It is often said that good results on IT-related projects and
programmes rely on good communications. This helps to explain why
the
NHS's £12.7bn National Programme for IT (NPfIT) is such a good
case study - an exemplar of how poor communications corresponds
with poor results.
The point is underlined by the details which have emerged this
week on the confusing and, as it turns out, overly optimistic
public and internal communications over the go-live of the
Cerner R0 e-records system at Weston Area Health Trust.
The
Care Records Service is the most important part of the NPfIT
and Weston was the second trust in England to go live with the
Cerner system, Nuffield Orthopaedic Centre being the first.
The idea of the Care Records Service is to give 50 million
people in England an e-record that can be accessed wherever it is
needed. Doctors support the idea even though some have lost faith
in the ability of the Department of Health and NHS Connecting for
Health to make it happen.
The Department of Health's public communications over Weston
began in 2006, when it tried to use the trust for political
advantage. This backfired. In a memo in 2006 to MPs of the Public
Accounts Committee, who were sceptical about the claimed successes
of the NPfIT, the Department of Health quoted Weston as being
particularly satisfied with its installation of the Cerner
system.
In fact Weston came to regard its Care Records Service as
disruptive and "never going to deliver what the NHS needed",
according to a paper this year to the trust's board of
directors.
All trust boards need to report externally on how many patients
they are treating, for what, and how quickly. Patient
administration systems such as Cerner Millennium should provide
this information, at least to ensure that trust boards are paid for
treating people.
But in the 18 months since its go-live, Weston was never
sufficiently certain of its management information from the system
to know it would get paid. A deleted section of a draft report of
Weston's Audit and Assurance Committee said in February 2008, "The
fact remains that the trust is still not at a stage, despite 18
months of work, of having the certainty that we are able to
communicate on activity [treating patients] and charge for all the
work undertaken".
The Department of Health also miscommunicated when giving an
assurance to the Public Accounts Committee that mistakes from an
earlier go-live of the Cerner system at Nuffield Orthopaedic Centre
would not be repeated.
Weston repeated some of the mistakes at Nuffield. Both Nuffield
and Weston - and other trusts since - have had difficulties
producing external statutory reports on their care and treatment of
patients.
What has happened at Weston could answer the question so many in
the NHS are asking: how is it that mistakes are unknowingly
replicated every time a trust goes live with the Care Records
Service?
The answer, from the facts at Weston, is that the board of a
trust which is due to go live with Cerner is assured that problems
at other trusts have been solved. But the team going live find out
only too late that the problems are still there.
It is arguably time for the Department of Health to come clean
about the NPfIT. Trust after trust has gone live with Cerner only
to find that problems have not been fixed.
It is uncomfortable for Computer Weekly to criticise the NPfIT
in this way. Many thousands of people are working on the programme,
or have a stake in its wished-for success. They want it to work. So
do doctors. Paper-based records that go missing can cause lives to
be lost unnecessarily. E-records make unequivocal sense.
But the NPfIT is demonstrably not the best vehicle to deliver
e-records. We say again, but now with more evidence in our
possession, that there needs to be a thorough, independent
published review of whether the NPfIT will meet the needs of NHS
trusts.
Meanwhile, money continues to be poured into the programme -
before anyone really knows whether the money is being well spent or
wasted on archeologically excavating ground which has little or
nothing worthwhile beneath the surface.