Joe’s view: of records standards

14 July 2000. My 10th wedding anniversary. I am in central Rome, near the Spanish Steps, in a shockingly bad hotel where I have slept fitfully.

My wife and I had arrived the previous night, having booked a flight with Lastminute.com (who were all the rage at the time). What I had hoped would be an impulsive and romantic weekend break, harking back to the earlier days of our relationship, has gone badly wrong.

To the Hotel de Russie, with love

I had reckoned without Rome film festival, which has booked out every decent hotel room. Once we landed, we had to roam the streets before checking into the Hotel Skinflint.

The peeling paintwork in the room is stained with what I hope is coffee and red wine. Fiona's face is like thunder and we retire to separate sides of the saggy old bed; which does its best to throw us together despite the frosty atmosphere.

At 6 am I wake to the nightmare, Fiona's last words of the previous evening ringing in my ears: “This is all your fault. I told you to book something months ago."

With something of the air of the ancient mariner about me, I rise silently and dress in the dark, exiting the room without waking Fiona, tiptoeing down five flights of creaking stairs.

Outside, I glimpse the Dome of Saint Peter’s and head towards it. Surely, if I walk towards the centre of power, I will encounter a swanky hotel where the application of a substantial amount of money or saintly intercession (I'm praying too) will salvage the big anniversary weekend.

I round the corner into the Piazza Del Populo and spy a doorman in a top hat minding a gleaming glass door. The flags of many nations fly above the door and it has its own red carpeted stairs up from the pavement. It’s the Hotel de Russie.

Dressed in an old T shirt and jeans, the night manager regarded me with suspicion. So I did what my father always advised in these potentially intimidating scenarios: “Act like you might be considering buying the place but you’re not sure if it's quite up to scratch.”

Flipping effective

Now, over the years, because there is more than one way of spelling Mcdonald, I have got into the habit of spelling it out and adding the phrase: "You know, like the Hamburger chain, McDonald?"

So when I asked for a double room with the required swagger and the hamburger reference the manager’s demeanor suddenly changed.

"Señor McDonald of the hamburgers! We are honoured to have you stay with us!” He clicked his fingers and flunkies were summoned to carry my meager hand luggage.

With much bowing and scraping, I was swept up to the gorgeous penthouse suite and out onto the balcony. It gave over breathtaking views of the Vatican at the front and the hotel’s own extensive and beautiful gardens at the back. "It'll have to do," I said. "Send a car to the Hotel Skinflint and bring Mrs McDonald here.”

That evening, we drank cocktails and dined in the garden of the Hotel de Russie, accompanied by the gentle jazz of the live piano player. A truly wonderful evening.

Mass content standards

Visiting St Peter’s the following day, I was struck by the grandeur of the Catholic Church’s global HQ. Inside the magnificent church, mass was being said in several languages; but I noted that the content of the mass could be followed in any language because the church had imposed the same content for all masses regardless of language. 

An amazing adoption of a global standard. Obviously, god-like authority can achieve the implementation of a global standard.

On Monday morning, we checked out of the Hotel de Russie and I cautiously looked at the bill through one half closed eye. Ouch! A month’s wages for two nights!

The moral of the story? Well, there are two. Firstly, if you want the best, you have to pay for it. And secondly, if you want to see standards adopted you need the authority to make them stick.

Systems are one thing, records are another

Last month, Simon Stevens, the chief executive of NHS England, set out the challenges facing the NHS. The ‘Five Year Forward View’, backed up last week by ‘Personalised Health and Care 2020’ (the IT strategy that isn’t a strategy but a “framework”) sets out to find the NHS £30 billion of otherwise missing funding by 2020-21.

It describes IT systems as the “electronic glue” that will both stick health and care together and break down the silos that lead to quality and efficiency gaps. No pressure, but it looks as if it is up to us to save the NHS.

Unfortunately, the electronic challenge of joining up services is not the biggest challenge ahead of us. The biggest challenge is agreeing the clinical records standards that will enable the free flow of records across the NHS and social care.

The clinical records standard setting work of the Royal College of Physicians has led on to the establishment of the Professional Record Standards Body, and I was happy to be involved in its establishment in the dying days of Connecting for Health.

The PRSB has enjoyed the backing (verbal rather than financial) of all the royal colleges. It is currently given a home by the Academy of Medical Royal Colleges, but financially is living from hand to mouth. With a General Election on the horizon, it faces an uncertain future.

We will get the standards we deserve if we don’t fund the PRSB properly and they will fail to get implemented if it lacks the necessary authority.

This is important, guys

The control of the standardised content of an NHS record represents the control of the future of healthcare and should not, in my opinion, left in the hands of politicians. Instead, it should be grasped by the Royal Colleges of Medicine, Nursing, Surgery and so forth in a tangible way.

It is reasonable to seek some financial help from the state in setting up the PRSB; but its work will be never ending, and standards will need constant updating.

As a result, the professional associations of us clinicians need to give it the authority and the cash to make our NHS electronic patient records the global leader they need to be if we are to hit our tough targets.

I know the readership of this column can deliver the “electronic glue” but can the clinicians get their act together to deliver the “social glue” and cash to make clinical records standards work? Time to put our money where our mouth is.

Joe McDonald

Joe McDonald is a practising NHS consultant psychiatrist. Over the past five years he has been an NHS trust medical director and national clinical lead for IT at NHS Connecting for Health – a stint that included 18 months as medical director of the Lorenzo delivery team!

His experiences in the National Programme for IT in the NHS have left him with a passion for usability and "end user knowledge networks.” He is the founding chairman of the National Mental Health Informatics Network. Motto: we don't get fooled again. Follow him on twitter @CompareSoftware