As doctors and managers struggle to implement the NHS's £6bn computer modernisation, one of its biggest IT contractors has unveiled a vision of the next step. This is an NHS in which everything down to the last bottle of pills contains a computer.
When patients walk into a surgery, their medical records appear immediately on their doctor's screen; when a nurse hands over a pill at a hospital bedside, the patient's record - and the pharmacy stock control system - is updated. Sensors inside people's bodies even give early warning of health problems.
BT is promoting the concept of pervasive healthcare computing to try to persuade drug companies and the health service to invest in radio frequency identification (RFID) tagging. However, researchers admit there are still uncertainties about the business case for the technology - and its "big brother" aspects.
RFID tags are electronic circuits that hold information relating to an object they are attached to - usually a unique identity number called an electronic product code - and then communicate it to a remote reader. (This distinguishes them from simple anti-theft tags.)
The technology is best known for its use in tagging pets and livestock. Passive tags cost as little as $0.20 if ordered in millions, says Robin Mannings, research foresight manager at BT.
Most of the impetus, however, is a result of interest by shopkeepers, who see RFID as a more versatile replacement for bar codes. The giant US supermarket chain Wal-Mart wants its top 100 suppliers to put RFID tags on pallets and cases of goods from January. As prices fall, individual products will start to carry the tags.
Researchers at BT say drugs could be one of the first sets of products to be tagged. One reason is that many people, from manufacturers to doctors to regulators, have real incentives for tracking pills and potions.
BT claims RFID tagging of drugs can also build on plans for national networks of electronic health records.
This week, the company unveiled its vision of the future at its Adastral Park laboratory near Ipswich.
The mock-up began with the patient enrolling for an identity card, including an RFID tag and two sets of biometric data - fingerprint and coordinates of eyes and nose. (BT is also bidding to supply systems for the national identity card.)
In their doctor's waiting room, patients slap their card down on the desk, and are automatically logged in the appointments schedule, which is displayed on a flat screen on the wall.
While waiting, patients can view their electronic health record at a terminal and read educational material aimed at their particular needs.
In the surgery, doctor and patient get access to records and prescribe drugs with their respective ID cards.
The next stop is a hospital bed, where the patient receives a visit from an "e-trolley" equipped with a display screen showing the prescrip tion, and automatically recording when the tablets are handed over.
The information feeds back to the hospital pharmacy's stock control system, and in turn to the companies making the drugs.
IT firms have been promoting similar visions for electronic health care for at least a decade. What's new about the BT mock-up is its emphasis on RFID.
Paul Bidos, a pharmaceutical industry consultant, says drug companies are interested in tagging bottles and packets of pills to help them run an efficient supply chain. Tags could also identify counterfeit drugs and help trace supplies in the event of a product recall.
The big question is who will pay for the infrastructure. As in other complex systems, the people who put up the money are not necessarily the ones to benefit. Bidos suggests the government could take a lead by demanding medical products are tagged. "If the NHS were to insist, it would happen pretty quickly."
The ultimate step in this process would be if pills contained RFID tags. The Department of Agriculture is already testing swallowable RFID pills to identify livestock, but no one is seriously proposing that humans take them. However, Mannings raises the possibility of a tag containing bio-sensors that could be implanted in the body to monitor people's health around the clock.
He admits he finds the idea uncomfortable. "But if it was guaranteed to give me early warning of prostate cancer, then I'd happily accept it."
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