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. 2001 Mar 24;322(7288):731.

Using internet to access confidential patient records

Information about NHSnet was incorrect

S N Walker 1
PMCID: PMC1119911  PMID: 11264217

Editor—I am extremely concerned that an article as out of date as Chadwick et al's was published by the BMJ.1 The editorial panel of the BMJ is clearly unaware of important and well publicised developments in information technology that have taken place over the past year and a quarter.

The information in Chadwick et al's article about NHSnet is incorrect in almost all respects. General practitioners do not have to pay either to connect to or use NHSnet, and uptake is increasing rapidly. By 1 October 2000, 70% of practices in England had an ISDN line (a telephone line giving high speed internet access) installed that connected them to the network; many of these practices are actively using NHSnet for email, clinical messaging, and browsing. Two thousand practices have connected recently. All general practitioners need to do before connecting to NHSnet is to agree to comply with a code of connection, which is designed to promote and ensure secure system management.

Users of NHSnet now have guaranteed levels of service that exceed the standards offered by commercial internet service providers, and internet gateways enable users to access the world wide web. The issue is not “can patient access to information be supported by the network?” (which it can) but the more complex clinical and ethical concerns about what information should be made available, in what form, and to whom. This fundamental issue is nothing to do with NHSnet as such.

NHSnet is more secure than the internet and is backed by more service guarantees, including message delivery times and message receipts. New national address books will be on line soon. Layered on the network is the capability to support strong authentication for remote access and strong encryption, and an interim public key infrastructure messaging solution is being implemented as part of the pathology test results messaging project.

Further information about NHSnet can be found on the NHS Information Authority's website (www.nhsia.nhs.uk).

References

  • 1.Chadwick DW, Crook PJ, Young AJ, McDowell DM, Dornan TL, New JP. Using the internet to access confidential patient records: a case study. BMJ. 2000;321:612–614. doi: 10.1136/bmj.321.7261.612. . (9 September.) [DOI] [PMC free article] [PubMed] [Google Scholar]
BMJ. 2001 Mar 24;322(7288):731.

Reply from then editor of Information in Practice section

Douglas Carnall 1

Editor—The delay between submission and publication of this paper was plainly too long, and in some details it has been overtaken by events. Just as the NHS struggles to bring some of its systems into the digital era, so does the BMJ.

The problem with the Information in Practice section of the journal is that it is monthly, and the small volume of submissions it has received has meant that the editorial committees to consider material for the section are convened every six weeks. Chadwick et al's paper was further delayed by our editorial request that the paper be revised to clarify public key encryption for a general medical audience and then queued for a space in the journal.

Plainly it would have been better to publish the paper much faster. We have conducted an internal review to learn from the incident and have circulated proposals to ensure prompter consideration of papers for the section. Despite this, we defend its publication: in a real life clinical setting its authors showed a competent alternative approach to the corporate network model on which NHSnet is based, as well as providing a useful lesson in how public key encryption might be used to secure clinical systems.

Many of the rapid responses on the BMJ 's website were critical,1-1 but the paper taken together with this post-publication peer review still gives a valuable lesson for clinicians and managers who wish to understand the issues behind setting up such a system.

References

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

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