Quote Originally Posted by bigdjiver View Post
NHS is not my field, but I would think confidentiality and identity are major issues, and so many records go back decades and too many entries are written for the writer to read are others.

A hospital is a very dynamic environment, bed allocation would not be a picnic either. Computer systems implement rules. Would you like to specify rules for bed allocation? Put very hard choices into writing and sign your name to them?
There are plenty of reasons. The major issues for any record system is around what data gets stored, where does it get stored, who owns and controls it, and who can access it. Even working with an off-the-shelf system within a single hospital, these problems are not trivial. When you're thinking about a system that integrates across the entire NHS, then you're teetering on the edge of insoluble. From a technical perspective, it's very, very difficult (not to mention expensive). From a cultural and political perspective, it's even trickier. WHat happens if a central data base is set-up, then one hospital is slightly lax in their procedures and suddenly, the wrong people have access to the whole country's medical records. It would make the current missing NI numbers seem rather trivial.

Alternatively, they can lock the system down. Then you have a patient come in unconscious - you identify them but can't access their records. You give them a drug to which they are known to be allergic to and kill them. The record of the allergy was recorded, but unavailable.

Those are just two ends of the spectrum - the reality would lie somewhere in between. Merely specifying a system that big and complex is a nightmare. I've worked with student records systems - including projects about integrating between institutions. The integration was pretty minor (basic ID information) and that was a huge task in a small number of institutions.

In terms of resource allocation - that is an area I'm working in at the moment. Complex resource allocation is getting into far more leading edge decision support models. Anyway, what we're dealing with in terms of resource planning in hospitals are complex, multi-criteria problems. There are a couple of models that one could use - all of which have issues.

Curiously, in the UK, there isn't a serious shortage of beds in hospitals: it's other constraints, mostly staffing related, that are the real bottle-necks.

Probably the biggest one is we have to define the objective of the resource planning - least cost, highest long-term survival rate, minimise wasted resources, etc. Then you throw in the constraints - be it prioritising different patients or modelling the rules of the various employment agreements in place. All of this needs to be thrown into a model. Without simplification, we'd be dealing with a model involving thousands of variables. It would take a typically, high-end PC a few hours to solve it for a single day in a single hospital. And then you have an orderly call in sick and the whole model needs to be recomputed.

The bottom line is there are plenty of good commercial solutions that do resource scheduling and record management that address all these issues. But I can guarantee that no-one has ever done a project even close to the scale of the NHS. It would be a huge challenge and one that's almost doomed to failure.