NPfIT is virtually dead says NHS Trust

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Ashford and St Peter's Hospitals NHS Trust has commissioned a review of its IT strategy in view of what it calls the "virtual demise" of the NPfIT, the National Programme for IT in the NHS.

An executive paper to the Trust's Board in June 2010 shows how little impression the NPfIT has made in some parts of the NHS, despite a spend so far on the national programme of about £5bn.

Since its launch in 2002, the NPfIT has been spoken of with reverence by notables and ministers who include Lord Hunt, John Read, Patricia Hewitt, Caroline Flint, Ben Bradshaw, Andy Burnham, John Hutton, Tony Blair and Gordon Brown.

Too soon to say the NPfIT is dead?

In my view it's too soon to say the NPfIT is dead. The Coalition is unlikely to cancel the Summary Care Record even though there are signs it will be little used by hospital doctors. There is a strong PR campaign within Connecting for Health and the Department of Health to sell the SCR to the latest NPfIT minister Simon Burns

Internal PR campaign on Summary Care Record a success

This internal PR campaign has been successful so far, partly because an undisclosed sum - which is believed to run into hundreds of millions of pounds - has already been spent on the SCR; and BT, which runs the scheme, could claim a hefty sum in compensation should the SCR be cancelled.

But  some NPfIT Care Records Service implementations are in trouble

That said, the NPfIT's success could be said to pivot on the Care Record Service implementations by local service providers BT and CSC of Cerner Millennium and iSoft's Lorenzo. Some prominent NHS sites are struggling with Cerner in London and Lorenzo in the north, not least at NHS Bury which has been trying for about eight months to embed Lorenzo Regional Care Release 1.9. CSC has yet to be paid for the go-live of Lorenzo at University Hospitals of Morecambe Bay NHS Trust

Will Burns & Co decide eventually to put these sorts of implementations out of their misery?

Relief at NHS Cerner sites as Coalition relaxes 18-week target?

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After the go-lives of the NPfIT Cerner Millennium system at Kingston Hospital NHS Trust and St George's Healthcare NHS Trust, not everything has gone smoothly. One of the problems has been keeping track of all patients and their appointments.
 
So the two trusts have every reason to be relieved that the new Health Secretary Andrew Lansley has signalled an end to centralised management of the 18-week target.

Cancel the NPfIT says motion to annual BMA conference

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The British Medical Association's Annual Representative Meeting, which starts today in Brighton, will hear a motion from the Northern Ireland Council which says:

"This Meeting believes that there has been little demonstrable benefit to the National Programme for IT for the NHS with an unacceptably high cost to benefit ratio and poor value and therefore, in the current time of financial constraint in the NHS, demands that the government cancel the National Programme for IT and divert the monies into frontline direct patient care."

It's also likely that the BMA ARM will hear a call for it to abandon its acceptance of the "opt-out" model for the summary care record scheme.

iSoft share price slumps again and CEO "forced to sell" shares

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The share price of NHS software supplier iSoft has fallen to a new low.
 
Under the NPfIT NHS IT scheme, iSoft's Lorenzo software is assigned to be the main  patient administration system used in  hospitals throughout England, outside of London and the south.  
 
Earlier this month iSoft shares fell by the most on record - 30%, to 39 Australian cents.
 
Now the share price has sunk to 17.5 cents, the lowest on record. 
 
In 2007 iSoft's shares reached a high of about $1.52.

Innovation in the NHS - yes it happens

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Healthcare software supplier System C has beaten nearly 3,000 entries from around the world to win 2010 Microsoft Partner of the Year award in the category 'Public sector health partner'. 

The award recognises innovation and solutions which clearly benefit customers ' businesses.

System C won for its Clinical Dashboard products which use indicators, gauges and charts to display real-time, relevant healthcare information - for example on clinical outcomes.  

The Dashboard products bring together data from many sources, including a hospital's PAS and clinical systems.








Trisha Greenhalgh on Summary Care Record - where does the truth lie?

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               "The National Programme for IT: it's time to acknowledge the elephant in the room"

Professor Trisha Greenhalgh OBE is Director of the Healthcare Innovation and Policy Unit at Barts and the London School of Medicine and Dentistry, Queen Mary University of London. She led the independent evaluation of the Summary Care Record Programme.  

The evaluation cost taxpayers more than £723,000, and there is no sign that the Department of Health and NHS Connecting for Health will take seriously the concerns the report raises. 

The views expressed in the article that follows are Trisha Greenhalgh's:

"Last week, I asked a packed conference hall of general practitioners if any of them had ever seen a Summary Care Record. Not a single hand went up.  

"Yet 30 million people in England have received a letter saying that a Summary Care Record will shortly be created for them from their GP-held medical record.

A pantomime-style clash? 

"Here is a clash of narratives that would sit comfortably in a pantomime. 

"Does the Summary Care Record exist? Oh no it doesn't, say some pundits, except in the dreams, manifestos and business plans of politicians and policymakers. 

If Whitehall can't close ID Cards, what hope 25% Govt-wide savings?

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By the end of the summer the Identity Documents Bill should become law. 

Its aim, which is consistent with the pledges previously made by both the Conservatives and the Liberal Democrats, is to repeal the Identity Cards Act which the Labour government passed in 2006.

But there are hints in a Cabinet Office document that it may not be easy in practice shutting down ID Cards or the Contactpoint database.  

Indeed the Cabinet office makes no commitment to shutting down either scheme - it leaves open the possibility of "rehshaping" them

The Cabinet Office "Structural Reform Plan" was published last week. It's an impressive plan.


Microsoft launches HealthVault - your personal health record?

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Microsoft is today launching HealthVault in the UK, a personal health data repository which has the implicit support of the Conservatives

John Coulthard, Senior Director Healthcare and Life Sciences at Microsoft, says:

"According to research, 13% of the UK population are actively interested and engaged in looking after their 'wellness' - i.e. they do things such as exercise regularly, look after their diet, monitor their weight, take their temperature and blood pressure. Many of these people record this data in a variety of places - from apps on their phones to scraps of paper.

"Today, with the launch of Microsoft HealthVault in the UK, we are offering those people a central repository for that data, where information can be entered manually by an individual for themselves or their family - or automatically from a range of compatible devices including weight scales, blood pressure monitors and pedometers.


Should large IT suppliers worry about Gov't spending cuts?

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Yes, to judge from the views of senior officials at the Cabinet Office who oversee IT in government. 

Officials are aggregating the value of contracts with  large suppliers, with a view to strengthening the government's hand in renegotiating deals. It's thought to be the first time government has taken such a holistic view of IT suppliers and the value of their contracts with departments and agencies.


Any need for Summary Care Record?

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           - "The SCR was based on an unresearched and unverified need."

           - It will be "next to impossible to keep SCR database accurately synchronised" 

Roz Foad, an NHS informatics expert, has responded to the excellent report by Trisha Greenhalgh and University College London on the NPfIT summary care record scheme.

Foad  is chair of the BCS Primary Health Care Specialist Group, and former IM&T Service Manager at Hertfordshire PCT.  

She says:

"What has not been examined to date are the alternatives to pushing data into a single database.






Cabinet Office answers my questions on reviews of IT projects

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These are my questions and the Cabinet Office's replies on Government plans to freeze projects over £1m and review major IT-related projects and programmes.

 

Me: I understand that an initial review of projects between £1m-£50m will be undertaken by departments, by the end of July. Given that some departments and agencies have been defensive and self-justifying in the past, can the Cabinet Office be certain that departments will be objective when reviewing their projects?

[For instance the Department of Health has said that the NPfIT is within budget, although the original contracts were announced as being worth £6.2bn and have since increased to a cost of about £7.3bn. The Department would say that the budgets have not increased; the contracts are delivering much more than originally intended. Some may see the increase, though, as scope creep.]

 

IT openness is coming - Cabinet Office

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Government CIO John Suffolk and his colleagues are preparing plans for the publication of IT-related documents that have always been secret and  difficult to obtain even under the Freedom of Information Act.

The plans include the publication of:

- Gateway reviews

- Project reports of all types

- Risk registers

Business cases

- Minutes of project meetings

- Health Check reports

Government CIOs contribute to the 2010 Budget

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The heads of Government IT, John Suffolk and Nigel Smith, are working with Government CIOs and senior responsible owners of major projects on "validation reviews" to assess whether savings on 80 large IT and non-IT projects, which cost £50m or more, can be made.

The reviews will also assess the impact of making the savings and how much the cuts will effect the overall feasibility of projects.  

The aim of the reviews is to lead to cuts that will contribute to the £6bn of savings promised by the new government in this financial year.

The results of the reviews will be reflected in tomorrow's Budget. 

Government CIOs have also been asked to give their initial views to the Treasury - in time for tomorrow's Budget -  on what cuts can feasibly be made. 

Clinicians may not access summary care records - today's UCL report

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An evaluation of the summary care records scheme by researchers at University College London has concluded that:

"Benefits of centrally-stored electronic summary records seem more subtle and contingent than many stakeholders anticipated, and clinicians may not access them. Complex interdependencies, inherent tensions, and high implementation workload should be expected when they are introduced on a national scale."

BMJ summary of UCL report: 


Will Summary Care Records do more harm than good?

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The Summary Care Record must be abandoned for reasons of safety, functionality, clinical autonomy, patient privacy, and human rights, says Professor Ross Anderson of Cambridge University.

He also says today that the SCR "brings very few benefits and has the potential to do serious harm".


Ross Anderson, professor of security engineering at the University of Cambridge Computer Laboratory, argues that the national database of national electronic database of patient records is not fit for purpose and illegal.

In the British Medical Journal his arguments go head to head with those of Mark Walport, a director of Wellcome Trust, who believes that the SCR will make valuable contributions to better care.

Their arguments come as a final report of University College London's evaluation of the summary care record scheme is published. A summary of the report is on the BMJ's website. 
 
Anderson says that a digital medical record system that shared information when appropriate between care providers, and was dependable and safe, would be of "great value". He adds:

"However, the summary care record isn't it. It must be abandoned - for reasons of safety, functionality, clinical autonomy, patient privacy, and human rights.








Report to reveal danger to patients posed by NHS IT database?

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Alex Deane, Director of Big Brother Watch - a campaign fighting intrusions on privacy - says of tomorrow's report by University College London on the NPfIT NHS Connecting for Health Summary Care Record scheme:

"This report reveals that there are serious and potentially irrevocable tensions at the heart of the Summary Care Record.

"Many GP practices aren't equipped to handle the technology and medical staff are suspicious of the data found on the system.

"We were told that the SCR would make our lives easier; this report shows that this insecure, inaccurate database is fraught with problems that pose a real danger to patients."

Links:

The coalition has performed a disgraceful u-turn on summary care records - Big Brother Watch

Highlights of confidential UCL report on summary care record scheme - IT Projects Blog

Choose and Book denies cancer patient an appointment, saying he's dead

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The danger of wrong data on an NPfIT system: a man with cancer couldn't make an appointment because a local Choose and Book system showed he was dead.

The Daily Mail reports the story under the headline:

"Sorry, you can't have an appointment... you're dead: Hospital refuses to see cancer sufferer because he's deceased."

At first glance the story could be vaguely amusing - if you're not the man involved; and if you ignore the fact that the government is continuing with uploads of incorrect data to NPfIT systems.

A report by University College London is due to be published tomorrow which will highlight inconsistencies, omissions and inaccuracies in data uploaded to the BT-run Summary Care Record database. The uploads will continue despite the well-informed criticisms of the scheme in the report.

The report's research was led by  Professor Trisha Greenhalgh who spoke with force and authority at the Smartgov conference in London yesterday. She criticised the government for continuing with the summary care records without taking any notice of what's in her team's report. This is despite taxpayers having spent nearly £1m on the Greenhalgh-led SCR research.

Is summary care record being reviewed because all IT-based projects are being reviewed?

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When NPfIT minister Simon Burns declared in a letter to the BMA that the government was reviewing the summary care records scheme, his announcement came at a good time: GPs were voting at their annual conference on motions to scrap the scheme.

Burns' letter was read out at the Local Medical Committees' annual conference last week. His promise of an SCR review averted a row with local GPs and the BMA.

Now it turns out that the Government is reviewing hundreds of large public sector projects that have a substantial IT element, including the summary records and indeed the £13bn NPfIT.

So Burns was announcing to the BMA a project review that would have happened anyway, as part of Cabinet Office ICT policy.

Highlights of confidential UCL report on summary care records

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Extended

A report by University College London on the summary care record scheme is expected to be published on Thursday.

Today this blog publishes highlights from a draft of the UCL SCR report.

It'll be interesting to compare the draft and final reports to see whether the Department of Health has softened any of the already-nuanced messages in the draft report.

In 2006 draft reports of the National Audit Office on the NPfIT went on a journey from criticism to praise. They went through a "clearance" process in which the Department of Health recommended many changes and PR-related additions before final publication.

iSoft issues market update, and its share price rises

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iSoft, an important supplier to the NHS IT scheme, issued a market update today,  which appears to have been well received by the market as the company's share price rose by about 16% to 28.5 cents. The share price over the past week had sunk to a five-year low of 24.5 cents.

The update was generally reassuring, though it referred to cost cutting in the current financial year and also said that, in respect of its contract with local service provider CSC in the Northern Cluster of the NPfIT in England, it expected revenue in 2011 to be significantly less than in this financial year, "which is why we have been working to build the order book of the company outside the CSC relationship".

iSoft said it doesn't have issues with CSC under the Northern Cluster contract. CSC has about £3bn worth of contracts under the NPfIT. 

"Our relationship with CSC is strong and the joint achievement of the successful 'go live' of Lorenzo Regional Care 1.9 at The University Hospitals of Morecambe Bay under the Northern Cluster Contract is a significant achievement as it operates as a validation of the Lorenzo platform in an Acute Care environment.

"The Northern Cluster Contract remains on foot and we continue to work with CSC in the continued roll out of the Early Adopter program for hospital trusts in that region."

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