Health officials in London are working with BT, Cerner and IT
specialists to rescue plans for integrated e-health records in the
capital amid signs that the government's one-size-fits-all approach
is disintegrating, Computer Weekly has learned.
The original plan which was announced in 2002, in a document
"Delivering 21st Century IT Support for the NHS", was for the
National Programme for IT [NPfIT] in the NHS to deliver "ruthless
standardisation". In London a single database to support electronic
health records for eight million people was to be rolled out to all
trusts and other NHS sites.
That plan turned out to be too ambitious - and was watered down
when officials and the NPfIT local service provider in the capital,
BT, decided to install different releases of the US-based
Cerner "Millennium" system to support e-recordsin NHS
trusts.
Now that plan, too, has run into trouble, Computer Weekly has
learned. BT, NHS IT specialists and Cerner have ended up
customising the standardised smartcard-based Cerner system for one
London trust, the Royal Free, after it ran into serious
problems.
In June 2008 the Royal Free Hampstead NHS Trust became the first
trust to install the London Configuration Release 1 [LC1] of Cerner
Millennium Care Records Service. It was the first installed Cerner
system in England where users had smartcard access to electronic
records. Three other London trusts are using the earlier LC0 of the
Cerner system.
But because of continued problems with the LC1 installation, the
Royal Free Hampstead NHS Trust, BT, Cerner and the London Programme
for IT have put in place a 90-day rescue plan of the trust's
systems, which began on 6 October. The plan involves setting up on
site what the Royal Free calls a "full systems and support
team".
The trust says the team is working on a software build directly
for the Royal Free and is "thus changing the London programme model
of one build appropriate for all trusts".
Health officials and BT had hoped to start rolling out LC1 to
other trusts and NHS sites in London - but work has been halted. It
is unclear when - and if - it will restart given the Royal Free's
problems and the customisation of its software.
The Royal Free's staff have had to cope with system crashes,
delays in booking patient appointments and data missing in
records.
Some health IT experts say the problems at the Royal Free and
other London trusts could end up with BT delivering a non-standard
system to NHS sites in the capital. This would wipe out some of the
cost savings of having standard software which could be upgraded
easily across NHS sites in the capital. It would also mean an end
to the NPfIT vision of fully integrated IT systems across
England.
The government announced in 2002 that there would be a "full
National Health Record Service, with core data and reference links
to local Electronic Patient Record systems for full record access"
by the end of December 2007. That promise now appears years away
from being fulfilled.
The government had also promised standardisation. It said in
Delivering 21st Century IT Support for the IT, "We will improve the
leadership and direction given to IT, and combine it with national
and local implementation that are based on ruthless
standardisation."
But a switch to non-standard systems in London could benefit
some trusts by reducing delays in the installations of reliable
replacements for legacy systems. And BT, NHS IT specialists and
health officials in London still hope to achieve the exchange of
health records across trusts with different and customised versions
of Cerner, or other systems.
A spokesman for BT has told Computer Weekly that it is
discussing with London trusts, Cerner and the London for IT the
best way to strike a balance between "tailoring the system to
reflect the working practices of a trust" while seeking to share
patient information across the programme.
The spokesman said, "The aim of the discussions is to agree a
more flexible, efficient and effective way of achieving the
original aims of the programme [the sharing of electronic health
records] and taking account of the changing NHS needs and
structures."
A spokeswoman for the Royal Free said, "Although we are
currently facing challenges with the [Cerner LC1] system we believe
that once these have been resolved, other trusts will benefit
significantly from the changes that are made as a result."
But the delivery of non-standard systems to London's trusts
raises questions about whether the Department of Health ever needed
to sign £6.2bn worth of contracts with local service providers.
Before the advent of the National Programme for IT [NPfIT] in
2002, healthcare IT companies were already supplying non-standard
systems to NHS trusts.