NHS Healthcare System

Simon Ambler.

Version: 1.1
Date: 7th November 2002

See associated solutions.


Loosely based on a question from the 2002 examination paper for MC106 Software Engineering and Professional Practice. The question concerned the following scenario.

Charnwood NHS Health Trust has about 40 healthcare workers, based at regional clinics, who look after patients living in the local community. These workers are constantly on the move and often have little opportunity to keep in touch with the clinic whilst visiting their patients. To prepare for a visit, a worker will need access to the patient's records, and may also need to refer to NHS guidelines and healthcare manuals. They therefore tend to carry a large quantity of paper and books around with them. During a visit, the worker may record an assessment of the patient, log any treatments, and make further appointments. They may also decide to refer the patient to a specialist or consultant, in which case they make a note to request it. After the visit, the patient's records will be sent back to the local clinic where they are examined and approved. The Trust has around 9,000 patients receiving care and an individual worker may see up to 50 patients a week. Periodically, the Trust will decide to do a health survey. When this happens, questionnaire forms are printed out and distributed to all the healthcare workers, who fill them out during their visits. The forms are returned to the clinic along with the patient records and forwarded to the Trust's headquarters for anaylsis.

The Trust has decided to invest in a new computer system in order to improve the efficiency of communication between its healthcare workers, the clinics, and its headquarters. The idea is to supply each worker with a mobile computing device, probably a handheld PC such as the Compaq iPAQ 3660 or Hewlett Packard Journada 680. These typically have 8MB of storage once software has been installed. They cost £350-400, weigh about 300g, and run for about 2.5 hours continous usage before the battery needs to be recharged. A worker will be able to download patient records and associated information from a central repository held at the headquaters. This could be done by using a docking cradle attached to a PC at a local clinic (110kb/s). An average record might be 20kB of data. Manuals and other documents could easily require 2MB of storage. During a visit, the worker will make additions to the patient's records, notes, appointments as necessary on their handheld PC (amounting to 5-10 minutes usage). Periodically, the worker will synchonize their handheld PC with the central repository so that any additions or changes to the patient records are uploaded or downloaded, as appropriate. An e-mail facility should be included in the system so that workers can keep in touch and liase with other NHS departments.

Data accuracy is a key issue in any NHS system. Healthcare workers need to have correct and up-to-date information while they are visiting patients. A recent audit revealed about 5 errors per 100 patient records. This rate should at least be halved by designing a good graphical user interface for the handheld PCs to make data entry easy. Different workers may often be involved in the same case so any changes to patient records need to be passed on quickly, within a week at least. The frequency of data transfer could be further improved by allowing daily remote access to the central repository using a mobile phone with an infra-red link and a modem (28 kb/s). In this case, security would become an issue because mobile phone calls can be intercepted. 128 bit encryption should be used for all confidential data.

The Trust want the new system to deliver management information, for example, whether health targets are being met; and to reduce administration costs, which are currently 20% of budget, by at least 1/5. It should also make it quicker to mount health surveys. The questionnaires could be distributed as electronic forms and the data could be retrieved by uploading. Currently, it can take up to 3 weeks for the forms to be printed and distributed and a further 4 weeks for the data to be entered for analysis.

The healthcare workers are broadly enthusiastic about the new system. Their main concern is that it should be quick and easy to use, so that they have more time to spend with patients. They don't want to wait more than 10 minutes for a download, or have to recharge their handheld PC more than once a day. In the past they have also expressed a reluctance to carry laptops which could weight up to 2.5kg.

A local company called GoSoft, which specializes in mobile computing, has won the contract to supply the software and hardware for the new system at a price of £150,000. They have 12 months to develop the system although they plan to deliver it in 8 months.

Summary of Structured Requirements

Details and Measurement

This document was prepared using XML for Structured Requirements © University of Leicester 2002. Please send any comments and bug reports to S.Ambler@mcs.le.ac.uk.