Software standards and the NHS

nhsLast week I attended an open debate at the British Computer Society (BCS) in London, which was a discussion on Personalised Health & Care 2020 (PH&C 2020). This is a “framework for action” produced by the NHS National Information Board. It runs in parallel with the NHS Five Year Forward View (which contains a commitment to exploit the information revolution).

One of the major topics discussed was the emergence of the Federation of Informatics Professionals (Fed-IP), which involves not only the BCS but also the UK Council for Health Informatics Professions (UKCHIP) and the Institute of Health Records & Information Management (IHRIM). Collectively, these three autonomous bodies will “work closely together to ensure that health informatics is recognised as a valued profession across the UK”.

This is a laudable objective, but how is it to be achieved? Surely not by the repetition of platitudes.

UKCHIP says it is the voluntary regulatory and registration body for individuals working in health and social care informatics. “Leading the Profession : Protecting Patients : Improving Care”

Dr Dan Poulter MP, Minister for Health, says “Strengthening the status of the informatics profession is needed across health, public health, care and support to ensure we recruit and retain the best information and IT specialists”.

Beverley Bryant, NHS England Director of Strategic Systems and Technology, says, “Professionalism in informatics and all that goes with it is at the heart of our vision for safe, technology enabled and patient centred care.” She follows up with, “I want to see every informatics job advertised with the person specification including as desirable, if not essential, evidence of signing up to a professional body.”

Voluntary membership of a professional body to be “desirable”… Where are the teeth in that?

It’s easy to knock initiatives like this. There’s no doubt it’s a step in the right direction but can we honestly say that encouraging systems and software engineers to belong to a professional body will put an end to “white elephant” public sector projects in the Health sector or anywhere else?

Perhaps the most encouraging recent news is that the Royal College of General Practitioners (RCGP) and the Royal College of Physicians (RCP) are looking at establishing a Faculty of Medical Informatics, to create a new medical sub-specialism. At least the medics know what it means to be professionally qualified, and what happens if such qualification is lost.

My business, Critical Software Technologies Ltd, operates mainly in safety critical software, such as for avionics systems. When such systems fail they don’t just embarrass and frustrate people, they kill them. In safety critical systems, it’s never considered enough to simply ensure that developers and implementers are suitably qualified. What they do – their specific output – has to be reviewed, independently, so as to ensure it has been done to rigorously defined standards. DO-178C in the case of avionics, but other industries follow similar guidance from, for example, the IEC 61508 family of standards.

There is no mention of development standards in PH&C 2020. The lack of consideration given to their use is exemplified in the second section. When making a comparison between the adoption of technology in healthcare and in aviation, ticketing is used as the comparator rather than avionics. Agreed, the discussion is about medical records rather than real-time decision-making, but incorrect, inadequate or lost records could ultimately have consequences much more disastrous than mere embarrassment or frustration.

Achieving the vision set out in PH&C 2020 is a massive challenge. In all probability, there will be a patchwork of partial successes. For further progress in the five years that follow the current plan, we should hope not only to have established an enforceable set of ‘qualifications to practice’ but also some meaningful development standards to ensure the quality of delivered systems.

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