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.
Spine data storage
BT's Spine partners include Logica, Sun and Oracle - which probably explains the database choices. For Spine, LogicaCMG will develop the core database application to store and update the national patient records.
In March 2004 BT said Sun Microsystems will provide the infrastructure for the project including the application server.
Sun Microsystems was awarded a 10-year contract by BT under NPfIT to provide the software, primarily Sun's Java system, services, computer systems and storage systems to enable the nationally accessible patient record database and transactional messaging service to be delivered. Also the infrastructure operational management of the project will be the responsibility of Sun Microsystems.
Spine applications are protected using the “Spine Security Broker”, or Sun Portal Server, Access Manager, AMSDK applications, and SAML.
Sun states 'To date BT and Sun have deployed over 1000 x64 and UltraSPARC processor-based Sun Fire servers and the Sun Java Enterprise System (Java ES) as the foundation for the NHS CRS infrastructure, which will provide an integrated care records service for the country's 50 million citizens. The entire NHS CRS system is written in Java utilising Java ES components, including components of the Java System Identity Management Suite which will provide a national approach to authentication, security and confidentiality. With a dedicated team of 100. Sun professionals, Sun has been able to support BT in delivering a better NHS service through its responsibility for the day-to-day running of all Sun servers and storage as part of a managed services solution.'
It will be interesting to see if Sun can seed new systems like Thumper and Honeycomb into the Spine.
Where Copan fits
BT has supplied five Copan MAID systems to offer dense and compact disk-based storage of patient data. The Copan MAID arrays function as a fourth tier of storage on the spine. It no doubt helps that Sun is a Copan reseller. Oracle is also listed as a Copan partner.
A MAID, or massive array of idle disks, scheme treats disk drives as tapes in a library and only has them powered up when needed. A Copan array will contain hundreds of terabytes of disk in a single cabinet (think bladed disks). Copan claims it offers disk backup at tape prices because of the savings involved.
Copan has recently added FalconStor de-duplication to its MAID arrays, thus enormously increasing their effective capacity, possibly by a factor of twenty.
Since Sun is responsible for the storage systems on the Spine it must have supplied the five Copan systems.
No one, neither BT, nor Sun, nor Copan, is talking publicly about the details of the Copan systems used in the NHS Spine but it clearly represents a massive win for Copan.