Select Committee on Science and Technology Fourth Report


Chapter summary

Information systems should provide opportunities to improve current infectious disease control. Surveillance can be enhanced by developing integrated information systems across all relevant Government departments and agencies in order to facilitate collation and analysis of information. Information Technology can be used to provide automated rapid feedback to health professionals. Surveillance information and electronic resources of information about best practice and current events relating to infectious disease inform clinical practice.

Resources are needed to improve information systems and work needs to be undertaken to ensure that there are links between relevant databases to allow rapid exchange of information. We warn that IT must be used to ensure that people can work more effectively rather than adding a further burden onto already high workloads. This demands adequate supply of IT, training of staff and provision of sufficient technical support staff.


"Information technology is not used to its full potential—various parts of the service cannot transfer information to other parts quickly and securely" [Bradford MDC, I p34].

6.1 We heard that implementing and supporting information technology was a key priority for action and was needed to improve services [Assoc Brit Pharma Industry, I p6; Assoc Clin Microb, I p15; Leeds City Council, I p99; Paton, Q621; PHLS Q277]. Advances in information technology in recent years provide opportunities to collate, analyse and disseminate information from a wide variety of sources in much larger volumes and at far greater speed than ever before. For example, IT has been used to share and disseminate information relating to the SARS outbreak across the world [AcMedSci, II p353].

6.2 We heard that information systems across different organisations, and sometimes within the same organisation, are incompatible. Thus priority should be given to making information transfer possible between different systems. This might be a "huge resource intensive issue" and requiring careful attention to the laws on data protection and human rights [Bradford MDC, I p34; PHLS, II p135; Spittle Q621].

6.3 The Government have announced a significant increase in spend on IT in the NHS in England, which will constitute an additional £400 million in 2003-04, £700 million in 2004-05 and £1,200 million in 2005-06 to the baseline spend in IT of £850-£1,050 million [Pattison, II, p271]. We heard that this, along with other advances, such as developing the integrated care record, should help to counter some concerns [Pattison, Catchpole Q637].

6.4 We take heed of the National Audit Office's caution that there are "continuing delays in the implementation of NHS national IT initiatives and networks" [II p378]. Furthermore, we are concerned that infection disease control should be recognised when developing IT in relation to health and should be integrated into any improved system.

6.5 We discuss below the main concerns relating to IT and make recommendations.

Encouraging reporting: electronic submission of information

6.6 One of the challenges facing surveillance activity is that relevant information needs to be gathered and transferred to appropriate authorities [PHLS, II p139]. Providing surveillance information is time consuming and often paper based. If it does use electronic systems, it is often necessary to enter information manually on more than one occasion because of different, incompatible IT systems [Assoc Med Microb I, p71; Kelsey, II p42].

6.7 The Association of Medical Microbiologists points out that transferring information should be "simple and automatic" [I p71, see also PHLS Q277]. Providing surveillance information should not be something separate to, but part of, every-day working practices. Dr Catchpole summed up the views of many when he stated:

"It should not be that we do surveillance as well as looking after patients, but that in looking after patients we are undertaking surveillance" [Q629].

6.8 We recommend that the Department of Health should ensure that procedures for collecting and reporting information electronically are integrated where possible into everyday working practices and are less burdensome than at present.

Analysing information

6.9 One of the concerns about surveillance is that advances in forecasting techniques are not being exploited by the infectious disease community [Borriello II p218, Q515; Seminar, p378-81]. Such techniques often require sophisticated hardware and software which is not routinely available.

6.10 We also heard that there is no common agreement over the terms and coding systems used in databases [PHLS, II p139]. We are concerned that this makes extracting comparable information from different databases extremely difficult and time consuming, which would be an obstacle to responding quickly in an emergency [Nicoll Q277]. The SARS outbreak indicated how important it was to be possible to share information internationally.

6.11 We recommend that the HPA should standardise information entry across all surveillance systems. This should be undertaken in consultation with representatives of all those involved in the collation and transfer of information for infectious disease control.

Sharing information

6.12 Information technology provides some exciting opportunities to facilitate collation and analysis of information from widely different and innovative sources [Catchpole, Q629]. Witnesses suggest that combining information systems about animal, human and food-borne infection would provide an immensely powerful tool for surveillance [PHLS, II p135]. Recent developments, such as the integrated care record, have potential for enabling access to a greater breadth and depth of patient information for surveillance purposes than at present [Catchpole, Q637].

"The worst thing that could happen is to build new, modern systems as islands of automation and not link them together. I would urge everybody to build a very robust infrastructure, that you can hang systems from and interchange data with. That is going to be the key here" [Spittle, Q631].

6.13 We note that in order for the integrated care record to provide maximum benefit to infectious disease services it is necessary to consult bodies which lie outside the immediate jurisdiction of the NHS Information Authority, such as the HPA [Catchpole, Q637]. If such consultation does not happen, we heard that significant opportunities to incorporate public health needs with immediate clinical needs could be wasted [Spittle, Q631]. The HPA and others could contribute to discussion as to what information is needed and in what format it should be presented.

6.14 There should be coordinated activity within the Department of Health and its agencies and across different Government Departments and agencies to ensure that all organisations involved in surveillance, prevention and treatment of infectious disease can share relevant information [Pattison, Q643]. In particular, the Department of Health should develop a system which allows interchange with other systems.

6.15 We recommend that the Government should develop a fully compatible electronic system of disease surveillance information across all relevant departments and agencies.

Disseminating information to health care professionals

6.16 We heard that one of the reasons for underreporting by clinicians is that they lack ownership in the surveillance process; if they do send in information it seems to disappear [Brit Infection Soc, I p38; Catchpole, Q639; Friedland, I p67; Little, Q401]. There have been some recent initiatives to increase feedback through world-wide-web technologies. Professor Duerden of the PHLS told us that there are web-based systems which allow health professionals both to report and to compare infectious disease events in their local area with the regional and national pattern [Q284; also see Inf Control Nurses Assoc, II p176, Q380].

6.17 Professor Finch told us that IT provides opportunities to enable health professions and public to gain access to information about best practice in relation to infectious disease such as via the recent initiatives of the National electronic Library for Communicable Disease or NHS Direct Online [p55; Q92; Haworth, I p76]

6.18 Both of the above areas of disseminating information should be further developed and we expect the Department of Health and the HPA to draw on the structures and projects that are already in place and provide appropriate funding. However, we also have some concern about email overload. Bombarding busy health professionals with emails about potential outbreaks could mean that many are not read and encourage complacency.

6.19 We recommend that the HPA takes the lead in further developing electronic methods for providing feedback about surveillance and for targeting delivery of information about infectious disease to healthcare professionals.

Warning: IT is not sufficient

6.20 Whilst the evidence pointed to the opportunities offered by better use of IT, there were also quiet warnings throughout. In particular, investing heavily in IT without due consideration to the way that the infectious disease service operates would be an ineffective way of using resources. Other issues which witnesses said needed to be addressed in order to implement an effective IT system, are outlined below.

(a)  Patient Confidentiality: Patient confidentiality and data protection could undermine opportunities to improve surveillance activity [Leeds City Council, I p99; US, II p388]. One way of overcoming this would be to provide information in anonymous form [Hawker, II p116; Nicoll, Q278; Pattison, Q647; Spittle, Q646]. However this would not be useful in all cases. If IT were to enable improved surveillance through exchange of information across organisations, data protection issues could arise. We urge the Department of Health to carefully consider ways in which this can be overcome.

(b)  Training and human support services: Simply investing in and implementing IT systems is not sufficient to ensure that the most value can be obtained from those systems. Consideration needs to be given to ensuring that staff are trained in IT skills and the resource implications of that time needed for training are considered. We point out that critical services must continue to run whether or not the IT system is working, which demands back-up facilities and IT support staff on call around the clock [Catchpole, Q629].

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