The Internet and 'e-business' - 
a guidance note for NHS Board Members
Preliminary Discussion Draft v0.1 Nicholas Beale 29 Sept 1999
Comments on this are actively solicited - please email nb@sciteb.com
- In 1998 the NHS Executive issued Guidance
for NHS Board Members on Addressing Information Management and Technology
in NHS Organisations. This was written by a working party led by the
Worshipful Company of Information Technologists (WCIT)
involving the NHS Executive,
the National Audit Office, the Audit
Commission and the British Computer Society (see wcit.sciteb.com/guide).
The successor to the Working Party responsible for this Guidance is
responsible for keeping the work up to date and for issuing short supplementary
notes. This is [or will be when approved] the first.
- The Internet is a system of communication which is comparable to the telephone.
In principle it is possible to pick up the telephone and communicate with
anyone else in the developed world. Similarly, any computer connected to the
Internet can communicate with any other computer, exchanging information by
means of well-defined 'protocols' such as Hypertext Transfer Protocol (HTTP).
A business which is cannot interact with its 'customers' and suppliers by
telephone is essentially cut off from the modern economy: a hospital without
a telephone system would be grossly disfunctional. Already all major businesses
in the developed world depend heavily on email and other forms of electronic
communication: by 2000 the Internet will certainly be the dominant medium
of communication between substantial organisations, and one of the most important
channels whereby consumers and members of the public obtain information: it
is already the dominant communication tool in universities, and any one recently
graduating will be pretty familiar with it.
- The importance of the Internet is acknowledged in the recent Government
White Paper ecommerce@its.best.uk and by all major businesses. Two
of the most valuable companies in the world are currently GE
and Microsoft. The Internet has transformed
Microsoft, which relies heavily on e-mail and other Internet technologies.
In GE, which is a collection of more traditional businesses, the Chairman,
Jack Welch (widely seen as the world's most admired manager), has recently
decreed that every GE senior manager, including himself, must find
an Internet Mentor from amongst the young people in their firm and spend two
hours per week with them, to learn how to use, and think strategically
about, this new communications dimension. Board Members should encourage
a similar system of Internet Mentors is their organisations.
- The Internet was developed to assist researchers who had to collaborate
although they were in different places, and it is ideally suited to the distribution
of information to Boards and Committees. Instead of distributing reams of
paper, the agenda for a meeting can be emailed with the necessary attachments,
and further information can be obtained by 'clicking' links in the documents.
Comments and questions on the documents can be circulated to colleagues with
the click of a mouse. The software to do all this is freely available. It
is better and cheaper for NHS bodies to train the minority of Board Members
who are not connected to the Internet, and lend them suitable equipment, than
to persist in the present paper-based systems. Far more importantly, a switch
to electronic distribution of Board Papers will improve decision-making and
develop a web-literate Board. Board Members should switch to electronic
distribution of 'papers' as soon as possible.
- Security and confidentiality are serious issues in the NHS, as they are
in most commercial concerns. Companies set up Intranets so that they
can make information available in an 'internet-like' way internally, but not
to the outside world, and extranets so that such information can be
available to selected partners in a more or less secure manner. They use computer
systems dedicated to controlling information flow between two networks ("firewalls")
and various other security measures. This is a rapidly evolving field and,
as with all security measures, there is no system that is completely un-beatable.
On the other hand, any competent IT security system would be harder to penetrate
than existing manual and semi-manual systems, provided that users
who authenticate themselves properly can only access the confidential information
that they really need, and that no users are given un-restricted access. Board
Members should ensure that, as part of the overall IT Policy, there is a security
policy that is effectively implemented and periodically reviewed and enhanced,
recognising the legitimate ethical concerns of patients and professionals.
- In common with most substantial organisations, NHS Bodies
are acutely conscious that they have multiple overlapping IT systems
with data held in incompatible formats. Although the problems
of dealing with such systems are considerable, there is such commercial
demand for solutions that effective remedies are emerging. These
all involve making the data in each system available over the
network, using technologies (CORBA, XML and Middleware are the
key buzzwords) that enable information to be gathered, shared
and transformed. Access to this information is increasingly through
the standard browser interfaces that are used to access the Web.
This makes the user's life simpler (since they only have to learn
to use a browser, which is a valuable generic skill) and reduces
the cost and complexity of the equipment they need. It also makes
it easier to switch from one application to another. It provides
a significant element of 'future-proofing' in that all personal
computers for the foreseeable future will have a browser interface,
and allows the deployment of mobile hand-held devices that access
the Web efficiently. Because this is now the clear strategic
direction of all major IT vendors, plans that are based on earlier
assumptions risk becoming obsolescent. Board Members should
ensure that that IT Plans have been reviewed recently for the
impact of the Internet, and that any systems which deviate from
the Web-enabled Browser-based interface view and subject to rigorous
scrutiny.
* * *
We hope this is a useful first draft. I believe we should keep this document
down to two pages if at all possible.
Click here to go to the guidance website.