The National Health Service and the internet

Abstract

MRCGP J R Soc Med 2003;96:490-493 'As a general practitioner piloting 21st century electronic links across the healthcare system, you get a thrill each time you send a prescription direct to the pharmacist. Then you find that, because pharmacists now telephone holders of uncashed prescriptions, your drugs bill is up by 20%. Equally, some of your patients send thoughtful emails, but you need nearly two hours a week to respond properly. Investment by the National Health Service (NHS) in internet infrastructure will open new opportunities for patients and clinicians. The initial funding was prompted by the 1998 report Information for Health, 2 and an additional £500 million is promised over the next few years. 3 Modernization of the infrastructure 4 includes not only better access to information sources 5-7 but also electronic transmission of prescriptions, electronic appointment booking and enhanced medical records. But how will patients and clinicians use the internet? The effects of this IT (information technology) revolution on practice and organization are not all predictable, 8,9 as Wyatt and Keen indicated in the above quotation. 1 In this review I look at how the internet is being used at present and try to identify emerging patterns. The paper is based on material obtained from a Medline search under the terms NHS AND Internet, Internet AND Outcomes AND UK, and Internet AND patient AND Information AND UK. This yielded 213 papers, in 47 of which the abstracts referred either to use of the internet in clinical care or to sites designed to improve the quality of care. The websites of the Department of Health and the NHS Information Authority were also searched with these terms. To obtain a consumer perspective, I used the Google and Yahoo search engines to identify the most popular websites. STRUCTURESInvestments by the NHS to improve access to internet technology and online information (for patients as well as clinicians) are being made in communications infrastructure, hardware and software licences. 10 How the infrastructure is to be set up is being determined centrally, and national contracts will be awarded. A start has been made on the measures necessary to ensure confidentiality of patients' data. The NHS has set up three core information services:. The 'Official NHS Gateway', also known as dot-NHS, dot-UK. 7 This has links to information about the services provided by the NHS and to league tables and star ratings . NHS Direct-on-line, 5 designed to provide clinical information for patients . National electronic Library for Health, 6 a portal to evidence-based medicine for professionals.The three differ in design and lack any common indexing system or search mechanism; consequently the user will have difficulty in merging the resources they offer. Outside the NHS there are few fixed structures, with the notable exception of those provided by the US National Library of Medicine (NLM). The NLM's range of biotechnology resources includes PubMed Medline, with its searchable archive of over 11 million j...