Case Study: Five MAIDs on the spine

The Spine is the infrastructure for providing core national services such as a database of all patients' demographic details. A vital component of the intention to have a national system of electronic care records for patients, it is designed to enable the NHS to work with common systems and securely share patient data.

BT builds and maintains The Spine on behalf of the NHS' Connecting for Health (CfH) agency. It was awarded the 10-year, £620 million contract in 2003. CfH is delivering the National Programme for IT (NPfIT) to bring modern computer systems into the NHS to improve patient care and services.

The Spine is a core data storage and messaging platform that will help enable an electronic NHS Care Record for every patient, securely accessible by healthcare professionals at any NHS location in England. When fully implemented, local records will automatically upload important information to the summary patient record on the Spine. Patient data will include NHS number, name, address and date of birth.

BT has developed the systems and software to support over 275,000 registered users generating each some 375,000 patient traces, 50,000 retrievals for patient demographic information and 65,000 new or update patient registrations with GPs.

Another aspect of the Spine concerns NHS finances. BT states that 'the spine also hosts the Payment by Results service that underpins a key government initiative that is changing the way money flows through the NHS. The Secondary User System Payment by Results Subsystem (SUS/PbR) provides a transparent, rules-based financial system for paying Trusts.

It aims to ensure a fair and consistent basis for hospital funding rather than reliance on historic budgets and the negotiating skills of individual managers. The PbR service currently has 1,200 users extracting 5,000 detailed activity reports each month. The SUS database receives on average one million records per day, and provides financial data with a monetary value of £4.7 billion each financial quarter.

There is also an electronic prescriptions service which uses the Spine. The NHS issues approximately 1.3 million prescriptions every working day, with around 70 percent of these prescriptions being repeats. This huge and ever-increasing volume of prescriptions is driving the need to change from a paper-based prescription process to a more efficient electronic one.

Altogether the data storage needs of the Spine are huge.

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