IT gurus attempt to win doctors' hearts and minds

Short abstract

Technical difficulties have contributed to delays in the NHS electronic booking project in England. But lack of support from GPs is also an issue. What is happening with the entire national information technology programme, which is essential for the new look NHS?

It has been a difficult month for the national IT programme for the NHS, launched in 2002. The National Audit Office, in its first investigation into the ongoing programme, found that technical difficulties had contributed to delays in one key element, the electronic booking project, an essential part of the government's ambitions to extend patients' choice in the NHS (BMJ 2005;330: 166, 22 Jan). Mean-while, a long running dispute with the largest supplier of GPs' computers continued to escalate.

Against that background, the IT programme is preparing a publicity campaign to win hearts and minds as the process begins of installing a new system for electronic care records, underpinning the electronic booking system, across England.

The NHS care records service will change current record systems by putting more than 50 million records on a digital database, allowing information to be shared safely across the NHS. For the first time there will be a central record of a patient's care, which will include information such as whether a patient has diabetes or a drug allergy.

Last week the IT programme published its first “deployment schedule,” indicating when individual trusts will receive standardised systems to produce these care records, procured under contracts worth more than £6bn ($11.3bn; €8.7bn). The national programme also confirmed that it had retained a leading public relations firm, Porter Novelli, to promote the records service to clinicians and patients. Trade journals reported the year long contract with the firm as being worth more than £1m; a spokesperson for the programme said it was worth “a substantial six figure sum.”

One of the big issues for doctors and patients alike is the security and confidentiality of data. Hopes are rising that a formula can be found to settle what is the biggest controversy facing the programme. A meeting of the Care Records Development Board last week agreed the wording of an “opt out” clause, together with a “care records guarantee” for patients.

Figure 1.

The board, which has 14 members, was set up last year after surveys showed that doctors were unhappy with the programme's level of consultation. The board's chairman, Harry Cayton, who is director for patients and the public at the Department of Health, said that the agreed wording reflects good clinical practice today. “This is not new ethics or new law,” he said. The opt out clause would allow patients to control who sees their electronic record, but they could not stop their clinician from keeping a record in the first place.

The NHS care record guarantee “will set out what the agreement is between users and the NHS about how their data will be collected, stored, and kept secure,” Mr Cayton said. He added that the agreed wording will be published on the board's website after it has been vetted by the Plain English Campaign.

Although the board has no formal power to direct the programme, Mr Cayton was confident that the new wording would be accepted by the programme's board, which is chaired by his health department colleague John Bacon.

But he may have a tough battle on his hands with doctors. Last year the BMA's annual representative meeting urged doctors to use the care records system with caution until questions of security, confidentiality, and data protection are resolved.

Mr Cayton plans to co-host a conference on the issue with the BMA in May. “I'm hopeful that the BMA will give it honest and open consideration,” he said.

While work on the central care record system continues, the national programme indicated last week that it will also press ahead with plans to introduce a new generation of hardware and software systems across the NHS in England. This will be essential for individual trusts to access the new care record system and will replace the hotchpotch of incompatible systems that has grown up in the NHS over the past 10 years or so. However, GPs and hospitals have been showing signs of resistance to the standardised systems being offered through the national programme.

The programme has published an “indicative deployment schedule” showing when each acute and primary care trust could expect to receive these new IT systems, which have been procured through deals with four major IT contractors.

According to the document, 54 trusts will begin receiving new systems by the end of March, with most of the rest by 2008. However, it stresses that the schedule will be “subject to change.” Much will depend on the availability of technical staff to manage the rollout—the largest exercise of its kind ever seen in the world. Individual NHS organisations will also need to find resources to pay for networks and other pieces of IT infrastructure as well as for training staff, which are not included in the national programme.

Health Minister John Hutton assured parliament last week that the national IT programme, the world's largest single IT scheme outside the military, is broadly on schedule. Apart from the work on electronic appointment booking, Mr Hutton said that “work is now well advanced to introduce electronic prescriptions during early 2005, with the core application delivered for integration testing by the end of 2004 as planned.” A new national data network is “on track and ready to deliver.”

Progress has also been made on other national services, particularly the rollout of the quality management and analysis system, an application to support the general medical service contract and the new “Contact” NHS email service, he said.

Everything, however, depends on whether NHS clinicians can be persuaded to engage with the programme.

Mr Cayton urged anyone with an interest—whether patients, health professionals, or IT experts—to get involved through a “stakeholder network” that meets mainly on the web. “It's our eyes and ears,” he said. “At the moment we've got 600 members. I see no reason why we shouldn't have 5000.”