility to act as the glue in the system, when you know information is not shared.
- Move house [“joking” Ed]. Actually its not such a crazy idea. People that live nearer the big teaching hospitals (usually) get alot less IT problems than people that live in more rural areas. Border zones are a particular problem
- Make sure all medical information about you (especially including your medication) is aligned – by keeping good medical records, and passing this to the doctors in the NHS you are with today.
Summary
We have explained why hospital computer systems don’t link up in the NHS. They should, they can, they might do (one day). We hope we have explained why this is such an infuriating issue for the public. And we are very sorry. There are things you can do to help, to act as glue in the system, until it is all sorted.
Other resources
The NHS did have a massive long-term project to bring in a National NHS EPR. After spending £10 billion of your money, without producing a useful system, it was abandoned in 2013
