The big screen

This week, the Prime Minister launched celebrations for the NHS’ 60th birthday with a speech promising to make the service more personal and preventative.

His proposals were to move blood screening, electrocardiograms and ultrasounds to the GP surgery and introduce new free screening for stroke, diabetes, heart and kidney disease.

Available free to patients identified as vulnerable, the service has been pushed for by the Diabetes, Heart Disease and Stroke (DHDS) Prevention Project since 2005.

A suitable screening system will now need to be built to hold the details of thousands of patients who take up the opportunity and eventually this will need to be integrated with the Care Records Service central database.

Existing services

How do current screening services cope with integrating data collected from trusts across the country?

The NHS Newborn Hearing Screening Programme (NHSP) is in the process of centralising its database containing test results from 182 different maternity trusts in England.

They are using InterSystems’ Ensemble integration platform to remove the need for manual importing or duplicate entry in their system.

NHSP’s head of communication and IT, Nick Waddell, told EHI: “One of the big problems in the past has been that the actual test equipment which the baby is screened with hasn’t been able to integrate its test results fully with eScreener Plus [the system for storing results], relying on manual input, and this caused some problems.

“There have been clinical instances where data has got lost and in some cases, data has been changed by screeners, either accidentally or on purpose. We wanted a system which would introduce safe clinical governance, securely storing data automatically, which cannot be tampered with unnecessarily.”

The new arrangement will enable the eScreener Plus to interface with these devices and automatically feed the data collected to the system, eliminating the need for manual data entry.

Working with Connecting for Health (CfH), the NHSP has ensured that all hospitals and PCTs can securely transfer data over the N3 network. Community based screening will also be able to use the system securely transferring data over a special secure portable modem.

Another screening service which has used InterSystems technology to centralise its database was the NHS Breast Screening Process, which consolidated four systems into one covering all 90 screening offices.

Sarah Cush, assistant director of NHSBSP, said: “The NHS Breast Screening Programme is continually looking to take advantage of developments in new technology. The upgraded NBSS system enhances the quality and efficiency of the service we provide to women, by making data more accessible and improving the reporting facilities for staff.”

The service is in talks with CfH about further improvements, including the development of generic interfaces to work with picture archiving and communication systems to attach digital mammography images to records used by the screening service.

Key role for Connecting for Health

A CfH spokesperson told EHI that the agency was committed to working with all national screening projects through the NHS Connecting for Health Systems and Service Delivery programme – formerly the National Health Applications and Infrastructure services (NHAIS) team.

“The Systems and Service Delivery team provides professional software development, support and hosting resources which are targeted to deliver high quality services and support to NHS Connecting for Health and the wider NHS. It is responsible for the delivery of national systems and ensures the maintenance and business continuity of some 38 products and services which underpin several key areas of the NHS, including national screening services.

“Another key role targeted is the development and execution of the migration plans to move users from existing to replacement NHS Connecting for Health services and developing new applications and tools on behalf of NHS Connecting for Health. The team is presently engaged in the delivery of the second phase of the National Bowel Screening Programme, Temporary Numbers Project phase 2 and the final stages of the delivery of the HealthSpace development programme phase 1.”

Gordon Hextall, chief operating officer of NHS Connecting for Health, added: "The Systems and Service Delivery team is integral to the success of NHS CfH. The team is maintaining a series of business critical systems for the NHS as well as developing new systems and migrating to the strategic systems. The team is delivery focused and produces high quality work for NHS CfH helping us to achieve our business objectives."

Move to GP surgeries

In primary care, diagnostic procedures such as blood screening, electrocardiograms and ultrasounds will move to GP surgeries. However, some suppliers told EHI that they are already prepared for such a transition.

In Manchester, 150 GP surgeries are now using a heart-check by phone – telemedical ECG service developed by UK company Broomwell. The service has earned praise from the local SHA for saving thousands of people from the stress and worry of hospital visits, and freeing up hospital resources.

Manchester-based GP, Dr Jonathan Lieberman said: “The system is great for use in diagnosing patients with chest pain symptoms. As a rule, patients would be referred to the local hospital outpatients department for an ECG to look for any signs of a cardiac illness. Now I can do an on-the-spot test in my surgery and get a simple phone call to tell me the extent of the cardiac problem and if the patient needs to be admitted to hospital or not.”

Broomwell’s cardiac monitoring service provides non-specialist GPs with expert cardiac diagnostic support. Practice nurses carry out ECG readings and the results are transmitted as a sound signal by telephone to Broomwell’s 24 hour monitoring centre in Manchester, whose staff provide an immediate verbal evaluation, followed by a written report, emailed back to the surgery in minutes.

The message from the IT community in response to Brown’s speech on the NHS seems to be “we are ready for the change.”

Joe Fernandez