Go-ahead for standalone systems in response to problems
developing integrated technology
Whitehall officials are altering course over their plans to
deploy fully integrated health systems under the multi-billion
pound National Programme for IT in the NHS (NPfIT).
They are drawing up proposals to deploy some standalone
technologies, negotiating nationally with suppliers to extend
legacy contracts, and installing older but proven software at new
sites.
The shift in strategy is being welcomed by some trusts given
delays in the delivery of joined-up or "core" systems from the four
Local Service Providers (LSPs) that are due to be deployed across
England.
The stop-gap measures will allow trusts to urgently replace
systems that suppliers are no longer supporting or that have become
so old they are unreliable. The measures will also provide
established technology to trusts that have few advanced
systems.
But extending the contracts of legacy suppliers, deploying
standalone software or installing proven systems that cannot be
easily integrated with others without significant enhancement or
replacement, has a price.
Some NHS trust IT directors are advising their boards that the
move could increase the costs and time taken to achieve a fully
joined-up NHS.
A paper presented last week to the board of North Central London
Strategic Health Authority, for example, said the delivery of the
first main release of a core NHS Care Records Service - including
electronic patient records - for acute trusts has been put back
from 2006 to 2008-9. This is six years after the NPfIT was
launched.
The authority said the LSP for London, the BT-led consortium
Capital Care Alliance, was "being more flexible in its approach,"
and offering "scaled down interim products" including standalone
systems as a stop gap.
The interim "tactical" solution, available from 2006 would
enable trusts to meet their business requirements until a strategic
solution is available in 2008 or 2009.
It would not allow the same degree of joined up working as the
strategic solution, said the paper.
Despite the delays, there will be some early integration
successes. Systems will be integrated to meet government
requirements for Choose and Book, which will allow a hospital
appointment to be booked when a patient wants it.
But some IT directors in the NHS believe that full and effective
integration of systems will take much longer than 2009, or may
never be achieved. This is in part of because of complexity and the
disjointed working of the health service. They say the plans should
be reviewed to make them less complex and ambitious.
There are signs around the country of a more pragmatic approach
to NHS IT modernisation.
In the South of England the main patient administration system
adopted by Fujitsu, the LSP is a Cerner product used at Homerton
foundation trust and Newham University Hospital Trust as part of on
an investment plan approved before the NPfIT contracts were
awarded.
In London, IDX's "Carecast" system is expected to be deployed,
as used by University College London Hospitals. The system was also
delivered under a deal agreed before the NPfIT's contracts were
signed.
West Suffolk NHS Hospital Trust reports that its Local Service
provider Accenture couldoffer a mixture of partially integrated and
standalone systems.
A paper to the board of North Bristol NHS Trust this summer
reported on positive developments over the NPfIT. It also said the
switch in Southern England from IDX to Cerner as a key contractor
may be an improvement but "raises questions of credibility about
the programme and its ability to deliver."
It noted the switch to Cerner marked a "strategic shift on
NPfIT's goals and will not necessarily require a single 'instance'
(of data) across the Cluster, nor will it be compliant with the
national spine for some time."
The data spine will hold summary patient records.
The government agency Connecting for Health, which is delivering
the NPfIT, said it was not relaxing its rules and specifications
for joined up systems.
Looking ahead, a spokesman said, "Systems will be of industrial
strength, have excellent service availability, solutions will be
spine compliant and local service providers will deliver a fully
integrated NHS Care Records Service as originally specifiedÉ An
independent study confirmed the central purchasing of core systems
and services will save the NHS in England some £4bn over 10
years."