There are many reasons the National Programme for IT
(NPfIT) in the NHS matters. One is that, at £12.4bn, it is costing
about £2bn more than the total build cost for the Channel Tunnel.
Another is that it could improve the treatment of
patients.
If it works, the NPfIT will, for example, replace paper medical
records that can only be in one place at a time, with an electronic
file that can be accessed by hospital doctors across England. And
an electronic medical record is less likely to go missing than a
paper record.
But the national programme also matters because it has the
potential to undermine patient care.
As revealed in a joint investigation last week by Computer
Weekly and Channel 4 News, after Newham Primary Care Trust in East
London and Nuffield Orthopaedic Centre at Oxford implemented a
system from US supplier Cerner, some patients did not receive a
timely appointment with a specialist because of IT-related
problems.
An enhanced version of this same Cerner system is due to be
implemented across England as part of the NPfIT.
John Bourn, head of the National Audit Office which investigated
a report of a serious untoward incident after the go-live at
Nuffield, said in a letter to MP Richard Bacon, "The [Cerner]
system reported that it was printing letters inviting patients to
clinics, and yet it soon became clear that far fewer people were
turning up to clinics than expected as they had not received any
notification to do so.
"Conversely, other patients were turning up for clinics that
they were not recorded as having been invited to. The impact of
this was inconvenience to patients, wasting of doctor and staff
time and a need to reschedule appointments. The missed appointments
then resulted in a backlog of outpatient appointments building
up."
After a go-live at Newham hospital, details on patient
appointments were lost - more than 110 of them for children. The
problem was spotted in October 2004, but it was six months before
health staff tried to contact parents of the children, and 30 were
never tracked down.
The incidents at Newham and Nuffield were not specifically the
fault of the supplier or the trust, but happened for a variety of
reasons.
Even so, they highlight the potential for IT systems to damage
the care of patients, a danger compounded by the absence of any
statutory framework or even regulation to help ensure that the
installations of new patient record systems in about 300 hospitals
will not harm patients.
A paper on the safety of new IT systems was published by the
British Computer Society at the Healthcare IT conference at
Harrogate in March this year. Until now, the paper has not been
publicised. It was entitled "Quality, Safety and Performance in
Healthcare IT: is it time for regulation?" and was the work of
Benedict Stanberry of Avienda, a healthcare IT consultancy.
Stanberry said that healthcare IT enjoys a "uniquely privileged
position" when compared to drugs and medical devices such as x-ray
equipment which have to go through formal checks to ensure they are
safe. IT systems that are used pervasively in hospitals go through
no statutory product licensing, manufacturing inspections or
incident reporting.
If health IT systems fail they can affect the safety of
patients. "Yet because there is a dearth of in-depth assessments of
how well healthcare IT applications work in practice, there has
been no consequent activity aimed at capturing, describing and then
disseminating best practice - that is, how to implement and use
healthcare IT applications safety, smoothly and responsibly,"
Stanberry said.
He added, "In fact we presently have a dangerous situation in
which healthcare IT systems are being installed and implemented at
breakneck speed."
Stanberry said the velocity of change meant that administrators,
doctors, nurses and IT managers "have such different and
conflicting views of the rightful role of IT in the care process
that there is now a very real potential for anarchy".
Since Stanberry wrote the paper there have been some positive
developments. Connecting for Health, which runs the NPfIT has, he
said, been proactive in seeking to improve the safety of new
systems.
Maureen Baker, special clinical adviser at the government's
National Patient Safety Agency, said she and her team have been in
partnership with Connecting for Health, which has "led to a
proactive approach in developing safer IT products to support
clinicians in delivering NHS care."
She added, "This partnership has achieved a great deal in a
short time, with a great deal still to do."
But in the meantime there is no sign that the government will
put in place a statutory framework to govern the safety of IT
systems in the NHS.
Today, Stanberry rates the regulation of safety of IT systems at
"C+ rather than B or A".
This is not a reassuring mark, given that new systems can harm
patients - if only because their failure can cause a backlog of
work which means that appointments and operations have to be
cancelled.
Source material: Nuffield trust minutes, letter to MP
Richard Bacon from John Bourn head of the National Audit Office,
and final report into the serious untoward incident involving
outpatient waiting time breaches in Newham - Newham Primary Care
Trust
More information:
www.computerweekly.com/npfit
A case for treatment
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