PATIENT RECORDS
The case for NPfIT 2.0 M
Experts agree that electronic health records are the key to developing safe, affordable 21st century health care. IT has delivered gains in industries such as finance, commerce and the media. There is widespread dismay and frustration at the slow rate of dissemination of IT in health care. NPfIT was the grand programme that would correct this, says Dr Derek Meyer
assive IT
programmes are notorious for
going wrong. Public sector IT programmes are notorious for going wrong. A massive public sector IT programme? When the press is full of articles highlighting NPfIT failures and politicians call for the system to be scrapped it is all too easy to accept this stereotype.
NPfIT may have put in the foundation needed for effective, affordable 21st century health care.
The UK has traditionally adopted a ‘close follower’ IT strategy and quickly adopts US developments in new technology. While the US has undisputed world leadership in health care and in information technology, it still has a health system that relies mainly on pen-and-paper. Why is health care so behind? Why is health care informatics so much more difficult to implement than financial services or commerce?
In the US various factors have been identified. Their system is too fragmented and an encouragement of competition prevents the necessary co-operation needed for system integration. There are disincentives to IT investment because the costs are borne by practitioners but the benefits flow to insurance companies. The medico-legal barriers are too high.
In England, we have avoided all of these. We started with a unitary, single payer health system. The government
52 nhe So what happened?
Infrastructure, such as N3 and NHSMail was successfully deployed.
The strategy of centrally- procured local systems makes sense, as it’s cheaper to buy in bulk and standardised systems are cheaper to maintain. The strategy was successful for PACS but other local hospital information system programmes have been less successful.
PACS allows radiology departments to get reports out quicker and this makes them more effective and more efficient. Cautious departments noticed the improvement achieved by early adopters and followed suite, even though this required modifications to the way they worked.
In contrast, early adopters of hospital information systems experienced pain and simply did not see the improvement in efficiency and effectiveness needed. As a result, cautious hospitals were not prepared to modify they way they worked to fit in with the IT systems and instead insisting that the systems
be modified to accommodate their working practices. This diminished the benefit of central procurement.
Healthspace is used by a fraction of the patients who could use it and the process of uploading summary care records has been partially halted. Choose and Book is unloved by GPs and has not been embraced by patients and there is no evidence that patient choice has in practice been significantly enhanced or that indirect measures of efficiency, such as DNA rates, have improved.
GP system integration such as GP to GP record transfer and software to uploaded summary care records has been successfully deployed and summary care records made available.
However, the core product, the NHS Care Records Service, has just not delivered.
So if everything was done by the book, why did the National Programme fail to deliver the improvements in efficiency
Sep/Oct 10
provided strong support and leadership from Tony Blair down. The programme had generous funding, strong and dedicated management and was not sidetracked by special interests or mired in inter- departmental strife. Contracts were awarded to the world’s leading IT companies, all of whom had a strong track record of successful project delivery.
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