Creating all electronic health records—the centrepiece of the £12bn (€15bn; $23bn) scheme to computerise the NHS in England—has been a challenge “far greater than expected,” the latest study of the world’s largest civil information technology programme reported last week.
In its second study of the National Programme for IT in the NHS, the National Audit Office concluded that software procured to create detailed electronic health records in secondary care may not be available until 2015, five years behind schedule.
The prediction will provide ammunition to critics calling for changes to the six year old project’s management, and the way it obtains patients’ consent for data to be shared.
Chaand Nagpaul, the BMA’s GP negotiator with responsibility for information technology, said that slipping deadlines and the “premature release of systems that are not fit for purpose” has left many doctors “thoroughly disillusioned.”
The audit office’s report, the text of which was agreed with the Department of Health, is more forthright than its 2006 predecessor, which covered mainly the initial procurement of systems (BMJ 2006;333:3-4; doi:10.1136/bmj.38889.569201.DE).
Although agreeing that many core systems had been installed on schedule, and that the programme’s overall cost is on target, it found that the implementation of centrally procured software for electronic care records has run late. Development of the “Lorenzo” standard system picked for all of England north of the Severn estuary and London “has taken much longer than originally planned.” The first release is expected to be available this summer, four years behind schedule.
The report calls on the information technology agency NHS Connecting for Health to set more realistic deployment plans “drawing a distinction between firm commitments in the near future and the less certain timelines that apply further ahead.”
Dr Nagpaul called for more effort to make the programme transparent to staff and patients, including adopting a “consent to view” procedure for sharing medical records, rather than assuming that patients give consent if they do not “opt out.”
NHS Connecting for Health admitted that original timescales were “unachievable, raised unrealistic expectations and put confidence in the programme at risk.”
Nonetheless, it said in a statement that the programme’s original vision “remains intact and still appears feasible.”
The main outstanding challenge is to finish developing and deploying care records systems to NHS trusts. The agency has recently agreed contracts that allow new information technology suppliers to supply systems to individual trusts, indicating a step away from the centralisation that was a hallmark of the programme. A formal review of the NHS’s information technology plans, expected to be published in July, is likely to reflect a new emphasis on local autonomy.
National Audit Office, London, 2008. The National Programme for IT in the NHS: Progress since 2006 is at www.nao.gov.uk