The National Health Service in Britain isn't universally admired for its IT efficiency. But Miles Gray, the urbane hardware solutions architect for the NHS, said at the Cloud Computing World Forum in London that if carefully implemented, the cloud can help the service gain effectiveness and save expenses.A national health service is an immense undertaking. With 82 million patient visits scheduled last year, the service relies upon hundreds of hospitals, doctor's offices and clinical systems to work together to provide patient services. Many of these systems invoke the number assigned to each patient by the National Health Service. Then again, many of them do not. They use the patient name or another identifier unique to the local system. The U.K. did not implement universal electronic medical records when it adopted national health care. Consequently, there are many different ways of identifying patients as they move from doctor to doctor or hospital to hospital, leading to the usual difficulties in sharing patient information. Gray advocated in an address at the forum June 30 that every health care provider adopt the NHS's unique identifier system. A health care provider needs to show up at a service trust office to be issued its own business identifier, based on two forms of submitted identification. If each participant and provider adopted the NHS identification system, then the friction involved in the exchange of medical records could be reduced. And if the identification system were uniformly used, then additional services from the government's planned G-Cloud and existing Web services could help the NHS cut costs. For example, of those 82 million patient visits scheduled last year, 6.6 million or seven percent of the patients never showed up. "An unattended visit ties up equipment and highly skilled personnel, who have to sit around whenever a patient fails to show for a scheduled visit," Gray told about 280 attendees at his talk at London's Olympia Centre on the second day of the Cloud Computing World Forum's conference. It would be "a huge savings" to reduce or eliminate these unfulfilled appointments but to do so, each health care provider needs to link its meeting scheduler with an address checking system that can provide the target patient's latest address and preferred method of contact. The government provides a national demographic service that includes a constantly updated address list, but only those providers that adopt the NHS identification numbers can access the system. Those who don't use NHS identifiers often contribute a disproportionate share of the unattended meetings because they're sending notices to the wrong address. Sometimes a provider must follow up a patient's medical procedure six months later or stage a surgery check-up 12 months later. A notice is sent but the provider often doesn't know if the targeted patient received it. When a reminder is sent close to the appointment date, the provider often doesn't know what the target's preferred notification process. Gray is a skeptic that cloud computing will solve all problems for the NHS. "We maintain a high level of security on our provider data. We know exactly where it is. That apparently is not very 'cloud,'" he said with an edge. And later, he discounted some of the claims made for the often hyped cloud form of computing. "Cloud means whatever the salesman walking through the door that day wants it to mean." But the NHS itself has struggled to modernize its systems and has several high profile projects that failed to live up to expectations after the investment of millions of pounds, said attendee Matt Johnson, cloud point man and systems analyst at eduserv.org.uk, a non-profit agency for education institutions, in an interview after Gray's address. Nevertheless, the use of existing and future G-Cloud services, like the address checking capability of the UK's national demographic system, represents "a huge opportunity for very large savings" and the way the NHS must seek to operate in the future, said Gray in an interview after his talk. "I believe the cloud will be substantial part of how we operate" in the future, he said. The attitude toward cloud computing is noticeably more conservative in the UK than in the US. Gray's caution reflects a skepticism that IT will just embark on another wild goose chase if it fails to adopt only the parts of a trend that serves its needs. The crowd at the World Forum was about 360, compared to thousands attending Cloud Connect in Santa Clara, Calif., and other cloud conferences in Silicon Valley in the U.S.