Could X-rays Be New Route To U.K. EHRs?Could X-rays Be New Route To U.K. EHRs?

The U.K.'s health informatics professionals have been tasked with building a paperless National Health Service (NHS) -- with an electronic health record (EHR) structure as its basis.

As many observers were quick to point out last month when the U.K. government issued the diktat, the country has tried this before. With the 2002-2011 National Program for IT, large budgets were given over to create 21st-century tech systems for the National Health Service (NHS). At the heart of this plan was a vision of a country-wide EHR (also known in the U.K. as electronic care records).

Critics pointed out over the course of the program that little EHR software was actually getting into the hands of clinicians. The Department of Health, the piece of central government that runs the NHS, pooh-poohed the naysayers for years. But the program's ability to deliver anything close to a national, integrated EHR was finally put to an end by a damning report by an independent state spending watchdog, the National Audit Office. In May 2011, the NAO shocked many commentators by deciding that the $2.7 billion (£1.7 billion) spent to date on building that national electronic care record was "not value for money" and the remaining $5.4 billion (£3.4 billion) tagged for further work on that front should be reallocated.

[ For more on the U.K.'s vision of a national connected medical records system, see U.K.'s EHR Scheme To Copy Obamacare. ]

As a result of the report, contracts were halted in August 2011. The U.K. government's official stance since then has been that hospitals should work to build their own EHRs instead. That seemed to fly in the face of common sense for some observers -- but we are talking about government here.

Now a possible way forward may be emerging for healthcare IT leaders, and it's based on an obscure method for sharing data in a completely different medical technology context. VNA (vendor-neutral archive) is a marketing concept from the X-ray industry in which image-recording devices allow access by devices from other manufacturers. This is especially important as most hospitals now use PACS (picture archiving and communications systems).

PACS have become quite standard in U.K. hospitals ('Trusts') as they eliminate the expense and hassle of working with wet film. As part of the terminated National Program, many Trusts outsourced the management of PACS data stores; X-rays aren't always large files, but multiple-slice CT scans can add up to gigabytes of information.

The problem -- which might turn out to create a new EHR opportunity -- is that government says Trusts can't keep using their National Program contracts to store these image files. So Trusts must figure out a way to build their own data centers to store all this data.

A proposed solution is to use new software to share PACS images along with other EHR documents. The advantage of this approach is that it would allow individual Trusts to continue using open standards in order to exchange patient medical records with other care providers, while also being able to choose the IT companies they work with, the types of systems they implement, and the way in which they prioritize and tackle projects. VNA might be an ideal solution for providing digital access to medical images and more.

"Trusts are finding that many successful EHR initiatives derive from digitizing paper records," said Mark Winstone, European sales and marketing director at SynApps, a company that markets a VNA document management system from EMC.

The vision is for clinicians and supporting staff to have secure yet straightforward access to their patients' full case histories, including latest physician notes, prescription details and test results, to improve patient safety and deliver better outcomes. "We're now talking about extending that digitization to deal not just with their PACS challenge, but to start getting ready to build EHRs too," said Winstone.

The ultimate role of VNA in delivering EHRs is not yet clear. But what is certain is that to achieve the goal of a paperless NHS and a system of national interoperability for the medical records of U.K. citizens, health content must be digitized and the content easily searchable. Challenges such as standards disputes and discrepancies in how different PACS systems tag information will also need to be overcome.

Companies like SynApps say the answer is to shift to extended enterprise content management. It's an intriguing idea, but it's still too early to see which path hard-pressed U.K. health informatics professionals will choose.