The Government has recognised that in a new era of information technology (IT) an NHS network (NHSnet) is essential to delivering an NHS 'information superhighway'.1
There are many powerful arguments for developing a private network to perform internal and clinical NHS 'business', and for doing this alongside the rapidly developing public internet. A privately managed service is able to provide a faster, more consistent and more reliable service, hence the development of NHSnet.
NHSnet is a secure wide area network (WAN) connecting NHS organisations, and is currently managed for the NHS by British Telecom and Cable and Wireless. NHSnet is also known as the NHS intranet and is thought to be the largest virtual private network in Europe. It provides:
- A similar range of communication and information services to that available on the internet
- A dedicated NHS network with guaranteed service and availability.
- A secure and controlled environment for healthcare information.
The services available on NHSnet are outlined in Table 1 (below).
Table 1: Services available on NHSnet
|Electronic mail (email)||The ability to send free text messages, with attachment documents if required, to recipients on NHSnet and the internet.|
|Electronic data interchange (EDI)||Registration and items of service sent directly from the practice system to the health authority computer system. Pathology and radiology results from hospitals to GP practice systems.|
|Access to NHSweb||The exclusive information source for NHS professionals.|
|Remote support for clinical systems||System suppliers can communicate via NHSnet to support GP systems.|
|Access to the internet||Worldwide connectivity through NHSnet secure gateways.|
|Online patient bookings||The ability to book patients needing minor surgery directly into hospital.|
The following organisations are connected to NHSnet:
- GP practices
- NHS hospitals
- Primary care groups and trusts
- Health authorities.
Figure 1 (below) shows a schematic diagram of the NHSnet and its links to other systems.
|Figure 1: Schematic diagram of the NHSnet and linkages|
By April 2001, 90% of practices were connected to NHSnet, and by April 2002 it is estimated that 100% of practices will be connected.
The majority of GPs are aware that NHSnet can be used to gain access to the world wide web and to send and receive emails, but are unaware of any other benefits.
The NHS is currently funding desktop access to NHSnet for every GP and practice manager's desk. During 2001/2 this will be extended to community nurses and hospitals and will cost well over £100 million. The Government would not invest such sums of money just to enable GPs to send and receive emails and to 'surf the net'.
The NHS wishes to make maximum use of IT in order to continue to develop the following:
- Electronic health records (EHRs)
- Electronic patient records (EPRs)
- Access for specified professionals (e.g. staff in A&E departments) to specified health information on individual patients 24 hours a day
- Electronic transfer of EPRs, from GP to GP
- Electronic prescribing
- Online booking of appointments
- A national electronic reference library
- Electronic delivery of pathology and X-ray results
- Storage of images, e.g. photographs, X-rays
- Electronic transfer of referral letters, outpatient letters and discharge summaries
- Electronic messaging between clinicians
- Access to the vast amounts of nformation available on the internet.
All of the above require a secure network as the basic building block, hence the importance of NHSnet.
Why use NHSnet instead of the internet?
Rather than allowing each individual and organisation in the NHS to connect to the internet via a multitude of internet service providers (ISPs), the Government developed NHSnet to provide a more secure and stable environment for messaging and exchange of information, while also providing access to the world wide web.
Email working to a common standard is essential to the development of clinical messaging in the future. A common approach to organisational and individual email addresses was essential to the establishment of online address books.
The speed and reliability of the internet is dependent on the number of people worldwide using it at any one time and the capacity of the ISP being used. The internet is not a secure environment, and there are a number of software programmes available that can integrate and read emails sent over the internet and are able to attach a computer virus to the message.
NHSnet guarantees a national level of service and ensures accessible and reliable messaging. It is not accessible to all users of the internet; access is restricted to approved users from approved sites.
A 'firewall' protects users of NHSnet from external attack. Almost on a weekly basis, the national news contains information about the latest virus to infect the computers of large organisations. In a recent episode, the NHSnet firewall intercepted 66000 computer viruses in a single day.
Many users of the internet have been troubled with junk emails. 'Spamming' is the term used to describe the sending of junk email, NHSnet established anti-spamming measures in December 2000.
Connections to NHSnet
Figures for April 2001:
- 8195 GP practices (93%) had an NHSnet line installed
- 7264 GP practices (83%) had an email system installed
- 100% of health authorities connected
- 97% of NHS trusts connected.
Numbers of messages transmitted across NHSnet:
- 1995-6 214085
- 1996-7 1860889
- 1997-8 10885377
- 1998-9 24702067
- 1999-0 66622166
These figures reflect the growing number of users connected to the network and the increasing use of email to replace telephone calls and manual paper flows.
What are GPnet and Project Connect?
The work associated with delivering NHSnet to GPs was called GPnet. The scope and direction of this work was changed last year, and the name was changed to Project Connect.
Project Connect has five key aims:
- To give people in GP practices access to NHSnet (for messaging and web browsing), at their desktops by March 2002.
- To ensure that GP connections to NHSnet are implemented effectively and work properly.
- To identify and disseminate the benefits arising from connection to NHSnet.
- To ensure that people in GP practices and trusts can communicate effectively via NHSnet and access information on NHSnet and the internet.
- To ensure that the NHS can implement secure messaging for pathology by 2002.
The NHS Information strategy Information for Health (1998)1 stated that, by 2002, secure, national standard pathology results messages would be flowing over NHSnet between all hospital laboratories and general practices.
Some practices are currently receiving pathology results from hospital laboratories via NHSnet. However, the messages do not conform to a common national standard, and not all practice computer systems can receive the messages let alone insert them into the EPR.
Furthermore, many pathology laboratories do not have the software or resources to send electronic pathology results to practices. The pathology message is sent in a format that is not encrypted (see later) and therefore not secure.
The Pathology Messaging Enabler Project (PMEP) was established as part of Project Connect to prepare the NHS-wide roll-out of pathology messaging to clinically endorsed standards. The objective is to ensure that the pathology messaging service will be clinically safe, secure and robust enough to handle more than 35 million reports a year.
Pathology messaging will be the start, soon to be followed by X-ray, referral letters, discharge summaries and out- patient letters. Standard message formats and encryption* of messages will be similar for all clinical messaging. Electronic transfer of computerised medical records between practices will eventually be via NHSnet.
* Encryption is a process whereby an email message is coded before transmission to prevent it being intercepted or received by someone for whom it was not intended, and being read by that person. The person for whom the message was intended would be able to decode it as he/she would have the 'key' to perform this task.
Secure information sources
The development of a secure network allows information to be freely available to all NHS staff, but not available to all via the internet.
One example of this is the development of the National electronic Library for Health (NeLH). This can be accessed by any person connected to NHSnet. Access to this valuable database can also be achieved via the internet by the use of a single password at http://www.nelh.nhs.uk.
Another example of a website that is only accessible over NHSnet is Doctor online at http://nww.doctoronline.nhs.uk.
Any website with the address nww instead of the usual www is only accessible via NHSnet.
It is important to have branch surgeries connected to NHSnet. In April 2001 a total of £3 million was allocated nationally to achieve this. This comprises £2000 for each branch surgery that satisfies the following requirements:
- Open for >20 hours per week
- Open for <20 hours per week where an existing kilostream or ISDN link is in place.
Practices with branch surgeries that have not been informed of this funding need to talk to their PCG/T and health authority as soon as possible.
Information and training
To get the maximum benefit from NHSnet, all users need training on the use of email and web browsing. In the future, additional training will be required to realise the benefits of pathology and radiology messaging, eventually leading to referral letters and discharge summaries routinely being sent over NHSnet.
GP to GP transfer of EHRs will be via NHSnet. A solution to electronic prescribing would be electronic transmission of the prescription from the GP to the pharmacist via NHSnet.
All these issues will need adequate training and information.
Training should be arranged via a PCG/PCT or health authority. Different members of the primary healthcare team are going to require different levels of training, depending on the tasks performed within the team and their existing level of knowledge.
Many IT departments within PCTs and health authorities are providing excellent training with options relating to users' experience. Training sessions can take place either offsite or in the practice, and be arranged at times to suit the practice.
All practices are supposed to receive a 'post-connection pack', once NHSnet is available in the practice. This pack is full of useful information and contains a number of useful website addresses. As yet, however, I have not come across a practice that has received it.
The post-connection pack can be downloaded from the internet at http://www.gpnet.nhsia.nhs.uk/gpnetwow/guidance.asp. Other useful information such as a training manual for Microsoft Outlook and a guide to the use of emails is also available from this website.
Computerisation within the health service has led to many 'data islands'. To connect the data islands and allow free passage of electronic information it is essential to have a secure and reliable network, such as NHSnet.
- Information for Health – An Information Strategy for the Modern NHS 1998–2005. NHS Executive, September 1998.